Chronic tennis elbow can be challenging to manage. Evidence from high quality clinical trials indicates that, while steroid injections improve the condition in the short term the longer-term outcome is worse than if the patient was to adopt a wait and see policy. Physiotherapy, consisting of exercise and manual therapy has been shown to speed up resolution of the condition compared to wait and see, but without the longer-term deleterious effects of steroid injections. This article presents the proposition that managing chronic tennis elbow might be optimised if the presenting patient features are considered. For example, evidence suggests that patients who have worse pain and disability, concomitant neck and shoulder pain, or evidence of central sensitisation are likely to have a worse prognosis. The proposition is that patients with a poor prognosis be more carefully examined and worked up in terms of management. In contrast, those who have low pain and disability, and low manual task requirements at work and home could achieve a good outcome with adopting a wait and see policy. The majority will benefit with an appropriately metered exercise programme