Tennis Elbow? But I don't play Tennis…
Lateral Epicondyalgia, AKA Tennis Elbow, (formerly known as Lateral Epicondylitis) is a disorder involving the structures of the elbow and forearm. Though it is called Tennis Elbow, the majority of people who develop it do so through non-tennis activities. The most common causes tend to be work-related activities, such as typing on a keyboard that is not positioned well or having to repetitively lift objects with certain hand or arm positions. Tennis Elbow is characterized by pain and discomfort on the outside of the elbow, occasionally radiating into the forearm or side of the arm. Generally, bringing your wrist backwards towards your forearm against resistance, gripping, and lifting certain objects will worsen the pain.
Fun Fact: Even though playing tennis is not the most common way to develop Lateral Epicondyalgia, it is named as such due to amateur tennis players developing it by performing repetitive backhand swings, while not having the proper forearm strength to handle the high number of repetitions.
So what exactly causes it?
There are multiple factors that can lead to developing Tennis Elbow, but the majority of them are related to bio-mechanical issues. With weakness in your forearm or shoulder stabilizers, or restricted range of motion in your wrist, elbow, or shoulder, the resulting compensations could lead you on a path to Tennis Elbow. The compensations are normally the back of the forearm muscles (forearm extensors) being overworked. This causes excessive and repetitive stresses on the tendons and bone (lateral epicondyle), which, if consistent enough, will cause pain.
How can I prevent it from developing?
As mentioned, this is a disorder caused by compensation of the forearm extensors. Thus, by making sure you have adequate strength and range of motion in your wrist and shoulder, these muscles will not have to pick up so much of the slack. From a clinical perspective, the majority of Tennis Elbow patients we have seen have restricted shoulder internal rotation and wrist extension. Working on both those areas, combined with stretching the back of the forearm are great preventative approaches. This can be accomplished through physical therapy modalities, orthopedic testing, neuromuscular testing, and physiotherapy rehabilitation.
I am not sure if it is Tennis Elbow, could it be something else?
Yes, it could be. There are multiple disorders that present with similar symptoms as Tennis elbow. Medial epicondylalgia, Tricep tendonitis, Olecranon Bursitis, and Posterior Impingement Syndrome all can be mistaken for Tennis Elbow. These conditions can all have similar symptoms, so it's important to have a doctor render an accurate diagnosis, so he or she can recommend the appropriate care approach to resolve it.
Frequently Asked Questions
Common questions about tennis elbow.
What is tennis elbow (lateral epicondylalgia)?
Tennis elbow, clinically lateral epicondylitis or lateral epicondylalgia, is an overuse injury of the common extensor tendon where it attaches at the outside of the elbow, mainly the extensor carpi radialis brevis (ECRB). Despite the "-itis" suffix, it is no longer considered an inflammatory condition; tissue studies show a degenerative process rather than traditional inflammation. It affects roughly 1% to 3% of people in the United States each year.
What are the symptoms of tennis elbow?
Tennis elbow usually causes pain or burning on the outer part of the elbow and a weakened grip, and pain can radiate from the outside of the elbow into the forearm and wrist. Tenderness is usually felt right over the lateral epicondyle (the bony bump on the outside of the elbow). Symptoms are often worse with forearm activity such as gripping a racquet, turning a wrench, or shaking hands, and typically build gradually over weeks to months.
What causes tennis elbow, and who is most at risk?
Tennis elbow is caused by repetitive strain from activities involving loaded, repeated gripping or wrist extension, which leads to microscopic tearing and degeneration of the forearm extensor tendon at the outside of the elbow. Most people who develop it are between 30 and 50 years old. Reported risk factors include smoking, obesity, repetitive movement for at least two hours a day, and handling heavy loads; despite the name, tennis players make up only about 10% of cases.
How long does tennis elbow take to heal?
Most cases of tennis elbow improve with nonsurgical care, though recovery is often slow. Many people have pain relief within about 12 months of conservative treatment, and roughly 80% to 90% recover spontaneously within one to two years. Cleveland Clinic notes it usually takes around six months to recover, with some people needing up to 18 months. If symptoms do not respond after 6 to 12 months of nonsurgical treatment, a doctor may consider surgery.
How is tennis elbow treated?
Most people improve with nonsurgical treatment; about 80% to 95% have success without surgery. First-line care includes rest and activity modification, ice, and over-the-counter pain relievers, often with a forearm counterforce strap or brace. Physical therapy commonly uses forearm stretching and strengthening, progressing to eccentric strengthening, plus hands-on (manual) techniques. Steroid injections may relieve symptoms but are used sparingly. Surgery is generally considered only after 6 to 12 months of nonsurgical care.
How can I prevent tennis elbow or keep it from coming back?
General prevention advice includes staying fit, using proper technique in your sport or job, and using well-designed equipment. For racquet sports, stiffer and looser-strung racquets can reduce stress on the forearm, and switching from an oversized to a smaller racquet head may help prevent symptoms from recurring. Recurrence is more likely if the tendon was not given time to fully heal or if forearm strength and joint mobility were not fully restored.
When should I see a clinician about elbow pain?
See a healthcare provider if your elbow is hard to move, swollen, or discolored; if pain is severe enough to interfere with your usual activities or your sleep; or if the pain lasts more than a week. Getting an accurate diagnosis matters because several other conditions can mimic tennis elbow. Most people recover with a few months of nonsurgical treatment, and surgery is generally considered only if severe symptoms persist after several months of conservative care.
The information on this website is general education about musculoskeletal and movement-related conditions. It is not medical advice or a diagnosis, and it cannot tell you what is causing your symptoms. Reading it is not a substitute for an in-person evaluation, and booking a visit does not confirm that your condition is right for our care until a provider has examined you. This information cannot identify every condition, and some urgent problems can feel like musculoskeletal pain. If your symptoms are severe or getting worse, or you are unsure how urgent they are, contact your physician, call 911, or go to the nearest emergency room. When in doubt, seek emergency care.
