Background Chronic lateral epicondylitis(LE), is associated with persistent pain and functional impairment in the upper extremity. While peripheral factors such as pain and muscle strength are well recognized, emerging evidence suggests that central mechanisms, including motor imagery ability and body awareness, may also contribute to dysfunction. Objective The aim of this study was to investigate the effect of pain intensity, motor imagery performance, grip strength, body awareness and pain duration on pain and disability in individuals with chronic LE. Design Cross-sectional. Methods This cross-sectional study included 98 individuals diagnosed with chronic LE. Function was assessed using the Patient-Rated Tennis Elbow Evaluation(PRTEE). Pain intensity was measured via the Visual Analog Scale(VAS), grip strength via hand dynamometry, motor imagery through left/right hand judgment using the Recognise™ application, and body awareness using the Body Awareness Questionnaire. Multiple linear regression analysis was performed to determine predictors of functional status. Results The regression model was statistically significant(F = 10.984, p < 0.001), explaining 49.6 % of the variance in function(adjusted R2 = 0.496). Pain during activity(β = 0.449, p < 0.001), pain at rest(β = 0.196, p = 0.049), pain duration(β = 0.207, p = 0.023), grip strength(β = 0.343, p < 0.001), and motor imagery reaction time(β = 0.228, p = 0.016) were significant predictors. Accuracy in motor imagery and body awareness did not significantly predict function. Conclusion Function in chronic LE is influenced by both peripheral and central factors. Rehabilitation approaches should therefore integrate strategies addressing both musculoskeletal impairments and altered neuromotor control to improve functional outcomes. Trial registiration Prospectively registered on Clinicaltrials.gov on 07/17/2024 (registration number: NCT06459102) (Link: https://clinicaltrials.gov/study/NCT06459102?term=NCT06459102&rank=1 ).