Lateral epicondylitis, also known as tennis elbow, is one of the most common causes of elbow pain. According to Confido manual therapist Denys Protopop , the problem does not affect only tennis players. Protopop explains what it is, why it develops and how it can be relieved.
Many people first notice pain on the outer side of the elbow during everyday movements (e.g. gripping, lifting, working at a computer). They may also feel that their hand strength has decreased (e.g. holding objects becomes unsteady). Tennis elbow usually develops gradually, not suddenly. Therefore, most people do not notice it in the initial stages.
“Although it is called tennis elbow, the condition is actually more common in people who perform repetitive hand and wrist movements,” says Protopop. These include office workers, manual labourers, athletes and people who regularly use tools or computers.
“It is also increasingly common in people who play recreational sports such as tennis, padel and badminton, where repetitive gripping and wrist extension put strain on the forearm tendons,” explains the manual therapist.
Why does tennis elbow cause pain?
According to Protopop, tennis elbow is not usually a classic inflammatory condition, but rather a tendinopathy (a degenerative change in the tendon). “The tendons that connect the forearm extensor muscles to the outside of the elbow become overloaded over time,” explains Protopop. “As a result, the collagen structure of the tendon begins to change, and small degenerative changes occur in the tissue.” He adds that these changes cause the tendon to temporarily lose its ability to tolerate normal mechanical stress. This means that even everyday activities, such as gripping objects, lifting or using a computer mouse, can cause pain.
When in pain, people often subconsciously compensate by changing movement patterns and load distribution. While this may temporarily reduce symptoms, it can also maintain or increase overload in other structures.
How can the problem be relieved?
Protopop explains that treatment for tennis elbow usually involves reducing the load, performing exercises to strengthen the forearm muscles, and a gradual return to daily activities. In addition to exercises, the manual therapist says that various supportive techniques may also be used to speed up recovery. One commonly used additional method is shockwave therapy(ESWT), especially in chronic cases. It is usually used in conjunction with exercise and load modification.
“Shockwave therapy transmits mechanical acoustic waves to the affected tendon,” says manual therapist Protopop. “This may improve local blood circulation and activate cellular regeneration processes.”
When to consider shockwave therapy?
Shockwave therapy may be helpful if symptoms have persisted for more than two to three months despite load adjustment and progressively increased strength training, and if pain continues to interfere with daily activities. “Many people reduce their activity, try anti-inflammatory medications or temporarily stop exercising, but the pain can still return during everyday movements,” explains Protopop. “Shockwave therapy is more effective when combined with a structured physiotherapy programme.”
How is shockwave therapy performed?
During shockwave therapy, a special hand-held device is placed on the painful area of the elbow, which delivers mechanical impulses into the tendon. “This can influence the biological processes that affect blood supply and cellular activity, thereby supporting tissue repair,” Protopop explains.
According to Protopop, rhythmic tapping sensations are usually felt during the procedure, and the intensity can be adjusted according to the sensitivity of the area, making the treatment generally well tolerated.
One session lasts about 10–15 minutes and does not require anaesthesia, so you can return to your daily activities the same day. “Shockwave therapy for lateral epicondylitis is usually performed as a series of procedures, often consisting of three to five sessions, but depending on the client’s condition, severity of symptoms and response to treatment, additional sessions may be required,” he adds.
“For many people with chronic tendon pain, shockwave therapy can be part of a holistic approach aimed at reducing pain and restoring normal function. However, it is not suitable for everyone,” says Protopop.
Before starting shockwave therapy, it is necessary to assess your health status and, if necessary, consult other specialists. “Shockwave therapy is usually avoided during pregnancy and in cases of blood clotting disorders, tumours or infections in the treatment area, and certain neurological diseases,” emphasises Protopop. “Shockwave therapy is also not performed in areas of open wounds or severely damaged tissue.” He adds that these are not absolute contraindications, but situations that require individual assessment.
Regardless of the methods chosen, daily load management also plays an important role in recovery.
How can you support your own recovery?
Recovery from tennis elbow may take several weeks to several months, and in some cases even longer, as it largely depends on load management and consistent exercise. Methods such as shockwave therapy can support the healing process, but Protopop says recovery usually depends on a combination of a professional approach and daily habits.
One of the most important things a person can do on their own, according to Protopop, is perform specific forearm strengthening exercises that help the tendon to re-adapt to the load.
Protopop also recommends temporarily reducing activities that overload the elbow, such as repetitive gripping or lifting heavy objects. “Small adjustments in workplace ergonomics, sports technique or the equipment used can also reduce excessive strain on the tendon,” he explains.