By the time he came into the clinic ten weeks had passed. Ten weeks of moving around in the same brace. Ten weeks of disturbed sleep because the knee ached whenever he turned. Ten weeks of finding stairs awkward and everyday tasks tiring.

He told us he felt weaker each week. His thigh muscles had wasted away. Walking felt heavy and clumsy. Even standing for long periods at work was draining.

The brace had stopped him from making things worse, but it had not made anything better. He admitted he had started to feel stuck.

Running very close to the tendon commonly affected in tennis elbow is a structure called the radial nerve. This nerve travels from the neck, down the arm, and passes directly through the area where many people feel outer elbow pain.

If this nerve becomes irritated or sensitised anywhere along its pathway, particularly at the neck or shoulder region, it can produce pain that feels almost identical to tennis elbow. The discomfort is often localised to the same area, which makes it easy to mistake for a tendon injury.

The important point is that nerves create symptoms differently from tendons. A nerve problem may persist despite rest or strengthening exercises because the underlying issue is not tissue damage at the elbow but irritation coming from higher up the arm or neck.

Many people spend months treating what they believe is tennis elbow. They may use straps, complete rehabilitation exercises, receive massage therapy, or even reduce activity levels significantly. When the pain does not improve, it becomes confusing and discouraging.

The reason treatment fails in these situations is simple. Tendon based treatment will not resolve a nerve driven problem.

If the radial nerve is being affected by reduced movement or irritation around the neck or upper limb, the elbow continues to hurt regardless of how much local treatment is applied. This is why some patients experience little or no progress despite doing everything correctly.

Once the real source is identified, improvement is often much faster than expected.

If you have been dealing with elbow pain that keeps returning, has lasted for months, or has not responded to typical tennis elbow treatment, there is a strong possibility the problem may not be the elbow itself.

The good news is that identifying the cause is usually quick and straightforward, and once understood, treatment can be highly effective.

If you recognise any of the symptoms discussed in this article, a good first step is to book a free discovery call. This allows us to understand your symptoms, discuss what may be driving your pain, and help you decide on the best next step toward resolving it.

Once he understood the plan his outlook changed.

He no longer felt like he was drifting in limbo. Each session became a step forward. Swelling began to settle. His range of motion improved. His muscles slowly came back to life. It was gradual progress but it was progress he could feel.

What mattered most was that he now had clarity. He knew what needed to happen and in what order. He knew his part in it and he could see the end goal.

Living with a complex knee injury is frustrating but when there is a clear roadmap it becomes manageable.

For him that meant moving from weeks of frustration in a brace to feeling hopeful about walking, working, and living normally again.

Joe Sharp

BSc (Hons) Physiotherapy