Elbow Pain from Typing and Gripping: Tennis Elbow Treatment in Crystal Palace
You've not taken up tennis. You've not been hammering or painting the house. Yet your elbow hurts when you lift your coffee cup, grip the steering wheel, or after a few hours at your desk. Maybe it's a dull ache that's been building for weeks, or perhaps it suddenly flared up after a particularly busy week. Either way, you've Googled it and discovered you've got tennis elbow, which feels slightly absurd given you spend most of your time in front of a screen.
Here's what's actually going on, why it's developed, and how I work with this condition at Moving Fox Osteopathy in Crystal Palace.
What Tennis Elbow Actually Is (and Why You Have It)
Tennis elbow, or lateral epicondylalgia if we're being technical, isn't really about tennis for most people. It's a degenerative overuse condition affecting the tendons that attach your wrist and finger extensor muscles to the outside of your elbow.
Here's what's actually happening. As we age, particularly after 40, our tendons naturally lose some of their capacity. They become less elastic, less resilient, and slower to recover from repeated use. At the same time, the repetitive demands we place on these tendons through typing, gripping, using a mouse, or playing instruments continue day after day.
So you have this gap developing between what your tendon can handle and what you're asking it to do. The load hasn't necessarily changed, but your capacity to manage that load has dropped. Eventually, the tendon can't keep up with the demands being placed on it, and that's when pain develops.
The usual culprits are activities you probably don't think twice about. Using a mouse for hours. Typing with your wrists in awkward positions. Gripping tools or steering wheels. Playing an instrument. Even just holding your phone whilst scrolling. None of these feel particularly strenuous in the moment, but the load accumulates. Your tendons are being asked to work constantly without proper recovery, and eventually they start to hurt.
What surprises many people is that rest alone doesn't fix it. In fact, complete rest can make things worse because your tendons lose capacity. They need to be loaded, just in a way that helps them adapt and strengthen rather than continuing to break down.
Why Your Elbow Pain Isn't Just About Your Elbow
When someone comes to see me with tennis elbow, I'm certainly interested in what's happening at the elbow itself. But I'm often more interested in what's going on at their shoulder and upper back.
Your arm doesn't work in isolation. When you reach, lift, type, or grip something, the movement should be distributed across your entire shoulder girdle, your shoulder blade, your upper back, and down through your core. When this system works well, the load is spread out. But when parts of this chain aren't doing their job properly, other areas have to compensate. And very often, it's your forearm and elbow that end up taking the strain they weren't designed to handle.
Here's what I commonly see. Someone has a shoulder that sits slightly rolled forward, perhaps from years at a desk. Their shoulder blade doesn't move as freely as it should, or doesn't activate at the right time when they lift their arm. Their upper back is stiff. When they reach forward to use their mouse or lift something, their shoulder girdle isn't providing the support it should. So their forearm muscles work harder to control and stabilise the movement. Do this hundreds of times a day, every day, and eventually the tendon at the elbow says enough.
This is why treating just the elbow often doesn't resolve the problem. You might get temporary relief, but the underlying pattern that created the issue is still there. The elbow keeps getting overloaded because the shoulder and upper back aren't pulling their weight, so to speak.
During an assessment, I'm watching how you move your arms overhead, how your shoulder blades respond, whether they're moving together with your arms or lagging behind. I'm checking if your thoracic spine can rotate properly, if your shoulders are habitually rounded. I want to understand the whole movement pattern, not just the painful bit.
Why Your Shoulder Blade Matters for Elbow Pain
Let me give you an example of what I mean by movement patterns. When you reach forward to use your mouse or pick something up, ideally that movement starts from your centre. Your shoulder blade should move first, setting up a stable base. Your shoulder follows, and then your arm extends. The whole thing should feel coordinated, as your arm is attached to your body through your shoulder blade.
But what I often see instead is someone reaching primarily through their arm and hand. The shoulder blade barely moves or moves too late. The work is being done almost entirely by the forearm and elbow, rather than being distributed across the whole arm and shoulder. Mostly people aren't even aware that a simple reaching should involve a sequence of movements starting all the way up in their back. They might tell me they do upper back exercises, and when I watch them, I can see they're moving their arms but not really engaging or feeding that movement into their shoulder blades and upper back back.
This dissociation, where some parts are moving separately rather than working jointly together, creates points of excessive tension and load. And one of those points is often is further down the arm like the elbow, forearm or wrist.
For desk workers specifically, there's usually an element of sustained static gripping as well. Holding a mouse in the same position, hands hovering over a keyboard without forearm support, wrists extended or deviated to the side for hours. These positions put continuous low-grade tension through the wrist extensors (the muscles that bend your wrist back). Add in poor shoulder mechanics and you've got a recipe for tennis elbow.
What Happens in Your First Session
When you come to see me, we start by talking through how this has developed for you. When did you first notice it? What makes it worse? What have you already tried? I want to know about your work setup, what you do in your spare time, whether you exercise and what that involves.
Then we look at movement. I'll assess your elbow directly, checking for tenderness and seeing how it responds to specific tests. But then we broaden out. I'm watching how you move your shoulder, how your shoulder blade responds when you lift your arm, what your thoracic spine mobility is like. I might ask you to show me how you sit at your desk, how you hold your mouse, what positions you work in and describe any other activities.
If you've told me you do some upper back exercises, I might ask to see one, just to observe the quality of movement and whether you're actually engaging the areas we want to target. Often there's a disconnect between doing a movement and feeling where the effort should be.
The hands-on treatment typically involves releasing tension in your forearm extensors if they're particularly tight, but I'll spend at least as much time working with your chest, the top of your shoulder, your upper back, and often your neck. We're addressing the whole system, not just the sore bit.
The Three Stages of Recovery
Recovery from tennis elbow isn't a straight line, and it takes time. I'm honest about that from the start. But there's a clear framework we follow, and understanding where you are in that process helps.
The first stage is pain modulation. We're working to settle the acute pain and irritation so you can start to use your arm more normally. This might involve isometric exercises, where you're contracting muscles without actually moving, which can help reduce pain without overloading the tendon. We'll also look at modifying activities that are particularly aggravating, not stopping them entirely, but finding ways to reduce the immediate strain.
Once pain starts to settle, we move into capacity building. This is where we're actively strengthening the tendon and the muscles around it, rebuilding their ability to handle load. But we're also working on the shoulder girdle and scapular mechanics, retraining the movement patterns that contributed to the problem in the first place. You're learning to feel where effort should be in your upper back when you move your arms, rather than doing everything through your forearm and elbow.
The final stage is functional movement integration, where we're taking those improved movement patterns and making sure they work in the context of your actual activities. How does your whole arm work with your trunk when you're typing, lifting, playing your instrument, exercising? We want the entire system moving together, with load distributed properly from your core and shoulder girdle out through your arm, not concentrated at your elbow.
This whole process may take somewhere between eight to twelve weeks before you notice significant improvement. The pain should gradually decrease in intensity and frequency, even if it's not completely gone. Some people progress faster, some slower. It depends on how long you've had the problem, how severe it is, and how committed and consistent you are with your movement re-education work.
Understanding Pain During Recovery
One of the most important conversations I have with people is about pain during recovery. Some level of discomfort whilst you're rebuilding capacity is absolutely normal and doesn't mean you're causing further damage. Your tendon needs to be loaded to adapt and strengthen. Complete rest doesn't help, but you will learn how to read your body signals to know when to slow down.
What I teach you is how to distinguish between acceptable discomfort and overdoing it. If pain lingers for more than an hour or two after an activity or exercise, or if you wake up the next day significantly worse - you've probably pushed too hard too soon. That's feedback to dial things back slightly, not a sign of failure or damage.
Flare-ups are part of the recovery process. They're frustrating but they don't mean you're back to square one. Often it just means you've increased load a bit quicker than your tendon was ready for. We adjust, you continue, and you're back on track. I make sure we stay in touch between sessions so I can help you navigate these moments rather than leaving you wondering if you've undone all the progress.
The other thing people often find surprising is the conversation about tendon ageing. Especially if you're in your forties or beyond, your tendons aren't as resilient as they were in your twenties. That's just normal biology. But that doesn't mean you're destined for chronic pain. It emphasises the importance of keeping them strong through appropriate loading. Tendons in midlife can still be robust and healthy, but they need consistent stimulus to maintain that capacity.
For women, particularly around perimenopause and menopause, there can be additional factors at play. Hormonal changes can affect connective tissue and joint health more broadly. If you're noticing elbow pain alongside other joint issues or widespread aches, it's worth exploring whether there's a bigger picture hormonal component. But even then, the approach of building capacity through movement still applies.
Desk Setup and Ergonomics
If you're a desk worker, we'll almost certainly talk about ergonomics. Not because desk setup is the entire solution, but because spending hours in positions that load your forearm and elbow excessively doesn't help whilst you're trying to recover.
A few things that often make a difference. Making sure your forearms are actually resting on your desk or armrests when you're typing, rather than holding them suspended. Keeping your mouse close to your keyboard so you're not repeatedly reaching out to the side. Some people find a vertical mouse helps, as it changes the forearm position and reduces strain on the wrist extensors.
But honestly, position is less important than regular breaks. If you can interrupt that sustained tension every thirty minutes or so with a few quick movements, even just for a few seconds, you break the accumulation of strain. Small, frequent breaks are more effective than one long break after hours of sustained work.
Your Role in Recovery
I can assess your movement patterns, release tight tissues, help you understand what's happening, and guide you through movement re-education process. But I can't do it for you. Tennis elbow recovery requires your active participation.
You'll need to do exercises at home, consistently. I will ask you to pay attention on how you're moving throughout your day, whether you're engaging your whole shoulder girdle when you reach and lift, or whether you've slipped back into old patterns where everything happens through your forearm. It’s not about being perfect, but it’s about making small changes over the period of time that counts.
If you exercise regularly, we'll look at how you're doing that. Are you actually using your upper back in pulling movements, or are your arms doing most of the work? When you press or push, does your shoulder blade move with your arm or stay stuck? These details matter because they're part of the pattern that either perpetuates the problem or helps resolve it.
This is collaborative. You're in control of the recovery, with my guidance and support. The progress might be gradual, but it's happening because you're consciously changing the patterns that created the issue in the first place.
What Recovery Actually Looks Like
I want to be honest with you about what recovery looks like. It's not a case of a few sessions and you're fixed. Tennis elbow is a stubborn condition that requires patience and consistent work. But the trajectory should be one of gradual improvement.
You might find certain activities remain a bit uncomfortable even as overall pain decreases. That's normal. You might have setbacks where pain flares up again after you've had a good few weeks. Also normal, and not a sign that you're not improving.
What we're looking for is that over the course of weeks and months, the pain is less constant, less intense, and you're able to do more without aggravating it. You're noticing that movements which used to always hurt now only hurt sometimes, or only hurt if you really overdo it. That's progress.
For some people, there's a residual mild discomfort that lingers even after the main recovery. Often that's manageable and doesn't interfere with daily life. Initially, the goal isn't necessarily zero pain, but getting you back to full function with pain that's minimal and doesn't limit what you can do.
Getting Started
If this resonates with what you're experiencing, book an initial consultation. We'll assess your specific movement patterns, work setup, and shoulder mechanics to understand what's driving the load on your elbow. Then we'll create a rehabilitation plan that makes sense for your situation.
Tennis elbow is frustrating, especially when it limits everyday activities. But with the right approach that addresses your whole movement system and your active involvement, it does get better.
Whether you're dealing with recent tennis elbow that's limiting your activities, or chronic pain you've been managing for years, book an initial assessment and let's figure out what your body needs.
Book Your Assessment
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