Persistent Elbow Pain? Understanding Tennis Elbow Through Tendon Science
- Dec 8, 2025
- 2 min read
Overview
Tennis Elbow (Lateral Epicondylalgia) is one of the most common upper-limb pain conditions, especially in people who type, lift, grip, or perform repetitive hand tasks.
Evidence now shows that this condition is degenerative, not inflammatory — meaning the tendon undergoes structural change over time due to overload.
What the Evidence Says
1. Tendon Degeneration, Not Inflammation
Multiple high-quality reviews describe Tennis Elbow as a tendinopathy — a failed tendon healing response, not a classic inflammatory process.
Coombes et al., 2015 (Lancet) — Lateral epicondylalgia is characterized by tendon degeneration, altered pain processing, and muscle impairments.
Rees et al., 2009 — Histological studies consistently show tendon disorganization and collagen disruption rather than inflammation.
Conclusion:
Anti-inflammatories may reduce symptoms temporarily, but they do not correct the underlying tendon pathology.
2. Imaging Is Rarely Needed
Current clinical guidelines recommend clinical evaluation as the primary diagnostic tool.
Bisset et al., 2005 (Systematic Review): Imaging adds little diagnostic value unless ruling out other conditions.
NICE MSK Guidance: Ultrasound/MRI is unnecessary in most cases.
3. Most Cases Improve Over Time
Several longitudinal studies show natural recovery in 6–24 months even without aggressive treatment.
However, recovery is faster and more complete when targeted loading programs are used.
What Works: Evidence-Based Treatment
1. Eccentric & Isometric Loading
This is the strongest evidence-supported intervention.
Stasinopoulos & Johnson, 2007 — Eccentric loading showed significant improvement in pain and grip strength.
Malliaras et al., 2013 — Tendon rehab should include eccentric, isometric, and progressive loading.
Loading stimulates tendon remodeling, improving collagen alignment and tensile capacity.
2. Manual Therapy (Short-Term Relief)
Joint mobilization, soft tissue techniques, and mobilization-with-movement provide short-term pain reduction.
Vicenzino et al., 2007 — Manual therapy improves grip strength and pain immediately, though effects are temporary.
3. Ergonomics & Kinetic Chain Correction
Poor wrist mechanics, shoulder weakness, and even cervical issues can influence tendon load.
Evidence is growing but not fully conclusive.
Summary
Tennis Elbow is best managed by addressing the root cause: tendon overload and degeneration.A long-term, structured physiotherapy plan focusing on loading, ergonomics, and functional retraining remains the most effective and safest approach.
At Co Recare Physio (Dubai Healthcare City), we use evidence-based tendon rehabilitation to restore strength, control, and pain-free function.
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