Physiotherapy Ascot Vale | Physio Treatment for Tennis Elbow

Factors Behind Ongoing Symptoms

Pain on the outer side of the elbow can make everyday activities more challenging, from lifting shopping bags to working at a computer or participating in recreational sports. While commonly known as tennis elbow, this condition affects a wide range of individuals and is not limited to tennis players. In a recent educational article, ALPHA Sports Medicine examines the signs commonly associated with tennis elbow, potential contributing factors, and the importance of understanding the condition before deciding on a management approach. The article also discusses how activity levels, movement patterns, and individual circumstances may influence recovery over time. Designed to support informed decision-making, the resource provides practical information for those seeking better to understand ongoing elbow discomfort and available physiotherapy options. For individuals looking for Physiotherapy Ascot Vale services, the article offers helpful insights into a condition that can affect work, sport, and daily routines.

Why Tennis Elbow Persists and Returns

You don’t have to play tennis to get it, and a cortisone injection probably isn’t the answer.

If your elbow has been aching every time you grip a barbell, swing a racquet, or reach for a tool on the job, you might be dealing with tennis elbow. A grumpy but common overuse injury that is unfortunately often mismanaged. 

The good news? It’s very treatable. The frustrating part is that a lot of people spend months doing the wrong things: resting when they shouldn’t, bracing when it won’t help, or jumping to injections that provide short-term relief but don’t fix the underlying problem.

This post breaks down what tennis elbow actually is, who gets it, and what the evidence says is the best way to treat it.

What Is Tennis Elbow?

Tennis elbow, also known as lateral epicondylitis, is pain on the outer side of the elbow. The pain occurs on the tendon at the point where the wrist extensor muscles attach to the bone. Despite the name, only about 5 to 10% of people who develop it actually play tennis.

For a long time, it was thought to be a straightforward inflammation problem. We now know it’s actually a tendinopathy.

A tendinopathy occurs when the load placed on a tendon exceeds its capacity to tolerate that load.

Symptoms include:

• Pain or burning in the outer elbow
• Weakness with gripping: handshakes, barbells, tool handles
• Pain that worsens with repetitive wrist and forearm movements
• Tenderness directly over the lateral epicondyle (outside of the elbow)

Who Gets Tennis Elbow? And Why?

Tennis elbow doesn’t discriminate. It affects people in their 30s to 50s most commonly, but we see it across a wide range of ages and activity types. Here’s how it tends to show up in the groups we see most often at ALPHA. 

Gym-Goers

Heavy pulling movements, including pull-ups, barbell rows, cable rows, and dumbbell work, place a significant load through the forearm extensors.

A sudden spike in volume (for example, adding a new exercise, increasing the resistance, or increasing training frequency) without adequate recovery is often the trigger. The tendon hasn’t had time to adapt to the new demand.

Racquet Sport Players (Hence Tennis Elbow)

This is the classic presentation. Repetitive backhands, combined with vibration loads from racquet-ball contact, create cumulative stress on the tendon. Poor technique, a racquet that’s too heavy or strung too tightly, increasing frequency or intensity of games, and inadequate warm-up all increase risk. It’s very common in recreational players who play frequently but don’t strength train. 

Tradespeople (Especially Those Who Train After Work)

This is one we see a lot. Electricians, carpenters, plumbers, and construction workers are already putting their forearms through a full day of gripping, twisting, and lifting, and then often heading to the gym after work. The cumulative load across the day adds up quickly and the tendon is already fatigued by the time the evening gym session starts. Often, these individuals are doing everything right in the gym, but the issue is total daily load. Over time, cumulative stress can exceed the tendon’s capacity.

What Is Actually Happening Inside the Tendon?

This is where the understanding of tennis elbow has shifted most in the last decade or so.

Old thinking framed it as an inflammatory problem. That’s where the name ‘epicondylitis’ comes from (the ‘-itis’ suffix signals inflammation). Treatment approaches built on that model: anti-inflammatories, cortisone injections, and rest. It made sense at the time.

Physio vs Bracing vs Cortisone vs Shockwave

When people come to us with tennis elbow, there are usually four options on the table.

1. Conservative Rehabilitation (Physiotherapy)

This is generally considered the first-line treatment for long-term management of tennis elbow. The evidence base is strong and consistent. A good physio-led programme will include:

• Load management: identifying what’s driving the problem and modifying it, not stopping all activity, and using acceptable pain parameters for activity.
• Progressive tendon loading: specifically graded exercises (usually wrist extension and forearm strengthening) that stimulate tendon remodelling over time.
• Manual therapy: joint mobilisation and soft tissue work can help with pain and offloading the tendon in the early stages.
• Education: understanding your tendons’ behaviour, triggers, and how to manage flare-ups which will inevitably occur as you find the balance between loading enough but not so much it aggravates the pain.
• Return to sport/work planning: a structured timeline that rebuilds capacity without flare-ups.

The key message here: rest doesn’t fix a tendinopathy. The tendon needs the right kind of load to remodel and strengthen. Complete rest takes the pain away temporarily, but the tendon remains weak, and symptoms return the moment you go back to your activity. We see this cycle repeat itself constantly in people who’ve been managing the problem on their own for months or even years.

2. Bracing and Counterforce Straps

You’ve almost certainly seen the forearm straps, the velcro bands worn just below the elbow. They’re pretty common in tennis clubs and gyms.

The braces work by distributing the load away from the painful tendon. They can reduce pain during activity, making them a useful tool to temporarily reduce pain, aid rehab, and get you through the workday. 

What they don’t do is treat the problem. They’re a crutch, not a cure. If you’re relying on a brace as your primary strategy and skipping the rehab, you’re managing symptoms without addressing the root cause. The pain will come back, and often be worse. 

Our advice: use a brace if it helps you manage pain whilst staying at work or keeping active while you’re doing your rehab, but don’t use it instead of rehab.

3. Cortisone Injections

Cortisone is probably the most frequently discussed treatment option we encounter for tennis elbow, and also the most misunderstood.

Studies consistently show that cortisone injections provide excellent short-term pain relief, typically in the first 4 to 6 weeks. But at 6 months and beyond, outcomes for people who received cortisone injections were no better than, and sometimes worse than, those who did physiotherapy alone. 

The bottom line on cortisone: it can be a useful tool in specific circumstances, particularly for people in severe pain who need short-term relief to engage with rehab, or for those who need to get through a critical event. But it should be part of a broader plan, not the entire strategy. If you’ve had an injection and felt great for a few weeks and then the pain came back, this is because the tendon itself hasn’t changed. The rehab still needs to be done to increase the capacity of the tendon.

4. Shockwave Therapy

Shockwave therapy has become an increasingly popular option for tendinopathies, and the evidence for tennis elbow is promising.

It works by delivering high-energy acoustic waves to the tendon, which are thought to stimulate tissue repair, disrupt calcific deposits, and desensitise the area by temporarily overloading pain receptors.

The research suggests that for chronic tennis elbow, particularly cases that haven’t responded well to standard rehab, shockwave shows meaningful improvements in pain and function. It tends to perform best when combined with a loading programme rather than used in isolation. 

Practically speaking, a typical course involves 3 to 5 sessions spaced a week apart. Our take: Shockwave is a worthwhile option for people who’ve been stuck with persistent tennis elbow, particularly those who’ve tried rehab without full resolution, or who’ve had repeated cortisone injections with diminishing returns. It’s not a magic fix on its own, but as part of a broader plan, it can genuinely help shift a stubborn tendon in the right direction.

At a Glance: How the Approaches Compare 

Tennis Elbow Exercises: What a Structured Programme Looks Like

One question we get regularly is what exercises people should be doing.

Early Stage: Isometric Loading

In the early weeks of rehabilitation, when pain is still elevated with activity, the focus is on finding a load level the tendon can tolerate. This usually starts with isometric exercises, where the muscle contracts without actually moving the joint.

For tennis elbow, a common starting point is an isometric wrist extension hold. You position the wrist in a neutral position and press against a fixed surface or use the other hand as resistance, holding for 30 to 45 seconds. This type of exercise has shown benefits for tendon pain in research and can often be performed at a manageable pain level, making it a useful bridge in the early stages.

The goal isn’t to build maximum strength. It’s to keep the tendon on the adaptation pathway rather than resting entirely and losing what little conditioning it currently has.

Progressive Loading Phase

As pain settles and the tendon becomes more tolerant, the exercises progress toward isotonic loading: wrist extension curls with a light dumbbell, forearm pronation and supination, and eccentric-focused movements that place greater demand on the tendon.

Bridging Back to Full Demands

The final stage closes the gap between rehab exercises and the actual demands of your activity. This is where a structured exercise rehabilitation programme becomes particularly valuable, as it tailors loading to your specific goals rather than following a generic template.

This stage is where a lot of people fall short. Pain settling is not the same as full recovery. The tendon needs exposure to the full demands of the task before you can consider it genuinely rehabilitated.

What You Can Start Doing Now

If you’re reading this and recognising your own elbow, here are a few principles to keep in mind before you come and see us:

• Don’t stop everything. Complete rest is rarely the right answer. Modify what you’re doing and keep pain below a 3 out of 10, but keep moving.
• Be patient with it. Tendons heal slowly. Six weeks of doing the right things will almost always outperform six months of muddling through alone.

Get a proper assessment. Lateral elbow pain isn’t always tennis elbow. There are other structures that can refer pain to this area, including the neck and radial nerve. A clinical assessment rules these out and makes sure your rehab is targeted.

When to Come and See Us

If your elbow has been bothering you for more than a few weeks, or if it keeps coming back every time you return to your sport or activity, it’s worth getting it properly assessed. At ALPHA, we take a thorough look at the full picture: your training load, your work demands, your movement patterns, not just the painful spot.

Tennis elbow is genuinely one of the more satisfying conditions to treat because, with the right approach, people get back to doing what they love. It just needs the right plan and the patience to follow it.

Find Answers About Ongoing Elbow Pain

Ascot Vale is a well-connected Melbourne suburb known for its community atmosphere, parklands, and local amenities. ALPHA Sports Medicine offers Physiotherapy throughout Ascot Vale and the surrounding suburbs.

People experiencing persistent elbow discomfort can explore ALPHA Sports Medicine’s educational article, Tennis Elbow Treatment That Actually Works (From a Physio), to gain a better understanding of the condition and the factors that may contribute to symptoms. ALPHA Sports Medicine provides individualised physiotherapy assessments and management strategies tailored to a person’s needs, goals, and lifestyle. Those looking to connect with a Physiotherapist Ascot Vale can contact ALPHA Sports Medicine to arrange a consultation or obtain further information about Tennis Elbow Treatment That Actually Works (From a Physio). Our team is available to discuss concerns, provide guidance, and help individuals make informed decisions about their next steps.

Contact Information:

Alpha Sports Medicine – Ascot Vale

246A Union Rd
Ascot Vale, VIC 3032
Australia

Ashton Wilson
https://alphasportsmed.com.au/