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Tennis Elbow Symptoms Causes Treatment Preventions & More All you need to know

December 27, 2021

Tennis elbow is not related to tennis, but it can occur to tennis players due to overuse of the forearm muscles.

It is the inflammation of the tendons of the forearm muscles that get attached to the lateral or outside of the forearm. The tendons of the forearm muscles attach to a bony protrusion on the outer side of the elbow where the tennis elbow develops.

Tennis Elbow Symptoms Causes Treatment Preventions

The tendons on the lateral side usually get overloaded due to repetitive movements of the wrist and arm. So it is no surprise that about half of the tennis players get this condition sometime in their life.

Also called lateral epicondylitis or lateral elbow pain, the condition most often affects people between thirty and fifty.

The condition is associated with pain in the elbow which may progress to include the forearm and hand.

Conservative treatment suffices; however, recurrent and severe disabling cases may require surgery.

The anatomy of the elbow tennis

Elbow joint is made up of three bones;

  • Upper arm bone (humerus)
  • Two forearm bones; the radius and ulna

Humerus has bony bumps at the bottom called epicondyles. The epicondyles provide attachment to several muscles of the forearm. The bony bump on the outside of the lateral side of the humerus is called the lateral epicondyle.

Elbow joint is held together by many muscles, ligaments, and tendons. The forces involved in tennis elbow are the ones that extend the forearm and wrist (straighten the wrist). The tendon that gets the brunt in the tennis elbow is the extensor carpi radialis brevis (ECRB).

Incorrect technique can cause the power to rotate through and around the wrist in the swing of a racquet. This creates a movement on the wrist instead of initiating an activity the elbow joint or shoulder. It increases pressure on the tendon resulting in irritation and inflammation.

Causes of tennis elbow

Some factors predispose a person to the development of the tennis elbow. These include;

  • Age; adults between the ages of 30 and 50 are more prone, yet the condition may affect any age
  • Occupation; jobs requiring repetitive motions of the wrist and arm
  • Certain sports; racket sports, especially if the service and backhand technique is not proper

Tennis elbow is a muscle strain injury that occurs due to overuse. Repeated contraction of the forearm muscles to straighten and raise your hand and wrist are the underlying cause.

Tiny tears in the tendon result from repeated incorrect movements of the arm—the wrong technique results in the swing's power to rotate through the racket and around the wrist. The move does not take place at the elbow or shoulder joint (the correct movement spots).

This increases the pressure on the tendons of extensor muscles creating minor tears and inflammation.

Signs and symptoms of tennis elbow

The pain develops slowly over time, and the patient usually does not recall any history of injury.

The classical sign of tennis elbow is pain just below the elbow that radiates from outside the elbow into your forearm and wrist. The pain is associated with;

  • Weak grip
  • Pain at night
  • Pain often affects the dominant side
  • Activities like turning a doorknob or holding a cup make the pain worse

The pain makes it difficult to perform everyday activities like shaking hands, holding an object or turning a doorknob, etc.

Diagnosis of tennis elbow

Your doctor may test a range of motions with your affected arm before asking about the location and nature of the pain.

X-ray confirms the diagnosis, and an MRI scan gives detailed information about the extent of the injury.

Sometimes an EMG (electromyography) is suggested if your doctor suspects nerve compression.

Treatment of tennis elbow

Conservative therapy effectively resolves the tennis elbow. In severe cases, surgery may be required.

  1. Initial management within the first week
    1. RICER

Rest, icing, light compression, elevation are standard protocols to treat tennis elbow initially. Using a sling is an option to immobilize the elbow and allow the injured tendons to heal.

  • Medications

Over-the-counter analgesics and NSAIDs help the pain, swelling, and inflammation of the tennis elbow.

Corticosteroid injections in severe cases should be employed along with rest.

  • TENS

Tennis elbow usually resolves after a few months. However, the pain can linger on, making everyday activities troublesome. The muscles may be stiff and weak, and there may be discomfort in the elbow and the rest of the arm.

TENS helps in such cases. TENS improves the strength and range of motion. Giving a break between sessions is essential otherwise, you can use TENS as frequently as you want.

Place two electrodes above the elbow and two below. You can also place a larger pad directly above the elbow and one down. Make sure to adjust the pads in a way to address your pain accurately.

  • Other options

Botox and extra-corporeal shock wave therapy (ESWT) are some other fair options for cases not resolved with conservative therapy.

ESWT is a technique that stimulates the body's intrinsic healing processes by sending sound waves to the elbow.

Heat, low-level laser are some other options. Injections of platelet-rich plasma (PRP acquired from the blood of the patient) encourage healing.

Dry needling also helps in which a small needle pierces the damaged tendon in many places repeatedly. It stimulates the local repair and healing process.

Ultrasonic tenotomy (TENEX procedure) is another option to address the tennis elbow. A special needle is inserted under ultrasound guidance into the damaged tendon over the elbow. The ultrasonic energy swiftly vibrates the needle to liquefy the damaged tissue, which can be sucked out.

  • Surgery

About 80-90% of tennis elbow cases resolve with conservative and non-invasive therapies. Some patients may require the removal of the damaged part of the tendon to help relieve pain. Surgery is only opted if the symptoms do not resolve in 6 to 12 months.

  1. Treatment after some weeks
  • Massage

Tennis elbow benefits from massage, especially with a technique called transverse friction massage. The massage is done by using the tips of one or two fingers and is applied to the tendons and the muscles.

Friction massage is said to be done when a penetrating pressure is accurately delivered through the fingertips. This increases the circulation and relaxes tight areas around the joint and adhesions within the muscles and tendons.

Transverse friction massage is also called cross-friction or cross-fiber massage. It helps promotes collagen healing by increasing circulation in the affected area. It also decreases cross-linkages among the collagen fibers, thereby decreasing adhesions and scar tissue formation, which develops perpendicular to the muscle fibers.

Transverse friction massage is a deep tissue massage technique that remodels the muscles and tendons to be more pliable and flexible, resulting in enhanced functionality of the elbow joint.

  • Therapeutic ultrasound

Ultrasonography caters to thermal and mechanical effects on the target tissue. It thereby results in

  • increased metabolism
  • improved circulation
  • extensibility and flexibility of connective tissue
  • tissue regeneration

Therapeutic ultrasonography also provides modest pain reduction if regularly used over one to three months. For effective results, the therapy should be employed two or three times per week for four to six weeks.

  • Active rehabilitation

Exercises that include stretches and progressive strengthening are a must for the tennis elbow. The therapist may require you to use weights or elastic resistance bands. All of them contribute to a strong forearm with a pain-free grip.

The exercises for the tennis elbow also help to alleviate pain in the long term. A daily routine of stretching and strengthening with weight lifting should be adopted. Initially, lighter weights should be lifted for a few reps.

The Tyler Twist

You can either use a flex bar or a rolled-up towel for this exercise. The aim is to grip a flexible item that exerts resistance during the exercise.

  • Hold the flexible object in a vertical position with your healthy arm at the level of your chest.
  • Take the affected hand and grip the top of the held item. Make sure your palm faces outwards.
  • Twist the object with your top hand and slowly move the thing to bring it horizontally to your chest.
  • Stop twisting and finish the exercise.
  • Repeat at least fifteen times.

Finger stretch with a rubber band

  • Place a rubber band around the thumb and fingers of the affected hand.
  • Make a cup shape of your hand.
  • Gently stretch your fingers and thumb outwards and then inwards.
  • Complete three sets with ten reps each.
  • Do this exercise at least twice daily.


  • Hold a soft object as a soft rubber ball in your affected hand.
  • Squeeze the ball and release.
  • Continue for 10 to 15 minutes.
  • Repeat the exercise at least thrice daily.

Prevention of tennis elbow

Prevention is possible through the following self-care measures;

  • Rest and avoidance of activities that aggravate elbow pain.
  • Learn the proper technique to avoid repetitive wrist motions.
  • The use of TENS and massage as a prophylactic measure also helps to avoid recurrence.
  • It is essential to pay attention to movement techniques during exercise or exertion. Your physical therapist may suggest an evaluation by experts in the case of sports-related tennis elbow. They will teach you techniques or movements that reduce stress on your injured tissue.
  • Learn how to spread the load of the movement to larger muscles of the shoulder and upper arms. Learn to avoid sending force through the wrist and elbow.
  • Warming up exercise is an absolute obligation to avoid sports injury.
  • Use lightweight tools and gadgets while playing sports. Take up light racquets with a larger grip to reduce the strain on the tendons. It is also vital that the tennis ball be dry and new as older and damp tennis balls also require more force to be struck with, which is unnecessary.
  • Build up the strength of forearm muscles
Abdur Rashid
Medically Reviewed By Abdur Rashid
MSC Public Health, MCSP, MHCPC
BSC (Hon) Physiotherapy
Consultant Neuro-spinal & Musculoskeletal Physiotherapist


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