Prevention and Management of Tennis Elbow

What is Tennis Elbow?

Tennis elbow (lateral epicondylitis) is pain that presents on the outside of the elbow.
It usually occurs when the forearm muscles that control the wrist are repeatedly stressed. This causes micro-tearing and degeneration of the common extensor muscle origin at the elbow. Tennis elbow does not only affect tennis players, but can affect anybody who does repetitive movements, such as gripping, lifting kettles or wringing of washing. Of course, as the name suggests, it often affects tennis players, especially on their backhand stroke.

How do I Protect my Elbows while Playing Tennis?

  1. Does it matter how well I play tennis?
    Faulty technique can cause tennis elbow. Ask a tennis coach to assess your backhand. Try to avoid the topspin forehand and doing a wrist flick when serving.
  2. How much tennis can I play per day?
    You are more likely to get tennis elbow if you play more than 2 hours per day. Vary your exercise with off-court activities such as core stability training.
  3. Does the tennis racket and grip affect my elbow?
    When you hit the ball, harmful vibrations (or shock waves) travel from the racket through the wrist down to your elbow. These vibrations hurt the elbow. Reducing these vibrations, reduces the risk of getting tennis elbow.
    Hitting the ball with your racket sweet spot reduces the vibrations. Rackets with larger head sizes have larger sweet spots, making it easier to hit the ball correctly.
    Use the continental grip position.
    Try to relax your grip immediately after hitting the ball.
    You can also use a rubber vibration absorber over your racket grip.
  4. Warm-up and Cool-down
    Take the time to warm-up to get the body and mind ready.
    Include some light jogging and try to get all the joints in your arms, legs and back moving through their full range.
    Cool-down must be done immediately after intensive play. This reduces muscle soreness. Stretch all the big muscle groups, including the wrist flexors and extensors.
  5. Can I do any exercises to strengthen the elbow?
    Yes. Strengthen your muscles around the shoulder, elbow and wrist joints can help protect the elbow.
    Core stability exercise will also help to improve your technique.
  6. What about the type of balls I play with?
    Always use new balls that have better elastic value.
    Avoid playing with heavy wet balls as this increases impact on the racket head.

Can Physiotherapy help if I suffer from Tennis Elbow?

  1. Your physiotherapist will in the first instance do a proper diagnosis of the pain. Not all elbow pain is tennis elbow – even for tennis players. It is possible, for instance, that pain can be referred from your neck (cervical spine) or caused by a neural entrapment.
  2. Once diagnosed as tennis elbow and the severity assessed, the physiotherapist can determine the best treatment plan, which may include a comprehensive strengthening programme, acupuncture, taping, bracing, heat treatment, massage, stretching and many more.
  3. For tennis players, it would also be worthwhile addressing your stroke mechanisms by having your serve and backhand assessed. Additionally, looking at the kinetic chain sequencing during the serve is important.
  4. Unfortunately in some severe cases, tennis elbow cannot be resolve by conservative management. It may be required that the injury be assessed by means of MRI or Ultrasound imaging. Your physiotherapist can refer you directly for this. Depending on the results, your physiotherapist may have to refer you to a specialist for possible surgical intervention.
  5. Your physiotherapist will also be able to assist with post-op rehabilitation in case surgery was required, with the aim of ensuring full function and return to sport as soon as possible.

The contents of this article – Tennis Elbow, is for informational purposes only and should not be treated as medical or health management advice. The materials herein are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor, physiotherapist or other health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this article or website. Reliance on any information provided herein is solely at your own risk.

Abrams, G.D. , Renstrom, P.A. & Safran,M.R. (2012) Epidemiology of musculoskeletal injuries in the tennis player. British Journal of Sports Medicine, 46, 492-498.
Bell, S. (2006). Elbow and Wrist Pain. In: P. Brukner & K. Khan(Eds.), Clinical Sports Medicine Third Edition (pp. 289-307). Australia: McGraw-Hill Professional