Tennis elbow

Lateral epicondylopathy (tennis elbow) is primarily caused by repetitive mechanical overload of the wrist extensor tendons at their origin on the lateral epicondyle, most often involving the extensor carpi radialis brevis (ECRB).

The condition develops through chronic microtrauma: repetitive loading (especially wrist extension, gripping, and forearm rotation) leads to microtears, collagen disruption, and progressive tendon degeneration (tendinosis) rather than acute inflammation.
Eccentric loading of the extensor tendons during activities such as gripping is a key biomechanical contributor.

Myotherapy session for lateral epicondylopathy (LET) is structured to address pain, restore tendon capacity, and optimise upper limb function through evidence-based conservative management.

Initially, the session involves a comprehensive assessment, including subjective history, palpation of the lateral epicondyle, and functional testing (e.g. pain with resisted wrist extension), to guide an individualised treatment plan.

Treatment typically combines manual therapy and exercise, which are the most supported interventions for LET.

Manual therapy consists of hands-on techniques such as soft tissue mobilisation of the forearm extensors, deep transverse friction massage, and joint mobilisation (e.g. radial head or elbow mobilisation). These techniques aim to reduce pain, improve tissue extensibility, enhance joint mechanics, and restore range of motion.

A core component of the session is progressive therapeutic exercise, particularly eccentric and isotonic loading of the wrist extensor muscles. These exercises are prescribed to stimulate tendon remodelling, improve load tolerance, and restore strength and endurance.

Evidence indicates that combining manual therapy with exercise results in improved pain and functional outcomes compared to passive approaches alone.

A key functional feature is reduced grip strength, which can significantly impact activities of daily living such as holding objects or using tools.

The cardinal symptom is localised pain over the lateral epicondyle, which may initially present as a mild ache but can progress to persistent or burning pain. This pain frequently radiates into the forearm and occasionally the wrist.

Lateral epicondylopathy is characterised primarily by pain and functional impairment at the lateral aspect of the elbow, associated with pathology of the common extensor tendon origin

Pain is typically activity-related, particularly exacerbated by tasks involving gripping, wrist extension, or forearm rotation (e.g. lifting objects, shaking hands, or turning a doorknob).
It may also occur during resisted wrist or finger extension and passive wrist flexion, which are commonly used as diagnostic clinical tests