Tennis elbow is the leading type of elbow pain, but only 5% of people report tennis as the cause. In this article, you’ll learn how to heal tennis elbow* in 4 steps so you’ll be ready for your next battle, whether you play tennis or not.
Nagging elbow and forearm pain is a problem for plenty of tennis players, athletes and anyone who performs repetitive forearm movements that require a strong grip.
If your pain is felt on the inside of your elbow, it’s likely golfer’s elbow, or medial epicondylitis, so check out my article on how to treat that issue.
But pain on the outside of your elbow? That’s likely tennis elbow or lateral epicondylitis.
Tennis elbow is a repetitive strain or overuse injury, and is the most common of all forearm injuries. It usually causes pain on a centralized point on the outside of the elbow, which may move down the forearm and wrist . A weakened grip is another common and frustrating symptom.
And despite the name, only about 5% of people diagnosed with tennis elbow actually associate it with playing tennis .
If your job or favorite hobby requires lots of repetitive motions or heavy lifting in certain positions, you could see tennis elbow develop. (Think carpentry, cooking, or working on your car.)
And a HUGE range of sports beyond just tennis can contribute to the pain, including swimming, baseball, or like a pal of mine experienced, hockey.
Stretching Won’t Cut It
My buddy Matt was dealing with tennis elbow for a few weeks that started after he played hockey 5 days in a row.
We play hockey together on Thursday nights and when he was dealing with pain he just wasn’t the same as he wasn’t scoring.
And he was bummed about it.
I asked him what was going on and he pointed to his elbow and said, “It hurts here.”
Since he pointed at his lateral epicondyle, I figured it was tennis elbow, made him do a quick test (the same one you’ll find in this article) and confirmed that’s what was up.
Then, I did something a bit mean (in the name of science) – I said I could help him but first recommended he do some research on how to heal tennis elbow and follow it.
I just wanted to see his results.
Guess what he found?
Static stretches targeted to the wrist extensors, the same muscles involved in tennis elbow:
After a couple of weeks of no relief, I shared the 3 exercises you’ll find below with him.
He followed them for a week and guess what? The next game he scored twice – once on a breakaway with a nice deke to his backhand and the other with his signature snap shot to the top corner.
I asked him how he felt and he told me, “Before I started I felt like I was at 40% and after a week I’m at 70%.”So why was static stretching such an epic fail?
Let’s take a look at the anatomy and movement patterns involved in tennis elbow to understand why the 4 step process I’ll provide is a much better fix.
What Causes Tennis Elbow
To start, let’s find your lateral epicondyle. Supinate your forearm, or turn it so your palm is facing up.
If you press your fingers onto the outside of your elbow, you’ll feel a bony prominence – that’s your lateral epicondyle.
This little bony bump is a part of your humerus, or upper arm bone, and is the spot where a lot of your extensor muscles originate. These muscles work to extend your wrist.
Image by www.orthobullets.com
Some of your supinator muscles also originate at the lateral epicondyle, which help to supinate your forearm.
So what it is about tennis that aggravates this region so easily it’s become synonymous with this injury?
There are a whole group of movements and motions that can contribute to pain in the area. Let’s say you are playing tennis and doing a forehand swing.
Image by www.myactivesg.com
There is a LOT of force generated as you swing the racquet forward to hit the ball. And when you hit the ball and generate this force, you do so in an extended wrist position.
All that generated force runs right up your contracted, shortened wrist and forearm extensor muscles and lands around the lateral epicondyle of the elbow.
Overtime and with lots of repetition, this can cause actual damage to the soft tissues in the area. Which in turn can cause you pain.
Similar issues arise in backhand swings as well. When you’re backhanding a tennis swing, your extensors are again completely fired up as you contact the ball.
Now think about serving.
Image by tennisnerd.net
Not only do you have a bit of that same wrist extension at the moment of impact, you’re whipping your forearm around as you swing up and over to smack the ball. You move your arm into a pronated position as you do this, meaning your supinator muscles are being stretched and elongated.
With enough repetition, this high-force, eccentric stretch of the muscles can cause damage on those supinator muscles originating on the lateral epicondyle, too.
Now think about how many times you swing or serve the ball in a single match…
Like I mentioned, it’s not just tennis that can cause the pain.
When sports or activities require movements that create similar forces through the wrist, forearm, and elbow (i.e., wrist extension with impact forces and aggressive, high velocity pronation) this problem can develop.
Hockey, like I mentioned above, with stickhandling and shooting, can definitely do it.
A non-sport example is a car mechanic who use wrenches all day also have the tendency to develop tennis elbow.
How to Heal Tennis Elbow in 4 Steps
Now that we understand the condition a little bit more, we can learn how to heal tennis elbow effectively. The first step is to make sure that lateral epicondylitis is really what you’re dealing with.
Step 1: Test if You Have It
There are a couple of simple tests to help determine whether the pain you’re dealing with is tennis elbow.
Tennis Elbow Test #1: Maudsley’s Test
- Start with your elbow bent by your side and palm facing the ground
- Straighten and spread the fingers apart
- Use one finger from your other hand to push down on your middle finger and resist the push
If pressing causes pain in the lateral epicondyle region, it’s a positive sign for tennis elbow. This also suggests that a specific extensor muscle – extensor digitorum – is involved.
Here’s another test that gives a little more info…
Tennis Elbow Test #2: Cozen’s Test
- Start with your elbow bent by your side and palm facing the ground
- Make a fist with your hand then extend and radially deviate (side bend thumb towards your body)
- Use your other hand to push down and away from yourself on the first knuckle of the fist
If this causes pain on the outside of your elbow, tennis elbow is probably behind your pain, and specifically your extensor carpi radialis longus and brevis muscles are likely involved.
If you tested positive on one or both of these tests, continue on to the next step because tennis elbow is your problem.
Step 2: Acute Stage
Let’s say you’re playing tennis and feeling fine one day, but the next day you feel pain around your lateral epicondyle. You are in the acute stage and need to relax and rest up.
Use ice on the area (for no more than 15 minutes at a time) and take it easy for 24-72 hours depending on how severe the pain is.
You can try a elbow compression sleeve, which can help encourage healing by increasing circulation to the area.
You should also consider anti-inflammatory supplements at this time. Omega-3’s, collagen, and turmeric are all great for decreasing inflammation. This turmeric supplement from PuraThrive is a great option.
Step 3: Post-Acute Stage
Once that acute pain starts to ease, you’ll want to work in a few new strategies while continuing use of those anti-inflammatory supplements. This post-acute stage can last anywhere from 7-14 days.
Try self-massage of the extensor muscles running along the outside of your forearm. You should also spend some time massaging the tissues around your lateral epicondyle.
This technique will further encourage blood flow to the area, a process that brings nutrition and aids in healing.
Continue to take it easy and avoid majorly provoking your pain. If you must do activities that flare up the area, you can try getting some kinesio taping done to help support your muscles and tendons.
Taping has been found to help ease pain and improve grip in people with lateral epicondylitis . So if you can’t give these muscles a break, be sure to at least give them some support!
It’s also time to start working in some tennis elbow exercises that go beyond the stretching my buddy Matt experimented with.
It’s important to restore full range of motion to the joints and build both strength and muscular balance, otherwise, you’ll just run into another injury down the road.
Step 4: Return to Sport & Work
Once you’re about 2 weeks out from your injury, you can start to ramp things up and rebuild your strength.
You should also start to progress your exercises to include multi-joint movements that rely on larger portions of your body’s kinetic chain to work together (think overhead presses or pull ups).
Be patient, but start to slowly increase the speed, power, and intensity demands you are putting on your forearm muscles as you work them over weeks.
Doing so will help you build up your resistance to injury so you can get back to doing your thing.
We want to make sure we get this lateral epicondylitis thing wrapped up and gone – not let it linger so it can come back in 2 months.
Following the 4 steps I’ve provided here could be enough to get you completely free of tennis elbow pain* in a matter of weeks. And that’s great news.
But, it’s important to remember that these issues in your body don’t appear in a vacuum.
An issue like lateral epicondylitis might just be a symptom of another issue or deficiency elsewhere in your body (likely the upper limb). Tennis elbow today might be a warning sign of shoulder pain tomorrow.
It’s important to consider your kinetic chain as a whole and not only address specific issues when they arise, but make sure you’re improving form and function on a bigger scale.
In other words – we need to consider not just how to heal tennis elbow, but how to improve the function of your ENTIRE upper body so that future injuries are less likely to occur.
This is why I’ve created my newest course, Upper Limb Control.
It’s designed to restore full function (that means mobility AND strength) of the wrist, hands, fingers and elbows*. There are a TON of muscles in this area that all need to be activated and strengthened so you can keep active.
*Although the information shared on PrecisionMovement.coach is based on a well-researched, scientific approach towards exercise and movement, every person is unique and individual results may vary.
Don’t wait for an injury to show up, be proactive and get everything working properly so you don’t have to suffer the frustration of having to sit out on the sidelines.
This article was reviewed and updated on August 26, 2021 by our Chief Medical Officer, Dr. Erin Boynton, MD, FRCS to include new research and information on latest surgical developments. Read more about Dr. B here.