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Tennis elbow (lateral epicondylitis): understanding your elbow pain and getting back to your activity

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What is tennis elbow (lateral epicondylitis)?

Lateral epicondyle anatomy

The lateral epicondyle is the small bony prominence on the outer side of the elbow, where the tendons of the wrist and finger extensor muscles attach. Lateral epicondylitis, better known as “tennis elbow”, is a painful condition of these tendons at their attachment, linked to repeated overload.

Why does this area become painful?

Pain appears when the wrist extensor tendons are subjected to too much repeated load, typically during repeated extension and gripping movements (a tennis backhand, screwing/tool use, manual work). Despite its name, tennis elbow mostly affects non-tennis players, often in a work or household context.

Outer elbow area in the HOPP app
Physio insight: despite its name, “tennis elbow” only affects a minority of tennis players: it mainly involves repetitive gripping and wrist extension movements, whether sporting, work-related or domestic (DIY, gardening).

Which sports contribute to tennis elbow?

All sports and activities that heavily load wrist extension and gripping carry a risk of this condition:

  • Tennis, particularly the backhand
  • Squash and badminton
  • Climbing and grip-intensive sports
  • Golf
  • Weight training with heavy grip exercises
  • Repetitive manual activities (DIY, gardening)
Physio tip: test your pain by extending your wrist against light resistance with your elbow straight: if pain is clear on the outer side of the elbow, it’s a good indicator of lateral epicondylitis. Gripping an object firmly can also reproduce the pain.

Treating tennis elbow in rehab with a sports physio

The goal of treatment is to progressively strengthen the wrist extensor tendons to restore their capacity to absorb load, while correcting the movement causing the overload.

  1. 1Reducing pain and managing load
  2. 2Elbow and wrist mobility
  3. 3Isometric strengthening
  4. 4Progressive concentric strengthening
  5. 5Eccentric strengthening
  6. 6Overall forearm work
  7. 7Correcting sporting technique
  8. 8Strengthening under sport-specific load
  9. 9Progressive return to your sport
  10. 10Return to competition

Why the physio’s initial assessment matters

During the initial assessment, the physiotherapist aims to identify the repetitive movements causing the pain (sport, work-related movement, household activity), how long the symptoms have been present, and your technique if you play tennis or another racquet sport.

“It’s not that the tendon is fragile, it’s that the load needs to be better dosed and distributed.”

Eccentric strengthening, the cornerstone of treatment

Strengthening the wrist extensors, particularly eccentrically, is the most scientifically validated basis for treating lateral epicondylitis. It’s complemented by overall forearm work and, if needed, correcting technique (racquet grip, work-related movement).

In brief

  • Eccentric strengthening of the wrist extensors
  • Progressive overall forearm strengthening
  • Correcting technique if needed
  • Gradual return: mobility, then load, then sport
Guided mobility exercise in the HOPP app

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Should you rest or keep playing sport?

Total rest is generally not the most effective solution. It’s better to temporarily adapt the movements that clearly reproduce the pain, while starting eccentric strengthening as soon as possible.

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When should you see a specialist for tennis elbow?

If pain persists for more than four to six weeks despite adapting your activities and a well-conducted strengthening programme, a medical opinion is recommended to consider further treatments.

The HOPP care programmes to treat your tennis elbow and get back to sport

This lateral epicondylitis requires rigorous, progressive eccentric strengthening. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

Gentle stretches for the wrist extensors and forearm.
Wrist and elbow mobility work to avoid any associated stiffness.
Progressive eccentric strengthening of the wrist extensors, the cornerstone of treatment.
A progressive, guided return to repeated gripping and extension movements.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

Essential

FROM INJURY TO
BACK TO YOUR ACTIVITIES

59€

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“AT YOUR OWN PACE WITH
DAILY ADAPTATION”

  • 100% of the treatment programme
  • Daily personalisation
  • Flexibility / Mobility
  • Strengthening
  • Proprioception
  • Progress tracking
  • Return-to-running programme
  • Theoretical content included
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149€

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“A PHYSIO
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  • 100% of the treatment programme
  • Daily personalisation
  • Flexibility / Mobility, Strengthening, Proprioception
  • Progress tracking
  • Return-to-running programme
  • Theoretical content included
  • + 4-week return-to-play plan with 6 difficulty levels
  • + 2 video calls with an expert sports physio / return check-up
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A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your elbow is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

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Post-effort RPE questionnaire in the HOPP app

F.A.Q

Does the HOPP programme replace a medical consultation?

No. HOPP is a support and rehab tool designed by sports physiotherapists, but it doesn’t replace a doctor’s opinion. If in doubt, or if the pain persists, see a health professional.

Is the programme suited to all sporting levels?

Yes. Every programme is personalised to your sport, your level and how you feel each day, whether you’re a recreational athlete or preparing for competition.

Should I stop tennis with this epicondylitis?

Not necessarily a complete stop, but a temporary adaptation of your volume and sometimes your technique (particularly the backhand), while starting eccentric strengthening in parallel.

How long does it take to recover from tennis elbow?

Lateral epicondylitis can take longer to heal than other tendinopathies, with gradual improvement over several weeks to a few months depending on how long the symptoms have been present.

Can a brace help?

A counterforce brace can temporarily relieve pain by reducing tension on the tendons, but it doesn’t replace progressive strengthening, which remains the underlying treatment.

Thibault Vignais, sports physio

Written by Thibault Vignais

Sports physio and osteopath, HOPP co-founder

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