11/09/2026
Lateral epicondylalgia (tennis elbow) is one of the most common musculoskeletal presentations in primary care — and one where the evidence base has shifted significantly in the last decade.
The traditional approach — corticosteroid injection, rest, and passive modalities — has been challenged by multiple high-quality trials. The seminal Coombes et al. (2013) trial demonstrated that physiotherapy and exercise was superior to corticosteroid injection at 1-year follow-up, and that injection combined with physiotherapy was no better than physiotherapy alone at 12 months.
Current best-evidence management for lateral epicondylalgia:
— Progressive wrist extensor loading programme (eccentric emphasis in early phases, progressing to heavy slow resistance)
— Load management and activity modification
— Pain science education and flare management guidance
— Elbow orthosis as a short-term symptomatic adjunct where required
Medial epicondylalgia (golfer's elbow) is managed on similar principles but requires focus on the flexor-pronator mass and careful assessment of associated structures — UCL integrity and cubital tunnel involvement.
If you're managing patients with persistent elbow pain who haven't responded to injection — a structured loading programme is the evidence-based next step.
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