Tennis Elbow Treatment in Five Dock: A Physio Guide

What tennis elbow actually is

Tennis elbow is a tendinopathy of the common extensor origin on the outside of the elbow, most often the extensor carpi radialis brevis tendon where it attaches to the lateral epicondyle. The clinical name is lateral elbow tendinopathy, and it describes a tendon that has been asked to handle more load than it can currently tolerate, not an inflamed tissue that needs to be rested until it settles.

That distinction changes what treatment looks like. Tendon tissue responds to graded loading. Complete rest usually calms symptoms for a while, then the first heavy grip task brings them straight back, because the tendon's capacity has dropped further in the meantime.

Most of the people we see for this at Five Dock have never held a racquet. Carpenters and electricians on tools all week, people doing high-volume gym work with barbells, kettlebells and pull-ups, new parents lifting a growing toddler, and office workers who added a heavy home-renovation weekend to an otherwise low-load month. Racquet sports do feature, particularly social tennis players who jumped from one hit a fortnight to three sessions a week, or who changed racquet, string tension or grip size.

How you know it is the tendon

The pattern is fairly consistent. Pain sits over a small area on the outside of the elbow, sometimes referring down into the forearm. It comes on with gripping, especially with the elbow straight: lifting a full kettle, turning a door handle, shaking hands, carrying shopping bags, a backhand. Mornings are often stiff, and the elbow tends to warm up a little with light activity before getting worse again with volume.

Several things mimic it. Pain that includes pins and needles, numbness, or that flares with neck movement can involve the cervical spine or the radial nerve. Pain further forward and deeper in the elbow may be radiocapitellar joint related. Pain on the inside of the elbow is a different tendon group again, common in throwers and golfers. Part of the reason for a proper assessment is ruling these in or out before anyone starts loading a tendon that was never the problem.

What assessment looks like

A first appointment at our Five Dock clinic runs one to one, with no double booking, so there is time to test properly rather than palpate the sore spot and hand over a theraband.

We start with the history: what changed in the four to twelve weeks before symptoms started, how long the elbow takes to settle after aggravating tasks, and what your week actually looks like in terms of grip and load. Then physical testing. Palpation of the extensor origin, resisted wrist and middle finger extension, and pain response to grip.

Grip strength is the number that matters most here, and we measure it rather than guess. Using AxIT force testing we record pain-free grip on both sides, and often grip with the elbow extended versus flexed, which is frequently where the deficit shows up. That gives a baseline you can retest in three or four weeks instead of relying on memory of how sore it felt last month.

We also look up the chain. Shoulder external rotation strength, scapular control and thoracic rotation all influence how much work the forearm has to do, particularly in racquet sports and overhead gym work. VALD ForceFrame testing lets us put numbers on shoulder strength where it is relevant.

What treatment involves

The backbone of a lateral elbow tendinopathy program is progressive loading of the wrist extensors and the grip, dosed to your current tolerance. That often starts with isometric holds if the elbow is highly irritable, moves to slow, heavy resistance work through range, and later adds the faster, more elastic demands that sport and manual work require.

Alongside that, we adjust the load coming from your week. That might mean changing grip positions at work, scaling back the specific gym lifts that spike symptoms while keeping the rest of your training, or altering how often you play rather than stopping entirely. Removing every provocative activity is rarely necessary and rarely helpful.

Hands-on treatment, soft tissue work through the forearm and elbow mobilisation can help manage symptoms in the short term. Some people are suitable for shockwave therapy, which we offer at Five Dock and use as an adjunct to loading rather than a replacement for it. Bracing and taping sometimes reduce symptoms enough to let you keep training while capacity builds.

Tendon rehab is usually measured in months rather than weeks. Grip strength and pain response to testing tend to give a clearer read on progress than day-to-day soreness, which is why we retest rather than rely on how the elbow felt yesterday.

When to get it looked at

Worth booking in if elbow pain has hung around more than two or three weeks, if it is limiting grip at work, or if it keeps returning each time you build training back up. Get it assessed sooner if you have numbness, pins and needles, night pain, or a clear traumatic onset.

If your elbow has been nagging since pre-season or since that renovation project, come in and have it assessed properly at Five Dock.

Read more about our tendinopathy services.

We go deeper on tendinopathy at sydneyshockwave.com.au.

If you would like it assessed at our Five Dock clinic, you can book a shockwave therapy appointment.