Tennis elbow: what it is and best exercises for pain relief

Your elbow is a pretty handy joint — in fact, you use it all the time. But you probably don’t think much about it until it hurts. If that happens, “tennis elbow” (formally known as lateral epicondylitis) is a possible culprit. You can develop it even if you’ve never swung a tennis racquet. Tennis elbow can be triggered by anything that involves repetitive or strenuous activity of your forearm, such as throwing a softball around with your kids over the weekend, or even by an afternoon of gardening.

The good news is that tennis elbow is very treatable with simple, at-home measures like exercise therapy. Here’s more about how tennis elbow happens, how to know if you have it, and the best exercises to prevent and relieve it.

What is tennis elbow?

Your elbow joint is made up of three bones: your upper arm bone (humerus) and two forearm bones (the radius and ulna). There are bony bumps at the bottom of your upper arm bone called epicondyles, says CJ Morrow, PT, DPT, a physical therapist at Hinge Health, where muscles attach to bone. The bony bump on the outside of your elbow (the lateral epicondyle) is the region that is painful in tennis elbow.

“With tennis elbow, the tendons that connect your forearm muscles on the outside of your elbow become inflamed, which can cause pain and tenderness,” explains Dr. Morrow. Tennis elbow is different from golfer’s elbow, which is tendonitis that occurs on the inside of your elbow. 

Usually, the symptoms of tennis elbow develop gradually. “It often starts as mild discomfort that worsens over a few weeks,” explains Dr. Morrow. You may notice pain or burning around your outer elbow that feels worse with activities like holding a tennis racquet or turning a wrench, and your grip strength may also decrease.

Causes of tennis elbow

You can certainly get tennis elbow from playing tennis. But most people with tennis elbow probably aren’t racquet sport enthusiasts.

Tennis elbow is an overuse injury, meaning that doing the same activity repeatedly without adding in therapeutic stretching or strengthening exercises to offset that repetition may — for some people — contribute to microscopic tears in the tendon where it attaches to the epicondyle, causing inflammation and pain. 

Research indicates that certain jobs or activities may increase your likelihood of developing overuse injuries like tennis elbow, such as:  

• Playing a musical instrument like violin or guitar 

• Sports and activities that involve overhead throwing (e.g., football, baseball) 

• Bowling

• Weightlifting 

• Sewing, typing on a computer, and other tasks that involve fine hand and wrist movements 

• Plumbing, painting, carpentry, butchery, construction, etc.

Although tennis elbow can result from years of doing these activities, it’s more likely to occur from short-term work or a sudden increase in the activity, such as a home project that involves a lot of shoveling or hammering nails. “These are all activities that involve repetitive gripping,” explains Dr. Morrow. “Anything that involves a lot of lifting and holding can trigger tennis elbow.”

Research also suggests that people between the ages of 40 and 60 may be more likely to develop tennis elbow. This may be because people in this age group are still fairly active, but their muscles are beginning to experience normal age-related changes, says Dr. Morrow. Just know that tennis elbow — just like any type of musculoskeletal pain — is not inevitable with age. Gentle movement and strengthening activities can help to offset this.

Tennis elbow treatment

Most cases of tennis elbow get better with some simple treatment strategies, usually within six to 12 weeks. Here’s how you can help heal your tennis elbow (and prevent it from coming back):

• Targeted exercises. There are exercises for tennis elbow pain relief that also help improve your elbow and wrist mobility. “The last thing you want to do is rest it completely,” says Dr. Morrow. “While muscle tissue will start to feel better if you don’t use it, once you return to the same activity you’ll irritate the tendon once again and go through the exact same process. Exercise helps to get to the root cause — tension from your forearm muscle pulling on your arm bone.”

• Ice. “I always recommend an ice massage following exercise or any sort of aggravating activity,” says Dr. Morrow. “This can help calm down the area while also promoting blood flow that helps bring in good healing nutrients.” 

• Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help tennis elbow pain. Sometimes topical medications such as diclofenac can also be helpful. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Try a brace. Braces are typically made of nylon, spandex, or a similar material. They simply apply pressure to your forearm muscles and reduce pressure on your painful elbow tendon. “It takes stress away from that area, and allows it to heal,” explains Dr. Morrow. You can use a compression brace while you work or play sports. Just make sure to apply the brace so that the cushion rests on your forearm muscles (about three to four inches from the tip of your elbow bone). A wrist brace can also be a useful tool to help support your forearm muscles, and this can help your sore elbow.

• Modify your lifting technique. You want to continue with your normal activities as much as you can when you experience a pain flare, but you can modify certain activities, such as lifting, to try to get some relief. Instead of lifting things with your palms facing down, try lifting objects with your palms up to shift stress from the outside to the inside of your elbow.  

• Physical therapy. If symptoms don’t get better with the above tips after a couple weeks, you may benefit from a course of elbow physical therapy exercises. Your therapist can teach you more targeted exercises, as well as ways to move your elbow in your daily activities and hobbies that don’t cause as much pain. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Some doctors recommend other treatments touted to promote tendon healing, like platelet rich plasma. But these can be expensive and there’s not good research yet that they work. In rare cases, you may benefit from surgery, but that’s usually not necessary unless symptoms haven’t gotten better after at least six months of treatment.

Isometric and eccentric exercises appear to be very effective types of exercise for many people with tennis elbow. Isometric exercises involve tightening or contracting a specific muscle or group of muscles without moving the joint involved. Eccentric movements focus on the lengthening phase of an exercise, or controlling weight as it moves in a downward motion. In other words, exercises that build strength with slow, lengthening muscle contractions can be very helpful. 

The given exercises recommended by Hinge Health physical therapists are great examples and can help keep your elbow healthy. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT tip: Strengthen your shoulders

“If you don’t have a good foundation with strong shoulder muscles, smaller muscles around your arms and elbows have to take up the slack,” says Dr. Morrow. Rows, straight-arm pulldowns, and a hand behind-the-back stretch are three very popular and effective movements to help strengthen your shoulder. You can access these exercises in the Hinge Health app or online. 

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Degen, R. M., Conti, M. S., Camp, C. L., Altchek, D. W., Dines, J. S., & Werner, B. C. (2017). Epidemiology and Disease Burden of Lateral Epicondylitis in the USA: Analysis of 85,318 Patients. HSS Journal ®, 14(1), 9–14. doi:10.1007/s11420-017-9559-3

2. Bretschneider, S. F., Los, F. S., Eygendaal, D., Kuijer, P. P. F. M., & Molen, H. F. (2021). Work‐relatedness of lateral epicondylitis: Systematic review including meta‐analysis and GRADE work‐relatedness of lateral epicondylitis. American Journal of Industrial Medicine, 65(1), 41–50. doi:10.1002/ajim.23303

3. Tennis Elbow: An Overview. (2018, May 30). National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK506998/#:~:text=About%202%25%20of%20the%20population,common%20in%20men%20and%20women. 

4. Kavi, T., Gupta, A., Hunter, K., Schreiber, C., Shaikh, H., & Turtz, A. R. (2018). Optic Nerve Sheath Diameter Assessment in Patients with Intracranial Pressure Monitoring. Cureus, 15(2): e35468. doi:10.7759/cureus.3546

5. Lucado, A. M., Day, J. M., Vincent, J. I., MacDermid, J. C., Fedorczyk, J., Grewal, R., & Martin, R. L. (2022). Lateral Elbow Pain and Muscle Function Impairments. Journal of Orthopaedic & Sports Physical Therapy, 52(12), CPG1–CPG111. doi:10.2519/jospt.2022.0302

6. Alaia, M. J. (2020, August). Tennis Elbow (Lateral Epicondylitis). American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow-lateral-epicondylitis/#:~:text=Tennis%20elbow%20is%20inflammation%20or,the%20outside%20of%20the%20elbow.

7. Jayanthi, N. (2022, October 24). Elbow tendinopathy (tennis and golf elbow) (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/elbow-tendinopathy-tennis-and-golf-elbow#:~:text=Chronic%20pain%20at%20the%20lateral,the%20underlying%20causes%20remain%20unclear.

8. Karjalainen, T. V., Silagy, M., O’Bryan, E., Johnston, R. V., Cyril, S., & Buchbinder, R. (2021). Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Cochrane Database of Systematic Reviews, 2021(9). doi:10.1002/14651858.cd010951.pub2