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  • Writer's pictureDavid Wilderman

What You Need to Know About Tennis Elbow

Tennis elbow is an extremely painful and often debilitating condition caused by overuse of the extensor muscles in your arm and forearm. It is often most painful where those extensor muscle tendons attach to the bone (lateral epicondyle) on the outside (lateral) aspect of the elbow. Interestingly, the majority of individuals who suffer from tennis elbow did not get it from playing tennis! It is estimated that less than 5% of all cases of tennis elbow occur in people who play tennis. Tennis elbow can happen to anyone who uses repetitive motions of their elbow, wrist, and hand for their sport, job, or activity.

The muscles you use to grip , twist, and carry things with your hand all attach to the lateral epicondyle (the rounded protuberance of bone on the outside of the elbow) on the outside (lateral) aspect of the elbow. That is why movements of the wrist or hand can actually cause pain in the elbow. Overuse of the wrist and hand, such as when using a computer or operating machinery, can lead to tennis elbow (as can playing tennis with an improper grip or technique). It can occur in adults, children, athletes, and non-athletes. It is more prevalent in men than women, and most commonly is seen in individuals between the ages of 30 and 50.


Symptoms of tennis elbow generally occur gradually over time (weeks or months) due to repetitive or forceful use of the wrist, hand, or elbow. However, onset can also occur suddenly as the result of excessive use of the wrist and hand for activities that require force, such as lifting, pulling, or twisting (such as pulling a lawnmower cord). Symptoms may include:

  • Pain that radiates into your forearm and wrist

  • Difficulty with gripping activities

  • Difficulty doing common activities such as holding a cup of coffee or turning a doorknob

  • Increased pain with lifting objects (such as a gallon of milk), opening a jar, or gripping something tightly, such as a fork or knife

  • Stiffness in the elbow


Since tennis elbow occurs due to repetitive motions, other muscles and joints in this area of the body can also be affected as well. Your Physical Therapist should perform a thorough evaluation of your elbow, wrist, hand, and shoulder to determine if other areas of your body are contributing to your pain. Special manual tests should be performed by your Physical Therapist to assist in a proper diagnosis as well as to detect other conditions such as muscle weakness that might have caused the problem in the first place. Rarely is an X-ray needed in order to diagnose tennis elbow.


For the first 24 to 48 hours after acute onset of pain, treatment should include”

  • Resting the arm and avoiding certain activities and modifying the way you perform other ones

  • Using ice 10-15 every other hour

  • Using an Ace wrap or tennis elbow strap to take pressure off of the painful muscles/tendons

Your Physical Therapist can design a specific individualized treatment program to help speed your recovery. Specific treatments to include manual therapy and specific exercises should also be used. If the condition is acute (one that has occurred within the past several weeks) it is critical that you treat as soon as possible. If left untreated, tennis elbow can become a chronic condition and last for months, even years. This will certainly occur if treatment is solely focused on relieving pain and treating the symptoms rather than addressing the underlying cause (often muscle weakness and improper form).

Improve Mobility–Manual therapy should be performed by your Physical Therapist to allow your muscles and joints to move more freely with less pain.

Increase Strength–One of the main causes of tennis elbow is insufficient muscle strength. This can not only be from weakness in the muscles of the forearm and wrist, but also in our postural muscles that support our spine, including our core musculature. It may actually be necessary to improve your overall fitness level to help manage your tennis elbow. Several types of exercises may be prescribed by your Physical Therapist, including:

  • Passive exercises, where your elbow and wrist are moved without the use of your muscles.

  • Active exercises (once symptoms improve), where you move your elbow and wrist without assistance.

  • Resistance exercises, once muscles have become stronger and pain has diminished, can be added to include weights and resistance bands.

Proper Use Of Muscles–Your muscles will need to be retrained so you use them properly. Simple things such as lifting a grocery bag will need to incorporate a contraction of the muscles around your shoulder blade and trunk to provide support for your arm muscles (your Physical Therapist can instruct you). Tips such as this will allow you to lessen the strain to the injured muscles and help you return to your normal activities while avoiding re-injury.

Return To Normal Activities–Your Physical Therapist can teach you how to stay active by modifying your daily activities to avoid pain and prevent recurrence of your injury. This will often involve making changes at home, at work, or on the playing field. This can include modifications to your worksite, your computer setup, your kitchen devices, your sports equipment, and even your tools used for yard work. It is important and emphasized that you take frequent stretch breaks to allow your muscles some rest from repetitive motions as well as sitting or standing in the same position. If tennis is, indeed, the cause of your tennis elbow, your Physical Therapist can determine if the problem stems from overtraining or whether the weight of the racquet or grip needs to be altered or adjusted. For others, improper form, poor overall fitness, or lack of strength in supporting the core muscles of the shoulder blade and trunk may be the problem.


Absolutely! This would require staying fit, using proper technique in your sport, activity, or job, as well as using equipment that is designed and appropriate for your body type and level of activity. Your Physical Therapist can show you how. If you had tennis elbow in the past, you may certainly be at risk for re-injury if the tendons did not have time to heal completely or if your joint mobility and muscle strength were not fully restored. Returning to sports or activities too soon before you have fully recovered can result in persistent elbow and forearm pain that can easily or frequently be re-injured. Your Physical Therapist can determine when you are ready to return to your sport, job, or activity and can help make sure that your elbow, forearm, and wrist and strong and ready for your challenges.

If you or someone you know is experiencing the signs and symptoms of tennis elbow don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at to schedule your FREE 30 minute consultation to see how Physical Therapy can help you. Don’t delay–schedule now!

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