Tennis Elbow: Why It Lingers and What Helps

The short answer

Tennis elbow is a problem with the tendons on the outside of the elbow where the wrist extensor muscles attach, and it lingers because those tendons have a poor blood supply and you keep using the arm all day without noticing. Treating the forearm muscles that pull on the tendon tends to work better than treating the sore spot on the elbow.

You do not have to play tennis to get it

Most of the people I treat for tennis elbow in Almancil have never held a racket. It comes from repeated gripping and wrist extension: padel, tennis, golf, gym work, laptop and mouse use, carrying shopping, trade work. Padel is the big one in the Algarve right now, partly because so many people have taken it up quickly and partly because the wrist action is sharper than in tennis.

The medical name is lateral epicondylitis, though the tissue is usually degenerative rather than inflamed by the time people seek help, which is part of why anti inflammatories often disappoint.

Why it hangs around for months

Three reasons, and they compound.

• Tendons heal slowly. Blood supply at the tendon attachment is poor compared with muscle, so repair takes longer than people expect.
• You never fully rest it. Opening doors, carrying bags, typing, driving. The arm gets loaded hundreds of times a day below the threshold you would notice.
• The restriction is up the forearm. The muscle bellies tighten and keep a constant pull on an attachment that is trying to heal. Treating only the painful point at the elbow leaves that pull in place.

What treatment involves

I work along the extensor muscles of the forearm rather than hammering the sore spot. ART for the upper limb, which involves holding tension in the tissue while you move the wrist and elbow through range, is the technique I reach for most here. It is specific, it reaches tissue that general massage tends to skate over, and it addresses the pull rather than the symptom.

I also check the neck, shoulder and wrist. Nerve irritation higher up the arm can produce elbow symptoms that look exactly like tennis elbow and will not respond to local treatment, so it is worth ruling out early rather than after six wasted sessions.

Expect improvement over a few sessions rather than one. Tennis elbow that has been there for months does not undo in an hour, and anyone who tells you otherwise is selling something.

What you do between sessions matters more here than usual

Load management is most of the result. That means changing grip size or racket tension if padel or tennis is the trigger, breaking up long typing stretches, and carrying bags with the palm up rather than down. Eccentric wrist extensor work, lowering a light weight slowly, has reasonable evidence behind it for tendon problems and is worth doing if you will actually do it daily.

Complete rest is rarely the answer. Tendons respond to graded load, and arms that do nothing for six weeks tend to come back weaker and flare again.

When to get it looked at properly

If you have numbness or pins and needles in the hand, weakness gripping, or pain that wakes you at night, get a medical assessment first. Those point at the nerve rather than the tendon, and massage is not the right first step.

Booking

Clinic sessions in Almancil are €37 for 30 minutes, €52 for 45 and €60 for an hour, and 45 minutes is usually right for an elbow because there is forearm, shoulder and neck to check. Mobile sessions across the Algarve are €140 per hour. WhatsApp 925 382 490.