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What is Tennis Elbow?

Tennis elbow is one of the most common upper body orthopedic injuries, especially when it becomes warmer outside and people pick up a new recreational activity. Although the name implies that this condition only occurs in tennis players, this is not always true! It is more common in tennis or racquet sports athletes, but it can also occur in anyone who performs repetitive arm motions through their job, recreational, or home activities.

Tennis elbow, or lateral epicondylitis, refers to pain on the outside (lateral) part of your elbow, often made worse with increased activity. The lateral epicondyle is the end of the humerus bone (upper arm bone), and your forearm muscles that extend your wrist and fingers (extensor muscles) attach to this bone. The tendon of these forearm muscles, called the common extensor tendon, can become inflamed with overuse. If left untreated, the pain can become worse over time.

Lateral Epicondylitis is the inflammation or irritation of the common extensor tendon, causing pain in the forearm or outside part of the elbow.

What Causes Tennis Elbow?


Typically, lateral epicondylitis is caused by repetitive overuse and overstretching of your forearm extensor muscles. The most common muscle affected is the extensor carpi radialis brevis (ECRB). When the forearm extensor muscles become overworked, they can develop trigger points or knots in the muscle. These knots are due to the build up of lactic acid and lack of stretching post activity. Trigger points can refer pain and cause weakness in the muscle. The more knots that develop and the tighter the extensor muscles become, the more that the tendon can become irritated.

This excess strain can result in tiny tears in the tendon where it attaches to the lateral epicondyle. This causes acute inflammation in the tendon, often leading to an increase in pain.

If left untreated, lateral epicondylitis can become a chronic condition and get worse over time. Due to the overuse, scar tissue can develop and thicken the tendon. At this stage, there are typically no inflammatory cells, and we call this condition Lateral Epicondylalgia.

Other Causes

  • Starting a new activity¬†
    • Rock climbing, tennis, water sports, CrossFit
  • Going too hard too fast
  • Improper technique or equipment while playing racquet sports
  • Prolonged use of hand or wrist
  • Typing or mousework at a computer
  • Painters, plumbers, machine operators
  • Excessive gripping or twisting activities
  • Lifting heavy objects
  • Forceful activities
  • Unknown
  • The pain can begin randomly, and we call this insidious onset

Signs and Symptoms of Tennis Elbow

  • Usually starts out gradually and become worse over time
  • Pain and tenderness on the outside part of your elbow
  • Pain may radiate into your forearm or wrist
  • Pain or weakness with gripping activities
  • Weakness or cramping in the forearm with recreational activities
  • Difficulty with opening a jar
  • Pain when lifting a heavy object or child
  • Stiffness in the elbow

Tips for managing pain if you think you may have lateral epicondylitis

  • Modify your activities
    • This includes taking a rest break from tennis, lifting, or any other activity that is painful
    • Remember, tendons take time to heal! Taking a few weeks off after the pain begins is typically recommended for a tendinitis injury
  • Try ice or anti-inflammatory medications
  • Perform stretches for your forearm, especially before and after increased activity
    • You can watch our video where we instruct on these specific exercises.
  • Massage your forearm muscles
    • You can use your opposite hand to massage the muscles on the back of your forearm
    • You could also use a handheld massage gun to gently loosen these muscles
  • Applying a compressive brace on your forearm
    • This helps release the amount of tension on the tendon on your lateral epicondyle

What happens if my pain doesn’t improve?

Physical Therapy for Tennis Elbow

If your pain lasts longer than a few weeks and doesn’t seem to be improving, it may be time to try Physical Therapy for tennis elbow!

Lateral epicondylitis is not always a one size fits all condition. There can be other factors contributing to your pain including numbness/tingling in the forearm, pain on the inside part of your elbow (medial epicondylitis/golfer’s elbow), and possibly shoulder and/or wrist pain. Our Physical Therapists will evaluate your elbow and determine the best plan and treatment approach specifically for you.

Don’t forget, you can refer yourself to Physical Therapy!

What Can I Expect during a PT Session? 

  • Pain Management: Your PT will help determine which movements cause your pain and help you avoid them in the beginning of treatment to decrease your symptoms.
  • Range of Motion and Stretching Exercises: Often your wrist and elbow motion becomes limited due to pain. Your PT will prescribe you stretches for the muscles around your elbow to help regain your mobility and allow you to move with less pain.
  • Strengthening Exercises: The forearm extensors and flexor muscles are typically weakened which makes it challenging to perform your daily activities such as gripping, typing, and lifting. Your PT will give you strengthening exercises for your weakened muscles in the forearm and hand to reduce the strain in your elbow.
  • Manual Therapy: Hands-on treatment also assists in loosening your tight forearm muscles and improving the stiffness in your elbow joint. Dry needling is also an effective approach for relieving lateral elbow pain!

You will receive a home exercise program that was designed specifically for you, and your PT will regularly check in with your exercises to make sure they are still beneficial for you. After you graduate from PT, these exercises will be your tool to help prevent future episodes of elbow pain.


Lateral elbow pain is very common, and our physical therapists are specifically trained to help relieve your symptoms. Regardless if you have had elbow pain for years or just started experiencing this pain recently, we can assist in alleviating your pain!

If you’re experiencing pain in your elbow, please contact us by using the form below and we can get you scheduled with one of our dedicated physical therapists!

Call To Book An Appointment!