Tennis Elbow Treatment and Prevention
A Guide to the Treatment and Prevention of Tennis Elbow and Elbow Injury.
by Brad Walker | First Published August 21, 2010 | Updated February 24, 2021
Tennis Elbow, while extremely common and very painful, is one of the most diagnosed conditions in the western world.
There are several conditions that affect the elbow area. The three most common conditions are lateral epicondylitis (tennis elbow), medial epicondylitis (golfers elbow), and medial collateral ligament sprain (throwers elbow).
The first two conditions are similar, however the first effects the outside of the elbow (lateral), and the second effects the inside of the elbow (medial). For this article, we’ll focus on lateral epicondylitis, or as it is more commonly known, tennis elbow.
What is Tennis Elbow?
Tennis elbow is a chronic injury that occurs when there is stress, strain or inflammation to the muscles, tendons or ligaments around the elbow joint and forearm. Small tears, called micro tears, form in the tendons and muscles that control the movement of the forearm, which can cause a restriction of movement, inflammation and pain.
If left untreated, this can lead to the formation of scar tissue and calcium deposits, which can put so much pressure on the muscles and nerves that they cut off the blood flow and pinch the nerves responsible for controlling the muscles in the forearm.
Anatomy of the Elbow
To get a better understanding of what tennis elbow is, it’s important to have a general understanding of the structure of the elbow joint, and how the muscles, tendons, ligaments and bones help the elbow joint to function.
As you can see from the diagram below, there are many muscles and tendons that make up the elbow joint and forearm. There are also three bones that make up the elbow joint; the Humerus, the Ulna and the Radius.
What Causes Tennis Elbow?
By far the most common cause of tennis elbow is overuse. Any action that places a repetitive and prolonged strain on the forearm muscles, coupled with inadequate rest, will strain and overwork those muscles and associated soft tissues.
There are also many other causes, like a direct injury, such as a bump or fall onto the elbow. Poor technique will contribute to the condition, such as using ill-fitted equipment, like tennis racquets, golf clubs, work tools, etc. While poor levels of general fitness and conditioning will also contribute.
Signs and Symptoms
Pain is the most common and obvious symptom associated with tennis elbow. Pain is most often experienced on the outside of the upper forearm, but can also be experienced anywhere from the elbow joint to the wrist.
Weakness, stiffness and a general restriction of movement are also quite common in sufferers of tennis elbow. Even tingling and numbness can be experienced.
Tennis Elbow Injury Treatment
If you do suffer from tennis elbow, it’s important that correct first aid principles are applied immediately. Tennis elbow is a soft tissue injury of the muscles and tendons around the elbow joint, and therefore should be treated like any other soft tissue injury. The RICER regimen explains the correct treatment for all soft tissue injuries. RICER stands for Rest, Ice, Compression, Elevation, and then obtaining a Referral from a qualified sports doctor or physical therapist.
Immediately following an injury, or at the onset of pain…
- Rest the injured limb, apply ice to the affected area, apply a compression bandage and elevate the limb if possible. This initial treatment needs to continue for at least 48 to 72 hours. This is the most critical time for the injured area; correct treatment now can mean the difference between a minor short-term injury or a permanent, re-occurring, debilitating injury.
- After the first 72 hours obtain a referral from a qualified professional and start a comprehensive rehabilitation program. This should include rehabilitation activities such as heat, massage, ultra-sound and TENS (transcutaneous electrical nerve stimulation).
- Once most of the pain has gone start conditioning the muscles around the elbow with balance, strength, agility and flexibility exercises and drills.
Preventing Tennis Elbow
Mark my words, “Prevention is much better than Cure.” Anything you can do to prevent an injury from occurring is worth it. Preventing a tennis elbow injury comes down to the conditioning of the muscles and tendons around the elbow, which ultimately involves improving both the strength and flexibility of the muscles and tendons.
There are several preventative techniques that will help to prevent tennis elbow, including bracing and strapping, modifying equipment, taking extended rests, and even learning new routines for repetitive activities. However, don’t forget common injury prevention strategies like, warming up properly and using a bit of old-fashioned common-sense. Even if you don’t have a tennis elbow injury now, the following suggestions will be helpful.
- Completely rehabilitate a tennis elbow injury before returning to activity.
- Always include a general warm up, followed by an activity specific warm up before training and especially competition.
- Cool down thoroughly after training and competition.
- Include an eccentric strength training program (muscle contraction and lengthening at the same time) for the shoulder and arm muscles. Click here to see strengthening exercises for tennis elbow.
- Practice balance, agility, and proprioception drills to improve shoulder and elbow stability.
- Reduce the frequency of, or stop completely, any activities that aggravate the elbow.
- Rest in between training sessions or competition allows the body to heal minor injuries and repair the muscles to be ready for the next round of activity.
The best preventative measures however, involve a consistent program of increasing the strength and flexibility of the shoulder and arm muscles. Increasing flexibility will contribute greatly to the ability of the shoulder and arm muscles to resist strains and injury. Get videos and photos of stretches for tennis here.
Research and References
- Bahr, R. Maehlum, S. (2004) Clinical Guide to Sports Injuries, 1st Edition (ISBN: 978-0736041171)
- Beachle, T. Earle, R. (2008). Essentials of Strength Training and Conditioning, 3rd Edition (ISBN: 978-0736058032)
- Bisset, L. Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia. Journal of Physiotherapy, 61(4): 174-181.
- Chesterton, l. Mallen, C. Hay, E. (2011). Management of tennis elbow. Open Access Journal of Sports Medicine, 2: 53–59.
- Page, P. (2010). A new exercise for tennis elbow that works. North American Journal of Sports Physical Therapy, 5(3): 189–193.
- Tortora, G. Derrickson, B. (2009) Principles of Anatomy and Physiology, 14th Edition (ISBN: 978-1118866096)
- Vaquero-Picado, A. Barco, R. Antuña, S.. (2016). Lateral epicondylitis of the elbow. EFORT Open Reviews, 1(11): 391–397.
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Wikipedia contributors. (2021, February 24). Tennis Elbow, In Wikipedia, The Free Encyclopedia.
About the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.
Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.