Tennis Elbow - What it is, symptoms, prevention and treatment

Did you know that up to half of tennis players develop tennis elbow at some point in their lives? This is a common overuse injury that causes pain, tenderness and discomfort in the elbow and forearm.

While tennis is generally a low risk sport, it’s important to be aware of issues like tennis elbow, which can affect your ability to play.

By knowing about tennis elbow symptoms, its causes and treatment, you might be able to address any issues early, and play your sport more safely.

What is tennis elbow?

It’s generally believed that tennis elbow is a kind of overuse injury that is caused by repetitive strain on the tendons and muscles in your forearm (tendons are fibres that attach muscle to bone). Its medical name is lateral epicondylitis. While it seems likely that tennis elbow is closely linked to overuse, the exact cause remains uncertain.

When you repeatedly swing a tennis racket and hit a ball in the backhand position, this motion appears to create microscopic tears in the tendon and muscles. If they don’t get enough time to repair, this damage may not heal properly, and over time this can develop into discomfort and pain.

Despite the name, tennis elbow isn’t only caused by playing tennis. Any activity that involves repeated gripping, wrist extension and forearm supination (when your palm and forearm face up) can cause tennis elbow. Sports like squash, badminton, padel and even golf may cause it. People working in professions where repetitive movement is required, including painters and decorators, plumbers, cooks, and carpenters, may also develop tennis elbow symptoms.

Causes of tennis elbow

Assuming you play tennis or another racket sport, there are likely to be a few factors that contribute to developing tennis elbow:

• It appears to be more common among people who play often and for longer sessions (i.e. two hours or more per day).
• Middle aged players (40+) tend to experience it more.
• Hitting heavy or wet tennis balls increases the risk.
• Having incorrect backhand technique (in one study, 90% of tennis players who improved their backhand stroke form recovered from tennis elbow).
• String tension - lower string tensions have been found to reduce the force transmitted to the elbow.
• Some experts believe that tennis elbow is linked to a lack of strength in the shoulders.

Read more: The perfect tennis warm up

Symptoms and diagnosis of tennis elbow pain

If you believe you might have developed tennis elbow, it’s important to book an appointment with a medical professional. Tennis elbow shares some symptoms in common with other injuries, so it’s best to get it looked at by a doctor or a qualified physio.

There are several common tennis elbow symptoms, including:

• Pain on the outside of your elbow: The pain may range from mild to severe. You will feel discomfort when you move your arm, and it may interrupt your sleep.
• Tenderness in the elbow: The elbow may feel tender to the touch, and you may notice swelling.
• Pain when moving your arm: You may notice the pain gets worse when lifting things, bending your arm, gripping, moving your wrist, straightening your arm, or extending your fingers.
• Gradual onset: Often, you may not be able to pinpoint exactly when the symptoms began.

Tennis elbow diagnosis

If you notice you have symptoms of tennis elbow, book an appointment with your doctor or a physio. The main methods they will use to diagnose the issue are:

• Taking a history: They will ask about how long the pain has lasted, frequency you play tennis, and ask for a description of the pain.
• Physical examination: Your doctor may choose to do a physical inspection of your elbow - including getting you to move the arm in certain ways or touching specific areas.

Sometimes, doctors may use more advanced imaging technologies when investigating tennis elbow (such as MRI or X-ray). These are usually only used if the initial treatment hasn’t solved the problem, and may help to find out if there’s another cause.

How long does tennis elbow last?

It really depends on the severity of your condition. For many people, tennis elbow symptoms will disappear in just a few weeks. For others, it can continue for months, or even years.

Treating tennis elbow pain

Depending on the severity of your pain and your personal needs, there are a variety of treatments for tennis elbow. For most tennis players, the ‘conservative’ treatments we describe below are more than enough. But for people with severe pain, long-lasting tennis elbow, or for people who play tennis professionally, more advanced treatments are sometimes used.

’Conservative’ tennis elbow treatments

In most cases, tennis elbow is treated using the following methods:

Rest

Stop playing tennis and avoid any activities which exacerbate the pain. According to the Chartered Society of Physiotherapy, the pain should begin to ease within two weeks. Every case is different, but it is likely to take at least a few months before it’s safe for you to begin playing tennis again.

Alternate ice and heat

Applying ice to a sore elbow narrows veins and reduces inflammation in sore areas (simply wrap a bag of ice cubes in a tea towel and apply it to your elbow). Then, use heat (such as from a hot water bottle) to encourage nutrient-rich blood to come to the area and help repair damage.

Over-the-counter medication

Common over-the-counter medications such as paracetamol or ibuprofen can help relieve the pain temporarily.

Braces and straps

Some people find that wearing an elbow brace (or similar straps) stops them from moving their arms in certain ways that cause tennis elbow pain during recovery.

Stretching exercises

Your doctor or physio can advise you on the best stretching exercises for tennis elbow. One stretch that may help is to:

• Extend the affected arm in front of you
• Let the wrist dangle with the palm facing down
• Use the other hand to push the extended hand down and towards your body
• Hold the stretch for 30 seconds then release
• Repeat three times

Advanced tennis elbow treatments

For most people, tennis elbow will go away by itself with adequate rest. However, for severe cases, more advanced treatments might be necessary.

If you’ve tried the ‘conservative’ treatments above without success, go back to your doctor. They may recommend more advanced methods, including:

• Injections: Injections in the elbow with platelet-rich plasma or corticosteroids may be an option for managing tennis elbow pain (although there’s some uncertainty about the effectiveness of these methods).
• Ultrasound: Ultrasound is sometimes used to treat tennis elbow. Sending ultrasound waves towards the painful area appears to encourage repair. But again, there’s some uncertainty about how effective this is.
• Surgery: For severe tennis elbow pain, surgery may be a last resort. A surgeon may remove the damaged part of the tendon, then reattach the health tendon to the bone.

Preventing tennis elbow

Prevention of tennis elbow is, of course, better than cure. So, whether you’ve had tennis elbow before or simply want to reduce your chances of developing it in the first place, the following tips can help.

Strengthening exercises for tennis elbow

The following exercises can help strengthen the muscles and tendons in your forearm, and reduce your risk of developing tennis elbow.

Wrist turns

• Bend your elbow so your arm is at a right angle
• Hold your palm open and facing up
• Turn your wrist slowly until it is facing down
• Hold for a moment, then return
• Repeat for three sets of 10 repetitions

A variation is to repeat this exercise while holding a light weight. If you’re at a gym, do the exercise with the lightest dumbbell. Or at home, something like a tin of food will do.

Wrist lifts

• Hold a very light weight or a tin of food in your hand
• Bend your elbow so it’s at a right angle
• Your palm should be facing upwards, holding the weight
• Slowly bend your wrist towards you
• Hold for a moment then return
• Repeat for three sets of 10 repetitions

Wrist extensions

• Sit on a chair with your elbow on the chair’s arm or a table to the side
• Your forearm should be supported on the surface, with your hand over the edge
• Use your other hand to raise the wrist up
• Then, slowly bend the wrist down as far as it will go
• Repeat for three sets of five repetitions

Work on your technique

As mentioned above, improving backhand technique can potentially eliminate tennis elbow pain. Correct tennis technique is complex, but some key points to remember include:

• Remember footwork: By pivoting onto your back foot before hitting the ball, most power will come from your legs and body, reducing strain on the arm.
• Correct grip: There are many different backhand grips, but choosing an appropriate grip for your playing style may help with avoiding tennis elbow.
• Swing: Your arm and shoulder should swing at the same time.
• Follow through: Make sure you follow through with a natural, clean swing.

Related: Thomas Johansson’s forehand guide for ASICS’ Tennis Academy

Manage the risk of tennis elbow

Although tennis elbow affects many tennis players at some point, the outlook for the condition is usually good. With adequate rest and some simple exercises and stretching, many people can return to the sport in good time.

By learning about tennis elbow - and taking some simple precautions to avoid it - you’ll have the tools you need to manage the risk, and keep enjoying your sport.

Ready to play again? Explore ASICS’ range of tennis shoes for men and women, and discover our professional standard tennis clothes too.