You recently started noticing a pain in your elbow. Every day—and especially when performing certain motions—the pain seems a little worse.
If that wasn’t troubling enough, the pain has begun to affect your grip strength, making it hard to keep up at work or keep playing the sports you love.
You’ve tried everything to manage the pain: icing, applying heat, stretching, massaging the hurt area, and taking over-the-counter pain medication like Ibuprofen or Tylenol.
And yet, the pain persists.
You may have heard of “tennis elbow”—but isn’t that something only full-time athletes deal with?
The truth is that lateral epicondylitis (or epicondylalgia)—commonly referred to as tennis elbow can affect anyone. It’s a fairly common injury, and you don’t have to play tennis (or any sports) to get it.
Maybe you know other people who have experienced this problem, and seen them wearing tennis braces, straps, and sleeves. But do those tennis elbow supports actually heal the injury, or do they just make the pain more manageable? And how can you know if those options will work for you?
Fortunately, treating tennis elbow is simple once you know what you’re dealing with.
So let’s take a closer look at tennis elbow: what is it? What does it feel like? How can you prevent it? And what can you do to treat the condition after it’s already started?
What Is Tennis Elbow?
Tennis elbow, also known as lateral epicondylitis or lateral epicondylalgia, is a pain related to the muscle and tendons in your forearm. As a result of constant, repetitive motion, the tendons near the elbow muscle—the extensor carpi radialis brevis (ECRB)—can start to tear.
The painful condition is most commonly associated with athletes, but it can be caused by everyday tasks you do at home or work, such as painting, vacuuming, scrubbing, yard work, playing an instrument, or lifting heavy objects.
Roughly 3 percent of the population—men and women alike—suffer from tennis elbow, regardless of whether they are athletes.
And many people don’t realize all the ways they use their elbows until they’re afflicted with a condition like tennis elbow.
The elbow itself is a complex hinge joint, based on interaction of the upper arm, forearm, and the wrist. The joint is complex because it needs to rotate in order for you to put your palm up or down, as well as bend your arm or wrist.
The nerves and blood supply that run the length of the arm and across the elbow are subject to constant bending and straightening. This can lead to irritation or pressure, which results in pain, numbness, and weakness in both arm and hand. The tendons that connect all the muscles involved in bending or straightening your fingers are a common location of tendonitis—another potential cause of tennis elbow.
Sometimes acute injuries can cause inflammation while your body heals. More commonly associated with tennis elbow, however, is a condition known as tendinosis. The wear and tear of repetitive motion leads to tissue degeneration and an abnormal arrangement of collagen fibers. As a result, the body produces fibroblasts: a cell that weakens collagen, which makes it more fragile and easier to break or injure.
The resulting pain can come from micro tears at the extensor tendon. Constant use of this tendon makes it difficult for the tears to heal—which weakens the area and leaves you in pain.
These micro tears aren’t difficult to treat on their own. But the wrong treatment approach can mask the pain without actually healing tendons and joints. And the buildup of scar tissue can make tennis elbow much more difficult to treat.
A doctor can diagnose the cause of pain by having you perform a series of small movements, such as flexing your arm, wrist, and elbow, and then pointing to where it hurts. An imaging test, such as an X-ray or MRI, can formally diagnose the problem, as well as eliminate other suspected causes.
Even after a tennis elbow injury has progressed and scar tissue has built up, a combination of doctors, physical therapists, and surgeons can work together to provide the tennis elbow treatment you need
Signs & Symptoms of Tennis Elbow
Many people assume acute arm pain is the result of a one-off injury—something that will go away on its own with time.
Lateral epicondylitis can quickly move from an uncomfortable but manageable condition to one so painful you can’t perform everyday activities and motions. Not only does this limit your ability to do the things you enjoy (like playing tennis or throwing a ball around with your child), but it can severely impact your ability to perform at work.
- A handyman who is less able to grip and turn a screwdriver.
- A chef who struggles to lift pots of water or flip burgers.
- A childcare provider who can’t grab toys from the shelf or lift even the smallest children.
- A painter who can’t use a brush.
The circumstances and causes may be different, but the effect can be just as severe.
You may experience tenderness or a burning sensation on the outside of the elbow. If you move your elbow or wrist, the pain may feel even worse. The pain then spreads down the forearm while also causing tightness and soreness. Some people notice the tightness first, while others only feel a tightening after the joint pain has spread.
Tennis elbow and the pain it causes can also weaken grip strength and make it difficult, if not impossible, to fully extend your elbow. While this can be frustrating when it keeps you from playing the sport you love, it can progress to the point where you can no longer turn a doorknob or lift a coffee cup without gritting your teeth in pain.
Everyday motions you used to take for granted can severely aggravate the pain, to the point that you are no longer able to do the things you love or perform the work you rely on for income.
- holding a racket
- hitting a ball
- swinging a golf club
- casting a fish line
- picking up objects with your palm down
- turning a screwdriver, doorknob, or steering wheel
- lifting groceries
Suddenly, you have to think twice about doing anything that involves bending your elbow, rotating your wrist, or tightening your grip.
Naturally, these symptoms can affect your performance and wellbeing over time. You may not be able to play at your best during competitions. Instead of alleviating stress, exercise can become a source of frustration. You might receive fewer hours at work, be disciplined for poor performance, or—worst case scenario—end up losing your job.
Making things even harder, the stress that comes from a loss of income or poor performance can heighten the nervous system. This not only increases the severity of the pain, but it can cause otherwise harmless stimuli to be read as pain signals.
Your nerves send out signals to your brain and spinal cord, which then sends out signal patterns to your muscles. The signal patterns that develop are how we are able to control our movements and engage in physical activities like walking, running, riding a bike, and play instruments.
Experts believe that chronic pain happens when muscle sensors misfire or malfunction, causing the brain and spinal cord to incorrectly adapt. The malfunctioning sensors end up “short circuiting,” in a way, causing the central nervous system to latch onto those signals and recognize them as painful.
This ends up resulting in chronic pain, further disrupting your quality of life.
Left untreated, tennis elbow can lead to a vicious cycle of increasing pain and decreasing functionality.
How to Prevent Tennis Elbow
Knowing how severe tennis elbow can become when untreated, you may be wondering how you can prevent it from happening in the first place.
There are plenty of measures you can take to prevent tennis elbow, and many of them are easy to implement and good for your overall health.
Healthy Lifestyle Choices
Your lifestyle choices are a key factor in tennis elbow prevention. A healthy lifestyle is a good idea regardless of your experience with elbow pain, but it can be especially important when trying to prevent the injury from occurring in the first place.
Eating a healthy diet and getting plenty of sleep and rest gives your muscles and tendons the nutrition and rest they need to recover from micro-tears and stay strong in the face of constant and repetitive motion. And eating anti-inflammatory foods—such as green leafy vegetables, nuts, and fatty fish—can reduce inflammation from tendonitis that may be causing increased sensitivity or pain..
Rest is especially important if you are already experiencing elbow pain. Your body needs time to heal from injuries, and trying to “push through” tennis elbow pain prevents the tendons from healing and could make the injury much worse. Give your body breaks during and between workouts. If you use a repetitive arm motion at work as well as in your preferred sport or activity (or if you hold two jobs), you may need to build set rest time into your schedule.
Strong, flexible muscles and tendons are more resistant to injury. Controlled stretches not only help prevent tennis elbow, but they can be an important part of healing the injury after it’s started by decreasing muscle stiffness and the shortening of tendons.
Here are a few recommended stretches you can use at home.
The wrist flexor stretch consists of holding your arm out straight, palm up. Using your other hand, hold the fingers of the outstretched hand and bend it towards you until you can feel a stretch in your forearm.
The finger stretch helps to gently stretch the tendons in your wrist and forearm and can increase grip strength. Wrap a rubber band around your fingers as you touch them to your thumb, then open and close your fingers at least 25 times.
The wrist flexor strengthening exercise helps prevent muscle stiffness while building up their strength. You can do this simple exercise with a 1-pound dumbbell, or even a can of beans. Take a seat and rest your forearm on your thigh or some other flat surface with your wrist hanging over the edge. Now raise your hand and lower it slowly—your arm should remain on that flat surface as you bend your hand at the wrist. Repeat this exercise at least 10 times.
Similar to stretching, yoga has been found to loosen the muscles and decrease stress that may be contributing to increased pain and decreased tissue healing. It helps prevent stiffness of joints, and doesn’t require an elbow strap if you do it long-term.
But while yoga can help prevent and heal tennis elbow, it’s important not to overdo it. Like other exercises and activities, pushing yourself too hard risks damaging muscles that are already sore to begin with. You’ll want to start slowly, with shorter holds for each position.
So what yoga poses are most beneficial in tennis elbow prevention?
The mountain pose with bound hands in front is a relatively simple stretch that loosens the arm and shoulder muscles. Stand up tall and straight and raise your arms in front of you so that your hands are at about the same height as your shoulders. Interlock your fingers and turn your wrists so the palms are facing outward, keeping your arms straight. You should feel a stretch from shoulder to fingertips. Hold it for about 30 to 60 seconds.
Planks can strengthen the arm muscles that support your elbow. This simple and adaptable move involves kneeling on the floor with both hands on the floor in front of you. You’ll want to lean your weight forward, so that your shoulders, arms, and hands support your upper body while your knees support your lower body. For an increased challenge, raise your knees and straighten your legs, shifting your weight onto your hands and toes. Hold for 15 to 60 seconds.
If you find planks are too intense, you can also try this stretch while standing up. Stand about 12 to 18 inches away from a wall, place your palms on the wall, and lean your upper body forward. Try to push the wall away from you.
The cobra pose consists of lying on the floor facedown with your hands under your chest, palms facing down. Slowly roll your body upward starting with the head, as if you are trying to look up at the ceiling. Keep your legs and hips on the floor, and extend your arms as you push your upper body up off of the floor. You should feel a stretch in your neck, chest, shoulders, and arms. Remember to breathe steadily while holding this pose for up to one minute.
These stretches are a great addition to your exercise routine, whether you’re trying to prevent tennis elbow or treat pain that has already started. Just remember to go easy on yourself. If something hurts, don’t keep pushing. Give yourself plenty of rest between workouts, and stop an exercise or stretch if the pain worsens.
Tennis Elbow Support: Treatment Techniques
If you suspect you may have tennis elbow, your next step is to get a formal diagnosis. You want to be sure that you are treating the correct injury, or you run the risk of causing more damage—like tendon strains or scar tissue buildup that could require surgery to repair.
A doctor or a physical therapist can diagnose lateral epicondylitis. The process typically involves a physical exam, and possibly an x-ray, MRI, or an ultrasound.
The question many tennis elbow sufferers have is how to reduce pain and help the injury heal so they can get back to the activities they love and the work they rely on.
Plenty of Rest
Rest is a critical piece of the recovery process. “Rest” in this scenario doesn’t mean full-on bed rest, though—just avoiding activities that can aggravate the injury. This is often called “relative rest” because it is different for everybody.
If you experience pain in your elbow or arm, stop whatever you are doing and give yourself a 30 to 60 second break. You can use this time to cool down with a simple stretch to help relieve sore muscles. When you return to the activity, check your posture and see if you can adjust it to be more symmetrical or modify the activity to make it more comfortable.
Soft-tissue injuries like tennis elbow or golfer’s elbow can be made worse by “pushing through” difficult workouts. An athlete who pulls a hamstring, for example, needs rest in order to heal properly. If they try to make a comeback too soon and push through unhealed pain, they are much more likely to aggravate the injury.
Tennis elbow isn’t always accompanied by inflammation. But if you are experiencing inflammation in your arm, there are a few natural treatment techniques.
Icing your upper forearm can help reduce inflammation—wait until after the exercise or activity to ice, not before. You can wrap or bandage the ice loosely while resting your arm above your heart for an even greater reduction in swelling or inflammation.
Changing your diet can also help with reducing tennis elbow-related inflammation. Anti-inflammatory foods, such as salmon, avocado, fruit, and veggies, have been proven to help with the recovery process.
Temporary Pain Relief
One of the best ways to treat tennis elbow is to strengthen your muscles and tendons. That means continuing to exercise and stretch. But that can be difficult when you’re in pain. While you don’t want to push yourself too hard and risk aggravating the injury, you need to be “functional” enough to keep up with your workout or physical therapy routine.
If needed, you can take medication such as Tylenol or Aspirin, or wear a support brace to help reduce pain. Either option offers pain relief. Just be aware that these are temporary fixes; they won’t address or correct the root of the problem. And using either method as your sole source of tennis elbow treatment could do more harm than good.
Over-the-counter pain medications only last a few hours, and can damage the stomach lining or the kidneys if taken too often. Braces do not have the same kind of dangerous side effects and can greatly reduce pain so you can train, compete, and get back to work. But, like medication, braces and elbow sleeves treat the pain, not the injury. That can lead many athletes and workers to push too hard, causing more damage and leading to a buildup of new scar tissue, to the point where surgery might be required to fix it.
That doesn’t mean braces or medication are bad—they are an important component of many people’s recovery from soft-tissue injuries. You just want to use them as part of a long-term, effective tennis elbow treatment plan, ideally one recommended by a doctor or physical therapist.
The surest way to treat tennis elbow is to stretch and strengthen the affected muscles.
Pre-Exercise Stretch Routine
Pre-stretching helps ease your muscles into more challenging physical activity. It’s akin to allowing the shower water to warm up before stepping in: it helps avoid an unpleasant shock.
Here are a few stretches to strengthen your arms and get you warmed up before more rigorous exercise.
The prayer stretch. Place your palms together while keeping your fingers straight—like you were praying. Slowly raise and lower your elbows to decrease the angle at the wrist, pressing your palms and fingers together as you do so. Repeat at least five times.
The reverse prayer stretch. Begin with the backs of your hands together in front of your body so your wrists are at hip level. Now slowly bring your arms upward until your thumbs are at your waist. This stretches the forearm extensors in a way you don’t get with the traditional prayer stretch. Hold for 10 seconds, and repeat 5-6 times.
The forearm flexor stretch. Extend your arm with the palm up and thumb pointing out. Using your other hand, pull down on the fingers of your extended arm until you feel the stretch in your forearm. Hold this position for about 30 seconds, or 5 slow, deep breaths.
The forearm extensor stretch. Hold one arm straight, palm down, while bending your wrist up so that your fingers are as high as they can go. Using your other hand, pull back on your fingers until your lower forearm starts to feel a stretch. Hold for at least 30 seconds or 5 slow, deep breaths.
Now that you’re warmed up, what exercise routines are best suited for recovering from tennis elbow (and preventing its return)?
Exercise Routines to Treat and Prevent Tennis Elbow
Strengthening the muscles and tendons in your arms is key to recovering from tennis elbow and reducing the likelihood of recurrence.
Cross training is a great way to strengthen your upper body and rehabilitate existing injuries. By incorporating a variety of exercises, you can target muscle groups and develop specific fitness components to support faster recovery. Cross training can reduce the risk of overuse injury, improve weight loss efforts, and boost overall fitness.
You can create a full workout routine based around cross training, or you can incorporate select cross training elements—such as strength and flexibility training—into your existing routine.
And the range of activities and combinations of exercises you can use helps reduce boredom and keep you motivated and engaged.
Yoga is another effective exercise routine when recovering from tennis elbow and other soft-tissue injuries. Many athletes use yoga as a way to improve performance and reduce the risk of injury by stretching and strengthening their muscles. Yoga can also be as hard or as easy as you want it to be, which makes it ideal when managing pain or recovering from an injury. It loosens the muscles, prevents stiffness in the joints, and can help you reach a point where you no longer require the use of an elbow strap or brace.
Like cross training, yoga can be adapted to help reach specific fitness goals, like flexibility, strength training, and injury recovery. And some poses are better suited to recovering from and preventing tennis elbow than others (mountain, planks, cobra).
Keep these tips in mind to get the most out of your yoga routine.
- Readjust or stop the stretch if you feel increased pain or discomfort
- Start with easier stretches and shorter holds, and increase difficulty as you gain flexibility
- Do the routine regularly (3-5x/week) for the best results
- Include yoga as one part of a larger exercise regimen and treatment plan.
Post-Exercise Stretching & Recovery
Whether you’re cross training, doing yoga, or hitting the court for your daily exercise, you’ll want to finish with some post-exercise stretching and recovery. Stretching, therapeutic massage, and physical therapy exercises after a workout can all help increase blood flow, relieve soreness, and build flexibility.
The calf and hamstring stretch builds flexibility while preventing your muscles from getting stiff. Find a comfortable place to sit down (perhaps a yoga mat) and extend your legs in front of you. Lift and turn your left leg so your foot rests against the inside of your right leg. Bending from the hip, reach for your right foot with your right hand, aiming for your toes, until you feel a stretch. Hold each leg for about 30 seconds.
The hip flexor stretch builds flexibility and keeps muscles from tightening. Kneel on the floor or a yoga mat and take a giant step forward with one leg into a lunge position. Make sure that your front knee does not bend further than your toes. Keeping your torso upright, tuck your tailbone under and push your hips forward until you feel the stretch along the front of your back leg. Hold the position for 30 seconds, then repeat with the other leg.
Once you receive a tennis elbow diagnosis from a doctor or a physical therapist, a physical therapist can show you rehabilitation exercises that you can do both in their office and in your home. A physical therapist can formulate an exercise process that specifically targets the areas you want to heal or strengthen.
One of the most common therapeutic exercises for tennis elbow is the rubber twist bar technique, a series of stretches using a flexible exercise bar that targets muscle, tissue, and joint pain.
Therapeutic massage can also help: specifically, friction massage, friction burn and hold massage, and pin and stretch massage.
For a friction massage, hold your hurting arm in front of you, and grab the upper part of your forearm with your opposite hand. Use your fingertips to rub the skin around the elbow in circular motions, and continue to do this from the elbow to your shoulder.
The friction burn and hold has been known to circulate fluids and encourage blood flow around sore muscles. Holding your affected arm in front of you, place the fingertips of your opposite hand just under the outstretched elbow. Gently twist the skin of your elbow in an outward direction, for about 5 to 10 seconds. Repeat the process by moving your fingers downward.
The pin and stretch massage helps to heal inflammation that may be causing or contributing to arm pain. Hold your hurting arm in front of you and grab your forearm underneath the elbow. Squeeze your arm muscles tightly, and maintain that grip throughout this exercise. Making a fist with the outstretched arm, curl your arm until your knuckles almost touch your shoulder. Hold for several seconds, and repeat three to four times.
Heat and ice are also effective in soothing sore muscles. Ice helps reduce inflammation and pain, while heat promotes blood flow to the injured area, speeding up the healing process. You’ll want to be careful, though, about using heat and ice at inappropriate times.
Applying heat helps expand blood vessels and increase blood flow, providing nutrients and oxygen to boost metabolism and help loosen and relax the muscles. As muscles, ligaments, and tendons begin to relax, pain should decrease while range of motion increases. Heat treatments aren’t a replacement for warm-ups, but it does serve as a “pre treatment” for an injured area, helping prevent further injuries during physical activity.
By contrast, cold treatments make the blood vessels less porous, and mitigate the possibility of swelling as a result of fluid flowing into tissue surrounding an injury. Using a cold treatment can help reduce muscle spasms while increasing your threshold for pain. Wait until after an activity to ice, though—icing beforehand can cause flare-ups or other injuries.
Ice or heat is generally applied for 10-20 minutes. Don’t be alarmed if your skin looks a little pink after applying ice or heat. Allow your skin to return to its normal color and temperature before starting another treatment. If you notice purple-red, dark red, or spotty red and white skin, hives, blisters, or swelling, stop icing or heating and consult a doctor.
Medication can serve as a complement to heat and ice treatments. Nonsteroidal medicines, such as Ibuprofen or Aspirin, can help with swelling when used as part of a tennis elbow treatment plan.
Steroid shots are designed to relieve pain and inflammation by being injected directly into hurting joints, and can only be provided by a doctor. Like non-steroidal painkillers, steroid shots are only a temporary fix. They won’t cure tennis elbow long-term. There are some risks with receiving steroid shots, particularly if you have an active infection or an existing bleeding problem. Your age, physical shape, and any other medications you take will be factored into which type of steroid, if any, is right for you (and how often it should be administered—typically just a few times a year). Ask your doctor for recommendations.
Tennis Elbow Supports (Straps, Braces, Sleeves, Bands)
Peer-reviewed studies have shown that straps and supports can provide “an immediate improvement on pain severity” for people suffering from tennis elbow (or golfer’s elbow). These wearable support options work by keeping the wrist extensor muscles from fully contracting, which helps reduce elbow strain.
Experts recommend wearing braces and straps for short periods of time if you have a diagnosed muscle tear (verified by an MRI or sonogram), or when engaging in activity that puts heavy exertion on the muscles. Braces and straps target different muscle areas with different amounts of pressure, and can be adjusted to provide greater pain relief.
But preventing further damage and actually healing the injury are two different things, and wearing a tennis elbow support, like a brace or sleeve, should only be one component of a larger, long-term treatment plan. And because tennis elbow and golfer’s elbow don’t always affect people in the same way, it’s important to understand the different types of supports available so you can find the right one for you.
A support brace can provide muscle and joint relief, and is quite versatile for use during your regular daily activities. An elbow strap can help with tendonitis that may be associated with your tennis elbow. Tennis elbow sleeves are intended to help prevent stiff joints and reduce elbow pain. Finally, bands target compression to specific areas, increasing circulation while reducing inflammation. And some products include a combination of support types, like a brace/sleeve combination.
Stop Elbow Pain Before It Stops You
Tennis elbow isn’t just for tennis players. Golfers, baseball players, bowlers, carpenters, mechanics, and people of all walks of life experience the condition at some point in their lives.
Fortunately, there are a variety of methods available to prevent and treat tennis elbow. Learn more about tennis elbow fitness, straps, bands, and other treatments.