Like many things, there’s a lot of misinformation out there about tennis elbow and how you can prevent it. Elbow joint pain is often not well-managed, and typical with many injuries, people focus more on local symptoms than on addressing contributing factors.
Here, we’ll talk about tennis elbow—what it is, how you can prevent it, and how we can help manage it at our physiotherapy clinic. We’ll answer questions like:
Tennis elbow is essentially a catch-all diagnosis for pain on the outside of the elbow, whether that’s elbow joint pain or pain in your elbow when straightening your arm. Usually, pain is pinpointed to the edge of the bone, the lateral epicondyle, but it can also radiate down or create a lot of tightness through the forearm. Or, it can radiate toward the back, or posterior, of the elbow, or above and to the outside of the elbow.
There are a lot of different ways tennis elbow is described or phrased, such as “lateral epicondylitis” or “lateral epicondylalgia.” Some diagnoses in people are more focused on the inflammatory process, while others talk more about wear and tear on the tendon.
Most people experience tennis elbow pain in the form of achiness. It can be quite strong, to the point where it’s difficult for you to grip or pick things up, to pull in different directions or do certain rotational movements like opening door knobs or twisting things. Symptoms can also be around weight-bearing, or even simple things like writing and computer work.
Like we mentioned above, tennis elbow pain is generally located along the outside of your elbow, either right on the bone or more along the forearm. Where pain is for you will depend on the contributing factors to the problem in your situation.
This is one of the most common questions we get. It’s first important to understand that the names “tennis elbow” and “golfer’s elbow” are a bit misleading, because they’re not necessarily directly related to playing tennis or golf.
“Tennis elbow” is used to describe elbow pain on the outside of the elbow, and “golfer’s elbow” refers to pain on the inside. However, treating and managing the conditions involves a lot more than just looking at the activity that brings on the symptom—whether or not it’s tennis and golf!
Contributing factors to tennis elbow can be broken up into two different segments—one being a local problem, relating to the elbow, the other a proximal problem higher up the arm. However, often these factors aren’t exclusive, and people will have a combination of both.
Of people who suffer from tennis elbow, a smaller percentage actually experience symptoms locally. Someone who is dealing with local issues typically has a history of wrist or forearm issues or injuries, such as fractures, injuries and stiffness in the wrist, arm and hand. We also see people in this category who have heavily overused their forearms, for example a tennis player, or someone like a plumber doing a lot of rotational work. In all these cases, the elbow issues typically build up over time, either because of increased stress and overload related to their activities, or as a result of previous injuries that reduced the area’s ability to handle the physical stresses of their activities.
The other contributing factor is proximal issues, which is often present in the above group as well. This is a problem that occurs higher up, such as in the shoulders and neck. When people come in with tennis elbow, one of the first things we’ll ask is about their shoulders and neck, which can surprise people. Contributing factors from above the elbow region actually play a really big role in the experience of symptoms. One reason for this is because your whole arm works as a unit: when one area of your arm is limited, the other areas will take on other activities and become overloaded.
As well, the nerves in your neck go to your shoulder and your whole upper body. So if you have any issues like stiffness, tightness or whiplash, it sensitizes the nerves that go down to your elbow, making them more likely to disrupt muscle control. More importantly, it can sensitize the nerves to the point that less irritation or less overload will cause more symptoms—it amplifies symptoms and irritability at the area of your elbow and in places where tendons attach to the bone, like in the lateral epicondyle region.
If you’ve never had tennis elbow before, you can help prevent it by making sure you’re not overloading areas like your forearm or elbow—when you’re doing activities, this looks like ensuring you have adequate strength and control for what you’re doing, and you have good ergonomics or mechanics for your hands, forearms and wrists. Also, if you do have old injuries or fractures, especially to your wrists or elbows, it’s important to properly address them.
Upper body strength and control also plays an important role in preventing tennis elbow. Pay attention to your postural muscles, shoulders and back, ensuring you have adequate strength for the activities you’re doing, again so you’re not overloading any parts of your upper body.
When you’re considering activity modification for tennis elbow, pain is a helpful indicator. When you have pain during an activity, try to do less of it; if you’re not experiencing pain during that activity, you’re likely fine.
Of course, this doesn’t include some of the contributing factors to tennis elbow—for example, shoulder movements that may put more stress on the elbow but don’t cause pain specifically. This is where you should pay attention to things that might bring on symptoms a few hours later or the next day, so you can modify your activities accordingly.
When you come in for a physiotherapy session at Endeavour, first, we’ll look at managing pain using things like manual therapy and electro-acupuncture, with the goal of reducing tension and nerve irritation, and to activate muscles that will help reduce stress on the local area. We’ll also look at managing pain and issues further up the chain, like in the neck and shoulders. We’ll then look at all the contributing factors like how you use your forearms—whether you’re working heavily with your hands in construction or you’re playing a sport—and how you use muscles in your shoulder and neck, ensuring that they’re creating stability. We’ll also talk about activity modifications, helping you understand what you should and shouldn’t be doing as you recover from tennis elbow.
In terms of exercise, we’ll start a program with you that involves not just arm and forearm-specific movements, but whole-body and upper-body movements as well. Initially we focus on things like resisted wrist extension and resisted wrist flexion, as well as supination and pronation, using tools such as resistance bands and small dumbbells. We also often start people right away with some sort of pulling or rowing movement—though it’s a shoulder blade exercise, research has shown that improving shoulder blade muscles accelerates the process of recovery from tennis elbow. Movements like that are a great initiator to adding load and stress onto the lateral elbow, while at the same time activating some of the muscles that are dysfunctional and part of the problem. We also work with some people on pressing type movements such as weight-bearing through the forearms with mini or elevated pushups.
Using a brace can be effective at managing symptoms in the short-term, especially if you really need or want to be able to participate in an activity or sport. However, it’s important to use tactics like a brace alongside a more comprehensive treatment program, because the brace won’t fix the problem in the long-term.
Heat isn’t harmful to tennis elbow, but it’s also not useful in accelerating healing. Ice can be used after an activity or during acute periods of pain, but we strongly recommend you only use it in short intervals of ten minutes or less, several times on and off. Excessive icing of the area can actually slow down healing, so it’s important to focus more on reducing activities in the short-term and avoid icing for long periods of time.
We often recommend forearm stretches—things that can easily be done with your own arm, like stretching it with the opposite arm, leaning up against a wall or desk to make it easier. Like anything else, these stretches will be somewhat helpful, but are best used as part of a more comprehensive treatment program that’s focused on building up strength and reducing irritation and vulnerability.
Self-massage at home in between physiotherapy sessions can be really helpful, but also has to be very specific to you and your situation—we recommend consulting one of our physiotherapists for guidelines on what will work best for you in terms of elbow strengthening exercises and other exercises you can do at home.
It really can vary! Like anything, if you don’t address your tennis elbow symptoms, like elbow joint pain or pain in your elbow when straightening your arm, it can last a really long time, even years. You may experience periods of time where symptoms aren’t as bad and disappear, but the problem will usually return if you’re not managing it and its contributing factors. As well, because contributing factors build up over time—like shoulder and neck dysfunction, old injuries or forearm overload—we often see people not coming into our clinic until symptoms are getting worse and are then harder to manage.
If tennis elbow is initially managed when you first experience symptoms, it can be managed in the span of weeks or months. That’s why we recommend getting your symptoms looked at as soon as you start experiencing any pain or dysfunction in your elbow, forearm or shoulder. It can also help prevent related or chronic issues like carpal tunnel.
In general, tennis elbow is something a lot of therapists have challenges treating and managing, often because the focus is locally on the problem, rather than all the contributing factors. At our physiotherapy clinic at Endeavour, we do address that every single time—get in touch to learn more and book your treatment!
The medical information on this blog is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not create any patient-therapist relationship and should not be used as a substitute for professional diagnosis and treatment.
Please consult your health care provider before making any health care decisions or for guidance about a specific medical condition. Endeavour Sports Performance and Rehabilitation and its practitioners expressly disclaim responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this article.