Evidence-based care at Vantage Point
Elbow Physiotherapy in Bondi Junction
Assessment and treatment for tennis elbow, golfer’s elbow, nerve irritation and elbow injuries, with a clear explanation of what is going on and a plan built around strength and load.
- APA Musculoskeletal Physiotherapists
- Strength testing with VALD dynamometry
- Rehabilitation after elbow surgery and fractures
Symptom profiles
Which best describes your symptoms?
Elbow pain presents in distinct ways, and each profile points to different structures and a different starting point for treatment. Select the one closest to yours.
Tennis Elbow (Lateral Elbow Pain)
Pain on the outside of the elbow, often spreading into the forearm, that comes on with gripping, lifting or repetitive wrist and hand work. Despite the name, it is common in office and trade work as well as racquet sports.
You might notice
- Pain lifting a kettle, coffee cup or bag with the palm down
- Pain gripping, shaking hands or using a mouse
- Tenderness over the bony point on the outside of the elbow
What is usually happening
The tendon that attaches the wrist and finger extensor muscles to the outside of the elbow has become sensitive to load, usually after more gripping or lifting than it was ready for. It is a tendinopathy rather than an inflammation, which is why treatment focuses on gradually rebuilding the tendon’s capacity. Many cases improve over a year, but it can take months, and the fastest relief is not always the best long-term option (Smidt et al., 2002; Bisset et al., 2006).
Common causes
Lateral elbow tendinopathy
The common extensor tendon on the outside of the elbow, irritated by gripping and wrist loading.
Radial tunnel irritation
Irritation of a nerve in the forearm that can cause aching just below the outside of the elbow.
Pain referred from the neck
The neck can refer pain to the outside of the elbow, so we always check it.
What we look at in your assessment
Grip and wrist strength measured with VALD dynamometry, tendon loading tests, a nerve and neck screen, and the gripping and lifting demands of your work and sport.
How treatment usually starts
Changes to how you grip and lift, hands-on treatment and dry needling where it helps settle pain, a counterforce brace if it helps, then progressive wrist and forearm strengthening, measured as you go.
Related services
Golfer’s Elbow (Medial Elbow Pain)
Pain on the inside of the elbow that comes on with gripping, swinging or turning the forearm, common in golf, throwing, climbing, weight training and manual work.
You might notice
- Pain gripping or carrying with the palm up
- Pain in the follow-through of a golf swing or throw
- Tenderness over the bony point on the inside of the elbow
What is usually happening
The tendon that attaches the wrist and finger flexor muscles to the inside of the elbow has become sensitive to load. The ulnar nerve runs close by, so tingling into the little and ring fingers can sit alongside it and changes the plan.
Common causes
Medial elbow tendinopathy
The common flexor tendon on the inside of the elbow, irritated by gripping and wrist flexion.
Ulnar collateral ligament strain
Strain of the ligament on the inside of the elbow, mostly in throwing athletes.
Ulnar nerve irritation
Irritation of the nerve behind the inside of the elbow, often alongside medial elbow pain.
What we look at in your assessment
Grip and wrist strength with VALD dynamometry, tendon and ligament tests, a check of the ulnar nerve, and your technique and training load.
How treatment usually starts
Load management and technique changes where they help, hands-on treatment and dry needling where useful, then progressive forearm, wrist and shoulder strengthening.
Related services
Nerve Irritation Around the Elbow
Pins and needles, numbness or aching that travels into the forearm and hand, often worse with the elbow bent for long periods, such as on the phone or overnight.
You might notice
- Tingling in the little and ring fingers
- Symptoms after leaning on the elbow or sleeping with it bent
- Clumsiness or weakness in the hand
What is usually happening
Three nerves pass around the elbow, and each can become irritated where it runs through a tight space. The ulnar nerve, at the inside of the elbow, is the most common, which is often called cubital tunnel syndrome. Because the neck can produce similar symptoms, we check it too.
Common causes
Cubital tunnel syndrome
Irritation of the ulnar nerve behind the inside of the elbow, affecting the little and ring fingers.
Radial tunnel syndrome
Irritation of a branch of the radial nerve in the forearm, causing aching below the outside of the elbow.
Nerve root irritation in the neck
A nerve irritated in the neck, which can cause similar symptoms along the arm.
What we look at in your assessment
Sensation, strength and reflexes, nerve tests at the elbow and neck, and the positions and activities that bring your symptoms on. If nerve studies are needed, we work with neurologists and pain specialists and collaborate with your GP to organise them.
How treatment usually starts
Changes to sustained elbow positions during the day and overnight, nerve mobility exercises and strengthening. If symptoms are worsening, we liaise with your GP and an orthopaedic or hand surgeon.
Related services
Elbow Pain in Athletes
Elbow pain that comes on with throwing, racquet sports, climbing, gymnastics or weight training, often building over a season or after a jump in training load.
You might notice
- Pain on the inside of the elbow late in a throw
- Pain at the front of the elbow with curls or chin-ups
- Pain at the back of the elbow as it straightens fully
What is usually happening
Throwing and overhead sports put large, repeated loads through the inside and back of the elbow, while lifting and climbing load the biceps tendon at the front. Pain usually reflects a mismatch between load and capacity, and the shoulder and trunk often play a part in how much load reaches the elbow.
Common causes
Ulnar collateral ligament injury
Strain or tear of the ligament on the inside of the elbow, mostly in throwers.
Posterior impingement
Pinching at the back of the elbow as it straightens under load, common in throwers and gymnasts.
Distal biceps tendinopathy
Pain at the front of the elbow from the biceps tendon, seen in weight training and climbing.
What we look at in your assessment
Your training load and technique with video analysis, elbow and shoulder range, and forearm, shoulder and trunk strength with VALD dynamometry.
How treatment usually starts
Load management and a modified training plan agreed with your coach, technique changes where they help, progressive strengthening and a graded return to full training based on milestones.
Related services
A Stiff or Swollen Elbow
An elbow that will not fully straighten or bend, or a swelling at the back of the elbow, sometimes after an injury and sometimes without a clear cause.
You might notice
- Difficulty fully straightening or bending the arm
- A soft swelling over the point of the elbow
- Aching and catching in the joint
What is usually happening
The elbow stiffens easily after an injury or a period of protection, and can also stiffen as the joint ages. A swelling at the point of the elbow is usually the bursa, a fluid-filled sac, reacting to pressure or a knock.
Common causes
Elbow osteoarthritis
Wear in the joint, with stiffness, aching and sometimes catching.
Olecranon bursitis
Swelling of the bursa at the point of the elbow, often from leaning on it or a knock. A hot, red bursa needs a medical review for infection.
Stiffness after injury
Movement lost after a fracture, dislocation or time in a sling.
What we look at in your assessment
Range of movement, strength, and how the stiffness affects your work and daily tasks.
How treatment usually starts
Movement within comfort and protection from pressure where the bursa is involved, then progressive stretching and strengthening to restore range and function.
Recovery After Elbow Injury or Surgery
Rehabilitation after an elbow fracture or dislocation, and before and after elbow surgery, starting when your surgeon advises and following their protocol.
You might notice
- Stiffness and weakness after time in a sling or cast
- Uncertainty about which movements are safe
- Wanting to get back to work, sport or lifting
What is usually happening
The elbow stiffens quickly after injury or surgery, so restoring movement early, within the limits your surgeon sets, matters. Strength comes next, staged to protect any repair while it heals.
Common injuries and surgeries
Elbow dislocation
Rehabilitation after the joint is put back in place, with or without surgery.
Radial head and other fractures
Rehabilitation after fractures treated in a cast or with surgery.
Distal biceps repair
Reattachment of a ruptured biceps tendon, followed by a protected, staged return to load.
Ligament reconstruction
Ulnar collateral ligament reconstruction in throwers, with a long, staged return to sport.
What we look at in your assessment
Your surgeon’s protocol, range of movement, swelling and wound checks, and baseline strength testing once it is safe to test.
How treatment usually starts
Before surgery, prehab builds strength and prepares you for recovery. Afterwards, protected movement comes first, then staged strengthening within your surgeon’s limits, progressed by measured milestones. We communicate with your surgeon throughout.
Related services
Pain or tingling spreading from your neck down your arm? See neck pain physiotherapy.
Understanding tennis elbow
The Quick Fix and the Long Run
Tennis elbow (lateral elbow pain) is a common cause of elbow pain, and the research shows a clear pattern: what feels best at 6 weeks is not always what works best at a year.
Two trials followed people for 12 months after a cortisone injection, physiotherapy, or simply waiting. The injection gave the fastest early relief. By 12 months, physiotherapy was doing better than the injection, waiting had done about as well as physiotherapy, and many injection successes had relapsed.
Share of people with a successful outcome
At 6 weeks
At 52 weeks
185 people with tennis elbow, recruited through their family doctors (Smidt et al., 2002).
What other trials have found
Brisbane trial of 198 people
Injection was best at 6 weeks but did worse than physiotherapy at 52 weeks, and 47 of the 65 early injection successes later relapsed (Bisset et al., 2006).
Surgery compared with placebo surgery
In a small trial of 26 people with long-standing tennis elbow, tendon release surgery gave no better results than a placebo operation. The trial stopped early, so it is not the final word (Kroslak and Murrell, 2018).
Your treatment
Five Steps, Each With a Clear Goal
Every consultation is 45 minutes. Your plan is built around what matters to you, whether that is lifting the kettle, a full day at the keyboard or getting back on court.
- 1
Assess
A detailed history and examination of your elbow, wrist, shoulder and neck, including screening for anything that needs a medical opinion.
Goal: A clear diagnosis
- 2
Explain
What is causing your pain, what to expect, and which activities are safe to keep doing.
Goal: Confidence to keep moving
- 3
Settle
Hands-on treatment, dry needling where it helps, and changes to how you grip, lift and load the arm to calm things down.
Goal: Pain under control
- 4
Strengthen
Progressive exercise for your forearm, wrist and shoulder, with VALD dynamometry to measure your strength.
Goal: Strength targets met
- 5
Stay well
A long-term program and a flare-up plan, so you know what to do if pain comes back.
Goal: Managing on your own
Injections
Where Injections Fit
Cortisone and platelet-rich plasma (PRP) injections are both offered for tennis elbow. The research on each is clearer than for most conditions, so it is worth knowing before you decide.
We do not give injections ourselves, but we often see people who are considering one, and we work with the GP, sports physician or specialist who provides it.
Cortisone injections
Fast relief, then a higher chance of relapse
In a trial of 165 people, those given a cortisone injection were less likely to have recovered at 1 year than those given a placebo injection (83% compared with 96%), and more likely to have a recurrence (54% compared with 12%) (Coombes et al., 2013).
PRP and autologous blood
Little or no benefit over placebo
A Cochrane review found these injections probably give little or no clinically important benefit for pain or function compared with a placebo injection (Karjalainen et al., 2021).
How we work with injections
An informed decision
If you are considering an injection, we talk through the research with you, and with your GP or specialist if you would like, so the decision is yours and you know what to expect.
The research
What the Research Tells Us
Natural history
Most tennis elbow improves over a year
In people who were simply monitored, 83% had a successful outcome at 12 months (Smidt et al., 2002). Physiotherapy gave faster relief than waiting over the first 6 weeks (Bisset et al., 2006).
Cortisone
Early benefit, later relapse
Across two trials, cortisone injections gave the best results at 6 weeks but poorer results at 12 months, with high recurrence rates (Bisset et al., 2006; Coombes et al., 2013).
PRP
Not supported by current evidence
A review of 32 trials concluded the evidence does not support autologous blood or PRP injections for lateral elbow pain (Karjalainen et al., 2021).
Bracing
A brace can ease pain in the short term
In a small trial, a counterforce brace reduced pain more than a placebo brace over the first 2 to 12 weeks (Kroslak et al., 2019).
Surgery
No better than placebo surgery in one small trial
Tendon release surgery for long-standing tennis elbow gave results similar to a placebo operation in 26 people (Kroslak and Murrell, 2018).
Tennis elbow can take months to settle, and the research shows the fastest option is not always the best one. That is why we measure your strength and build your plan around load, not just pain relief.
Fees and funding
Consultations and Rebates
Every consultation is 45 minutes. The number of consultations you need depends on your elbow and your goals, so we discuss your plan with you at your first visit.
Book an AppointmentWays to claim
- Private health: rebates claimed on the spot with HICAPS
- Medicare: rebates with a GP referral
- Workers compensation: fees set by SIRA, with approvals coordinated with your case manager
- CTP: fees set by SIRA
Common Questions
Will my tennis elbow get better on its own?
Often, yes, but it can take months. In one trial, 83% of people who were simply monitored had a successful outcome at 12 months (Smidt et al., 2002). Physiotherapy gave faster relief than waiting over the first 6 weeks (Bisset et al., 2006), and helps you keep working and training while it settles.
Should I get a cortisone injection for tennis elbow?
It is a decision for you and your doctor, and it helps to know the research. Cortisone usually gives fast relief, but in trials it led to worse results at 12 months and a much higher chance of the pain coming back (Bisset et al., 2006; Coombes et al., 2013). We are happy to talk it through with you and your GP or specialist.
Is a PRP injection worth trying?
Current evidence does not support it. A Cochrane review found PRP and autologous blood injections probably give little or no benefit over a placebo injection for tennis elbow (Karjalainen et al., 2021).
Should I wear an elbow brace?
A counterforce brace can help in the short term. In a small trial, it reduced pain more than a placebo brace over the first 2 to 12 weeks (Kroslak et al., 2019). We use it alongside strengthening, not instead of it.
Do I need surgery for tennis elbow?
Rarely. In a small trial, tendon release surgery gave results similar to a placebo operation (Kroslak and Murrell, 2018). For other elbow injuries, such as a ruptured biceps tendon, we liaise with orthopaedic surgeons promptly.
How many sessions will I need?
It depends on your elbow, how long you have had symptoms and your goals. We give you an estimate at your first visit and review it as you meet each step’s goal.
Can I claim my physio through private health?
Yes. Rebates are claimed on the spot with HICAPS. Medicare rebates are available with a GP referral, and workers compensation and CTP claims are accepted once approved.
What research is this page based on?
- Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939–944.
- Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013;309(5):461–469.
- Karjalainen TV, Silagy M, O’Bryan E, Johnston RV, Cyril S, Buchbinder R. Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Cochrane Database Syst Rev. 2021;9(9):CD010951.
- Kroslak M, Murrell GAC. Surgical treatment of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. Am J Sports Med. 2018;46(5):1106–1113.
- Kroslak M, Pirapakaran K, Murrell GAC. Counterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. J Shoulder Elbow Surg. 2019;28(2):288–295.
- Smidt N, van der Windt DAWM, Assendelft WJJ, Devillé WLJM, Korthals-de Bos IBC, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359(9307):657–662.
- Clinically reviewed by David Cohen and Zachary Ehrenfeld, APA Musculoskeletal Physiotherapists and Directors of Vantage Point Physiotherapy. Last reviewed October 2026.
