Tennis elbow is one of the most common injuries I see in clinic, and interestingly, most of the people I treat have never picked up a tennis racquet.
As an Exercise Physiologist with a Masters in Clinical Exercise Physiology and someone who spends a lot of time around golf, strength training, and sport, I commonly see tennis elbow develop in people who have recently increased a new activity. Often this is retirees taking up golf, tennis, gardening, or returning to the gym after years away from structured exercise.
The biggest misconception is that tennis elbow is simply an “overuse injury” that needs complete rest. In reality, it is often a combination of load management issues and reduced tissue strength.
Understanding why the pain developed in the first place is usually the key to fixing it long term.
What Is Tennis Elbow?
Tennis elbow, also known as lateral epicondylalgia, involves irritation of the tendons on the outside of the elbow. These tendons help control gripping, wrist extension, and forearm rotation.
Despite the name, tennis players are only a small percentage of the people affected.
I regularly see tennis elbow in:
- Golfers
- Office workers
- Tradies
- Gardeners
- Gym-goers
- Retirees starting new hobbies
- Anyone increasing gripping or forearm load too quickly
A common pattern is someone introducing a new stimulus without gradually building tolerance.
For example:
- Playing more golf than usual
- Changing golf or tennis technique
- Increasing gardening workload
- Starting strength training suddenly
- Using tools repetitively without conditioning
The tendon simply gets exposed to more load than it currently has the capacity to tolerate.
The Biggest Mistakes People Make With Tennis Elbow
One of the most common things I hear is:
“I’ve been getting massage and stretching for months but it keeps coming back.”
Massage, stretching, dry needling, and manual therapy absolutely have their place. They can help reduce symptoms, improve short-term comfort, and assist early in rehab.
But in my experience, they are rarely enough on their own.
The tendon still needs to regain strength and tolerance to load.
Another major mistake is complete rest.
While avoiding aggravating movements for a short period can help settle symptoms, tendons adapt through appropriate loading. If someone completely stops activity until the pain disappears, then suddenly returns to golf, gardening, or training, the same problem often returns quickly.
The goal is not “do nothing.”
The goal is finding the right amount of load.
The Best Exercises for Tennis Elbow
There is no single magic exercise for tennis elbow. The best rehab programs are based on where the person currently sits in their recovery and what activities are aggravating their symptoms.
That said, there are several movement patterns I consistently come back to in clinic because they reliably improve strength, tolerance, and function.
Grip Strength Training
Grip weakness is incredibly common in people with tennis elbow.
Improving grip strength and hand control often becomes a major turning point in rehab. I commonly use tennis balls or therapy putty because they allow patients to strengthen through different hand positions and improve dexterity at the same time.
One of the biggest things I encourage patients to do is test and retest grip strength over time. Improvements here often correlate strongly with reduced symptoms and improved function.
Forearm Rotation Strengthening
Controlled pronation and supination work is another staple.
For golfers especially, I often use a golf club for this movement because it mimics real sporting demands. Patients can start with their hand positioned closer to the end of the club to reduce load and gradually progress further down the shaft to increase difficulty.
The key is slow, controlled movement rather than speed.
Wrist Flexion and Extension Loading
Another movement pattern I frequently use involves controlled loading through wrist flexion and extension positions.
Initially, this may simply involve manipulating body weight through the arms at bench height before progressing to increased load tolerance.
Again, the focus is not on chasing pain but progressively improving the tendon’s capacity.
How I Progress Tennis Elbow Rehab
One of the most important parts of rehab is identifying where pain begins during loading.
I often think of rehab as a progression:
- Isometric loading
- Isotonic strengthening
- Grip loading
- Plyometric or faster movements
- Sport-specific or work-specific tasks
If a patient gets pain during a particular stage, we simply step back one phase and rebuild gradually.
For example, if gripping movements are flaring symptoms, we may temporarily reduce gripping intensity and focus more heavily on earlier-stage loading until tolerance improves.
This approach allows people to continue progressing without repeatedly aggravating the tendon.
Understanding Pain During Rehab
One phrase I wish could disappear from rehab forever is:
“No pain, no gain.”
The discomfort experienced during heavy exercise or muscle fatigue is very different from tendon irritation.
Pain is useful information.
One of the biggest things I teach patients is learning to understand their symptoms:
- Is the pain muscular?
- Is it tendon pain?
- Does it settle quickly?
- Does it linger afterward?
- Is it worse the next day?
If pain continues lingering well after activity or progressively worsens, that is usually a sign the tissue has been overloaded beyond its current capacity.
Appropriate rehab should challenge the tendon without constantly flaring it up.
A Real Golf Case Study
One memorable patient I worked with was a golfer trying to change their swing technique.
They had significantly increased their practice volume while learning the new movement pattern and eventually developed persistent tennis elbow symptoms.
Instead of telling them to completely stop golfing, we focused on modifying how they practiced.
We introduced:
- Warm-up strategies
- Smaller practice blocks
- More recovery between sessions
- Golf-specific strengthening exercises
Over time, their body adapted to the new swing demands and symptoms settled without needing to stop the sport they enjoyed.
This is an important point:
Most people do not need to stop activity completely.
They usually need better load management and progressive strengthening.
When Should You See a Clinician?
Not every elbow pain issue is actually tennis elbow.
Neck referral, nerve irritation, joint issues, and other conditions can sometimes present similarly. As Exercise Physiologists, we can often recognise the signs of tennis elbow, but diagnosis is outside our scope of practice.
That is why getting assessed by a qualified clinician first is important.
Once a diagnosis is established, Exercise Physiology can play a major role in rebuilding strength, improving load tolerance, and helping people return confidently to work, training, and sport.
Final Thoughts
Tennis elbow is rarely just a “tightness” problem.
In most cases, it is a load and capacity problem.
The goal is not complete rest or chasing temporary symptom relief. The goal is improving the tendon’s ability to tolerate the demands you want to place on it.
With the right balance of load management, strengthening, mobility, and gradual progression, most people can return to the activities they enjoy without constantly flaring symptoms.
If you are struggling with ongoing tennis elbow symptoms, book an assessment to better understand what is driving your pain and how a structured return-to-sport or return-to-activity program can help.
