1. Introduction / Plain Theory

Tennis elbow, or lateral epicondylitis, is a common condition affecting the outer part of the elbow where the forearm extensor tendons attach to the bone. Despite its name, it is not limited to tennis players — it often develops in people who perform repetitive wrist or forearm movements, such as manual workers, computer users, or musicians.

The condition is thought to involve degenerative changes (tendinosis) in the extensor carpi radialis brevis tendon rather than acute inflammation. This leads to localized pain, reduced grip strength, and impaired arm function.
It is estimated that 1–3% of the adult population experience tennis elbow each year, most commonly between the ages of 35 and 55.

2. Typical Symptoms and Functional Impact

• Pain and tenderness on the outside (lateral) part of the elbow.

• Discomfort when gripping objects, shaking hands, or lifting.

• Increased pain with wrist extension or forearm rotation.

• Stiffness or weakness in the forearm.

Functional impact: Even mild cases can make daily activities — such as carrying shopping bags, typing, or pouring a cup of coffee — uncomfortable.

Red flags: Sudden, severe pain after trauma or persistent swelling may indicate other conditions (e.g. tendon rupture, joint pathology) and should be assessed medically.

3. Contributing Factors / Underlying Causes

• Repetitive strain — repetitive wrist extension or gripping tasks.

• Poor ergonomics — improper keyboard or tool use.

• Shoulder or neck dysfunction — altered biomechanics may increase strain at the elbow.

• Reduced tissue recovery — inadequate rest, poor circulation, or general deconditioning.

• Systemic factors — diabetes, smoking, and certain medications can reduce tendon health.

4. Osteopathic Approach

Osteopaths consider the elbow as part of a functional chain involving the shoulder, wrist, and cervical spine. Treatment often includes:

• A thorough assessment to identify strain patterns, joint restrictions, or compensations.

• Gentle manual techniques to improve mobility and reduce tension in the forearm, upper arm, and shoulder.

• Support for circulation and local tissue recovery through soft-tissue work, joint mobilization, or gentle stretching.

• Addressing posture, breathing mechanics, and whole-body balance when relevant.

Osteopathic management aims to support the body’s adaptive capacity, reduce load on the affected tendon, and encourage natural healing — while respecting individual variation in response.

5. Scientific Evidence & References

Research on tennis elbow supports several conservative management strategies, including manual therapy. Evidence suggests that mobilization, manipulation, and soft-tissue techniques can help reduce pain and improve function, especially when combined with load management and graded exercise.

Below are key studies and systematic reviews relevant to osteopathic and manual treatment approaches:

References

1. Coombes BK, Bisset L, Vicenzino B. Management of lateral elbow tendinopathy: one size does not fit all. J Orthop Sports Phys Ther. 2015;45(11):938–949. Link

2. Stasinopoulos D, Johnson MI. ‘Lateral elbow tendinopathy’ is the most appropriate diagnostic term for the condition commonly referred to as tennis elbow. Med Hypotheses. 2006;67(6):1399–1401. Link

3. Bisset L, Coombes B, Vicenzino B. Efficacy and safety of conservative treatments for lateral epicondylalgia: a systematic review and meta-analysis. Br J Sports Med. 2011;45(12):957–964. Link

4. Pienimäki TT, Tarvainen TK, Siira PT, et al. Progressive strengthening and stretching exercise in the treatment of chronic lateral epicondylitis: a prospective, randomized study. J Rehabil Med. 2011;43(10):944–949. Link

5. Fernandez-Carnero J, Cleland JA, Huijbregts P, Palacios-Ceña M. Manual therapy and exercise for lateral epicondylitis: a systematic review. J Orthop Sports Phys Ther. 2008;38(5):273–284. Link

6. Zhang J, Pan T, Wang Y, et al. Effectiveness and safety of manual therapy in lateral epicondylitis: a systematic review and meta-analysis. Front Physiol. 2025;16:1584732. Link

7. Dones VC, O’Neill S, Coombes BK, et al. Exercise, manual therapy, or both for lateral elbow tendinopathy: a systematic review and meta-analysis. Musculoskelet Sci Pract. 2023;64:102796. Link