Tennis elbow—known medically as Lateral Elbow Tendinopathy (LET) or lateral epicondylalgia—is one of the most frequent elbow injuries treated in physical therapy clinics.

Despite its name, tennis elbow isn’t limited to tennis players. It can turn simple, everyday movements—like shaking hands, holding a coffee mug, typing, carrying groceries, or opening a door—into painful challenges.

At Threshold PT, we specialize in non-surgical, targeted rehabilitation for elbow, wrist, and hand conditions. Below, we break down what causes tennis elbow, why quick fixes like cortisone injections often backfire, and how structured physical therapy exercises can help you recover.

What is Tennis Elbow (Lateral Epicondylopathy)?

Tennis elbow affects approximately 1–3% of the population, most commonly occurring between the ages of 30 and 50. It causes pain on the outside of the elbow where forearm muscles attach to the bony bump called the lateral epicondyle.

While common in manual laborers and racket sport athletes, tennis elbow frequently develops after any unaccustomed increase in repetitive forearm activity—such as home improvement projects, gardening, computer work, or starting a new exercise routine.

What Causes the Pain?

In most cases, the overloaded tissue is the tendon of the Extensor Carpi Radialis Brevis (ECRB) muscle, which controls wrist extension and radial deviation (tilting the wrist toward the thumb). When loaded beyond its capacity, the tendon undergoes micro-level changes, leading to local tenderness, reduced grip strength, and pain.

You may have tennis elbow if you experience:

• Pain when pressing directly on the outer elbow bone.
• Pain while gripping objects.
• Pain when extending your wrist or middle finger against resistance.

How to Treat Tennis Elbow: The EdUReP Model

Conservative physical therapy is the gold standard for treating lateral epicondylitis. Early intervention leads to significantly better long-term outcomes and prevents chronic symptoms.

At Threshold PT, our physical therapists utilize evidence-based frameworks like the EdUReP Model (Education, Unload, Reload, Prevention):

1. Education: Understanding what motions trigger your pain—such as lifting objects with your palm facing down—allows you to modify daily movements safely.
2. Unload: Temporarily reducing repetitive strain on the ECRB tendon gives inflamed tissues time to calm down.
3. Reload: Gradually introducing progressive exercise therapy restores the tendon’s load capacity and strength.
4. Prevention: Sustaining a customized maintenance program prevents future flare-ups when returning to full activity.

Should You Get a Corticosteroid Shot for Tennis Elbow?

When dealing with severe elbow pain, a cortisone injection sounds like a quick solution. However, current medical research advises caution.

“Strong evidence shows that corticosteroid injections provide short-term pain relief but lead to worse outcomes at 6 and 12 months compared to physical therapy management or a wait-and-see approach, with high rates of recurrence.”

While a cortisone shot may dull pain for a few weeks, it does not repair or strengthen the weakened tendon. Masking the pain can lead to premature overuse, making the underlying tendon breakdown worse over time. Physical therapy offers a safer, more sustainable path to true healing.

Targeted Physical Therapy Exercises for Tennis Elbow

Because no two elbows are identical, physical therapy management requires a tailored approach. Below are effective exercise progressions used in physical therapy to rebuild tendon health.

Phase 1: Isometric Exercises (Pain Relief & Early Activation)

Isometric contractions (holding a muscle contraction without joint movement) produce an analgesic effect, reducing pain signals sent to the brain while safe-loading the tendon early in recovery.

Phase 2: Eccentric Exercises (Tendon Remodeling)

Eccentric loading—lengthening the muscle under tension—is essential for stimulating collagen repair within the tendon matrix.

Phase 3: Targeted Stretching & Soft Tissue Work

Stretching an acutely inflamed tendon can sometimes increase irritation. However, using controlled methods like contract-relax stretching or soft tissue mobilization can ease muscle tension in the forearm.

Phase 4: Spine, Nerve, and Proximal Strengthening

Elbow injuries rarely occur in isolation. Restricting thoracic mobility or compressing cervical nerves in the neck can heighten sensitivity at the elbow joint.

• Thoracic Spine Mobility: Improving mid-back extension and rotation improves mechanical efficiency across the upper extremity.
• Shoulder & Scapular Strengthening: Strengthening the shoulder girdle prevents compensatory overwork at the wrist and forearm during heavy lifting or sports.

Recover From Tennis Elbow with an Expert at Threshold PT

If tennis elbow is holding you back from your daily routine, workout regimen, or favorite sports, generic advice won’t get you across the finish line.

At Threshold PT, our expert outpatient physical therapy team delivers comprehensive assessments, hands-on care, and personalized rehab plans designed to resolve elbow pain at the source.

Schedule your Evaluation today!