Tennis Elbow
Pain on the outside of the elbow when gripping, lifting or twisting. Usually from work or everyday tasks, not tennis. It’s a tendon overload problem, and most people get better.
Quick answer: Most tennis elbow gets better within a year, often sooner. The best treatment is to keep using the arm but ease off painful tasks, then build forearm strength with exercises. Gel, simple pain relief and a forearm strap can help in the meantime. Cortisone injections aren’t recommended. See your GP if it’s no better after 6–12 weeks.
The tennis elbow ladder
Time is the main treatment: most people recover within a year, often sooner. The ladder makes the wait less painful.
- Step 1 · Self-careAdjust your load and give it timeKeep using the arm, but ease off tasks that cause more than mild pain and change how you do them.
- Works
- About 8–9 in 10 are better by a year with wait-and-see in trials, often within months
- Cost
- Free
- How long
- Weeks to months
- Watch for
- Complete rest: tendons get weaker, not better
Your tendon wants less load, not a sling.
- Step 2 · PharmacyAnti-inflammatory gel and simple pain reliefSuch as diclofenac gel, paracetamol or a short course of anti-inflammatory tablets.
- Works
- Gel: about 7 in 10 improve vs 5 in 10 on a dummy treatment over a few weeks (low-quality evidence)
- Cost
- About $10–25
- How long
- Short term, while you sort the load
- Watch for
- Skin irritation from gel. Tablets: stomach upset; not for everyone. Check with your pharmacist
Rub it in, then go fix your mouse grip.
- Step 3 · PharmacyForearm braceA strap just below the elbow to take load off the tendon during activities.
- Works
- Evidence weak but low risk; may ease pain during activities
- Cost
- About $20–40
- How long
- Wear during aggravating tasks
- Watch for
- Too tight: numb fingers. Loosen it
Cheap, safe, and worth a go.
- Step 4 · Allied healthPhysio-guided strengtheningA program that slowly builds up load on the forearm muscles and tendon.
- Works
- More people improve by 6 weeks than with wait-and-see; no difference by a year
- Cost
- About $90–130 a session; Medicare rebates with a GP care plan
- How long
- 6–12 weeks or more, mostly done at home
- Watch for
- Some discomfort during exercises is expected; sharp pain means back off
The exercises only work if you do them, not if you photograph the handout.
- Step 5 · ProcedureShockwave therapySound waves applied to the tendon over a few sessions.
- Works
- Little or no benefit over sham in better-quality trials
- Cost
- About $60–120 a session, usually 3–5 sessions
- How long
- A few weeks
- Watch for
- Pain during treatment, bruising
Loud, popular, and less impressive than the noise suggests.
- Step 6 · SpecialistSurgeryOnly considered if pain lasts more than 6 to 12 months despite good non-surgical care.
- Works
- No better than sham surgery in a small trial; benefit uncertain
- Cost
- Specialist and hospital fees vary widely; private cover helps
- How long
- Weeks to months of recovery
- Watch for
- Infection, stiffness, ongoing pain
Rarely needed. The calendar usually wins first.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Cortisone injectionEases pain for a few weeks, but people are less likely to be better at 1 year and far more likely to relapse (54% vs 12% in a large Australian trial).
- PRP and blood injectionsNo better than a dummy treatment, and costly.
- Scans (ultrasound or MRI)Rarely change treatment for typical tennis elbow. A picture of a grumpy tendon is still a grumpy tendon.
- Therapeutic ultrasoundReviews find little or no benefit. A warm wand and a hefty invoice.
- Laser therapySmall, low-quality studies with mixed results. Not worth the appointments.
What you can do
- Lift with your palm facing up, use both hands, and use thicker grips on tools and racquets.
- Take regular breaks from repetitive tasks and keyboard or mouse work.
- Do the exercises in our tennis elbow exercise handout: a few minutes a day, building up slowly.
- Return to sport gradually. A coach can check your technique and grip size.
See your GP if
- Pain isn’t improving after 6 to 12 weeks
- Pain stops you working or sleeping
- You have numbness, tingling or weakness in your hand, or neck pain spreading down your arm
- Pain started after a fall or injury
See a doctor the same day for a hot, red, swollen elbow, especially with fever, or if you can’t bend or straighten your elbow after an injury.
Common questions
How long does tennis elbow last?
It usually settles within 12 to 18 months, often sooner. See your GP if pain isn’t improving after 6 to 12 weeks.
Should I get a cortisone injection for tennis elbow?
It isn’t recommended. It eases pain for a few weeks, but people are less likely to be better at 1 year and far more likely to relapse.
What exercises help tennis elbow?
A physio-guided strengthening program that slowly builds up load on the forearm muscles and tendon over 6 to 12 weeks or more.
Does a tennis elbow brace work?
A strap just below the elbow may ease pain during activities. The evidence is weak, but it’s cheap and safe to try.
Helpful resources
- Tennis elbow exercise handoutPrintable, one page, with sets and progressions. Free, from us.
- RACGP HANDI: Exercise for tennis elbowThe GP college’s evidence-based forearm exercise program. Free.
Evidence and more information
- Healthdirect: Tennis elbow
- Coombes et al, JAMA 2013: steroid injection and physiotherapy trial
- Cochrane: Blood and PRP injections for lateral elbow pain
- Bisset et al, BMJ 2006: physiotherapy, injection or wait and see
- Cochrane: NSAIDs for tennis elbow
maladywise.com/tennis-elbow/