Tennis Elbow

December 11, 2014

Experiencing Pain

Can you recall the last time your body told you there’s a problem? Too often, the pain we experience starts as a dull ache but increases into something much worse. And sadly, these aches and pains seem to happen during the things we love or at least have to do. As with all things, overuse and at times poor mechanics can lead to issues.

Tennis elbow is one such instance.

What Is Tennis Elbow?

Tennis elbow is the term coined for any soreness or pain that occurs on the outside (lateral) of the upper arm near the elbow. In technical terms, it’s called lateral epicondylitis. Lateral because it is on the outside of the elbow. Epicondylitis because the pain is typically at the bony prominence on the lateral elbow (epicondyle) and it is an inflammatory problem (itis).

Interestingly, the root of the term, tennis elbow, comes from over 100 years ago, when it was mentioned in an article as “lawn tennis arm.” The observation was about the frequent use of a backstroke or backhand shot causing a strain near the elbow.

The issue arises with frequent use of an arm, especially using the forearm extensor muscles. This can happen in sports but also in other occupations with consistent use of your arms, like painters and construction workers. All racket sports and occupations that require the manipulation of tools like hammers require the holder of the implement to grip with the wrist and hand while using the elbow and arm to move the tool. This creates stress on two muscles that run from the elbow to the wrist: the extensor carpi radialis longus and brevis.

All tissues in the body have a certain zone or threshold of tolerance for the stressors they encounter. Muscles and tendons create forces that create tension and pull on their attachment sites. The tissue, if loaded in this zone, stays healthy and pain free. Tennis elbow pain occurs when the abilities of the tissue are stressed outside the threshold.

Tennis elbow becomes an issue when frequent stresses on the tendons that attach your forearm muscle near the elbow begin to fray or tear, causing irritation and pain near your elbow.

Trauma in the elbow leads to firing of pain fibers, reflexive tightening of the muscles around the elbow, and possible changes in blood flow, which reduces the oxygen supply to the muscles.

Abnormal cervical posture and abnormal positioning of the scapula can later the position and motion of the arm. This places the shoulder, elbow, and hand in a less efficient starting position for functional tasks.

Motion restrictions and pathology of the lower cervical spine can cause an elevation in the resting tone of the musculature around the elbow. The elbow gets its nerve supply from the nerves coming from cervical spine levels C6 to C8. Any irritation to these nerves can alter the function of the forearm muscles.

How Can You Tell If You Have Tennis Elbow?

The main indicator will be pain. It will begin subtly but the pain will gradually worsen as the small tears in the tendon increase. Additionally, you will feel pain during specific motions such as grasping an object or twisting your arm like when you use a screwdriver. Often pain is created by lifting plates and cups or pulling a milk carton out of the refrigerator. If the pain radiates from the elbow down your arm, you might have tennis elbow. Typically, the pain is easily identified as coming from the lateral side of the elbow.

How to Treat Tennis Elbow?

A clear first step is to avoid the actions that are causing pain in order to rest your arm. Give your arm a break for a couple weeks from the tasks or activities that make it hurt. Ice massage for 10-15 minutes around the elbow will help reduce pain and inflammation. If the pain comes from an obvious source such as a sport you play or a job you do, the next step is to consider the best way to move. Is there a better way to complete your sporting action that puts less stress on your arm? Is there a better way to paint or build that gives optimal movement to the arm? Those actions will bring life to your work rather than continue to degrade your quality of life.

There are specific exercises you work with your physical therapist to achieve that will help strength your arm. The exact type of exercise, repetitions, and loads are based on the pain, the stage of healing (acute, remodeling, chronic), and treatment goals. The basic components of and initial program are to normalize joint motion, provide the right stimulus to help the tissue heal, normalize the muscle firing patterns, restore normal function and activities, and to reduce pain.

For starters, manual joint mobilization is a big key. Having full range of motion is the key to any healthy joint.

Resisted exercises are employed to first inhibit pain and provide increased circulation to the region and at last to improve the tissue tolerance as a means of preventing re-injury.

Postural exercises are initiated when appropriate to improve shoulder, elbow and hand position. Optimal positioning creates more optimal motion.

The neck region is evaluated and exercises are employed to optimize cervical motion.


Tennis elbow stints work by compressing the upper forearm and absorbing the forces, which are transmitted through the soft tissues to the point of pain on the outside of the elbow. They also change the angle at which the tendon works at the elbow, which changes the forces, which are applied to the tendon attachment allowing the injured area time to recover.

Cock-up wrist splints can also be used. These splints reduce the tension on the musculature by shortening the muscle tendon unit at the wrist. A reduction in tension helps the tissue heal.

Experiencing pain in your arm and thinking it might be tennis elbow? Stop by Pro-Motion and we’d be glad to evaluate it!

Photo credit: Aiky Ratsimanohatra via Flickr/Creative Commons

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