What Is It?
Lateral epicondylalgia (tennis elbow) involves degenerative change in the common extensor tendon origin at the lateral epicondyle of the humerus. Despite the name, only a minority of sufferers play tennis — it is predominantly seen in desk workers, tradespeople, and anyone requiring repetitive wrist extension or gripping. Medial epicondylalgia (golfer's elbow) involves the same pathology at the common flexor tendon origin on the medial epicondyle, associated with repetitive wrist flexion and forehand gripping.
Both conditions show histological features of failed tendon healing — angiofibroblastic hyperplasia, collagen disarray, and neovascularisation — with no evidence of inflammatory cells in chronic presentations. This is why anti-inflammatory approaches (NSAIDs, corticosteroid injection) provide only temporary relief and may impair long-term tendon recovery.
Common Causes
- Repetitive mouse and keyboard use maintaining the wrist in extension (lateral) or flexion (medial)
- Manual trade work — carpentry, plumbing, painting — requiring sustained gripping and tool use
- Racquet sports with poor technique or inappropriate equipment (grip size, string tension)
- Sudden load spike after a period of reduced activity
- Weakness in the deep neck flexors and scapular stabilisers altering neuromuscular control of the elbow
How Myotherapy Can Help
- Soft tissue therapy — forearm extensor/flexor muscle belly release to reduce the load placed on the tendon origin
- Dry needling — into the common extensor/flexor tendons and associated trigger points; provides immediate pain reduction through neurological pain modulation
- Isometric exercise — strong evidence for immediate analgesia; particularly useful in acute pain phases and as a daily self-management strategy
- Progressive tendon loading (isotonic exercise) — the primary long-term intervention; gradual eccentric and concentric loading of the tendon according to the reactive–degenerative continuum
- Load modification education — workstation setup, grip strength management, and activity pacing
Expected Outcomes
Lateral epicondylalgia has a favourable natural history — approximately 90% resolve within 12 months — but this is slow without intervention. Combined manual therapy and exercise accelerates recovery significantly: Bisset et al. (2006) demonstrated superiority over corticosteroid injection at 12 months. Expect meaningful symptom reduction within 4–8 weeks of consistent treatment. Isometric loading provides immediate analgesia, making it a practical in-session and home tool from the first appointment.
Likely Symptom Changes
Early: post-session reduction in resting elbow pain; isometric exercises produce immediate analgesia lasting several hours. Weeks 2–4: reduced pain with gripping and typing activities. Weeks 4–8: progressive increase in pain-free grip strength and endurance. A 24-hour pain rule applies to tendon loading — some discomfort during exercise is acceptable, but if pain persists beyond 24 hours post-exercise, the load was excessive and should be reduced. Full capacity restoration typically takes 3–6 months in established tendinopathy.
References
- Bisset, L., et al. (2006). Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial. BMJ, 333(7575), 939.
- Rio, E., et al. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19), 1277–1283.
- Coombes, B. K., et al. (2015). Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia. JAMA, 309(5), 461–469.
Elbow pain with gripping, typing, or sport?
The good news: with the right loading protocol, these tendinopathies respond very well to treatment.