A Helpful Guide to Tennis Elbow (Outer Elbow Pain)

 Nurudeen Tijani (T.J.) Founder of TitaniumPhysique | Pain Relief Fitness Coach

Written by: Nurudeen Tijani

Updated: May 12, 2024

I've been lifting for ten years, and I've dealt with and overcome many elbow injuries. For gym goers and weight lifters, the primary cause of tennis elbow (outer elbow pain) is restricted forearm extensor muscles that strain the extensor tendon during push exercises. To prevent elbow discomfort, maintain pliable forearms through self-myofascial release exercises. These exercises can instantly relieve the restrictions in the muscles and minimize the risk of injury, overuse, and inflammation.

An illustration of tennis elbow (outer elbow pain) and forearm extensors
YouTube video

Understanding Tennis Elbow from Lifting Weights


Why does the outside part of my elbow hurt from lifting? How do I fix it?

Outer elbow pain from lifting can occur for several reasons:

    1. Restricted forearm extensor muscles (shortened, tight, and tense muscles)
    2. Inadequate stretching and warm-up of the forearm muscles before exercising
    3. Excessive resistance (i.e., heavy weight lifting)
    4. Poor lifting form or technique
    5. Overtraining (e.g., a sudden increase in upper body training volume or performing excessive sets of arm/elbow exercises in a workout session)
    6. Inadequate recovery
    7. Lack of myofascial release

    These factors, individually or in combination, can cause discomfort at the outer part of the elbow. Yet, for most people, the primary cause is restricted forearm extensor muscles that strain the extensor tendon during push movements.

    To prevent this condition, prioritize proper form, gradually increase resistance, allow adequate rest periods, and, most importantly, maintain pliable forearms through self-myofascial release "SMR" exercises.

    SMR involves using tools like foam rollers or massage balls to release tight and tense muscles. Restricted muscles exert tension and strain tendons. When you release these muscles, they become more pliable and elastic, reducing the pulling tension on the tendon and joint. SMR is the fastest way to treat and alleviate muscle and tendon pain.

    Get instant access to my in-depth and highly-rated course for a step-by-step guide to performing SMR exercises effectively. Start eliminating your elbow pain today! Click here to access the TitaniumPhysique Program now.

    What is tennis elbow?

    Tennis elbow, also known as lateral epicondylitis or outer elbow pain, is an overuse injury causing pain at the outer part of the elbow joint due to inflammation of the common extensor tendon. 

    In weight training, tennis elbow results from repetitive movements during exercise, leading to strain and discomfort. It can develop gradually over time (chronic) or occur suddenly (acute) from overloading the tendon.

    Signs and symptoms of tennis elbow from weight training include the following:

    • A burning sensation or pain on the outer part of the elbow
    • Tenderness, swelling, and soreness in the elbow
    • Sharp, shooting, sudden, severe, or dull pain on the outside part of the elbow
    • Difficulty bending and straightening the arm
    • Weak grip strength
    • Difficulty performing activities or exercises that require wrist extension
    • Pain that radiates from the outer elbow down the forearm
    • Increased pain when applying pressure to the affected area
    • Stiffness and limited range of motion in the elbow joint
    • Pain that worsens with repetitive movements or gripping activities
    An illustration of the forearm extensor muscles and tendon

    An illustration of the forearm extensor muscles and the common extensor tendon.

    Can you get tennis elbow from lifting weights?

    Yes, you can develop tennis elbow from weight lifting. For example, "push" exercises like the overhead press, bench press, or tricep pushdowns can trigger acute tennis elbow or worsen chronic pain. 

    However, it's essential to understand that weight training is not the underlying cause of this condition. The root causes of tennis elbow from lifting include chronic inflammation, magnesium deficiency, and muscle restriction.

    For a deep dive into the root causes of elbow pain, elbow tendonitis injuries, elbow bursitis, chronic versus acute pain, and the fastest way to fix these conditions, check out these helpful resources:

    Why do I suddenly feel outer elbow pain without an apparent cause?

    The muscle conditions that lead to outer elbow pain develop gradually and cumulatively. Over time, the repetitive use of the forearm extensor muscles can lead to muscle restriction, causing them to become shortened and inelastic. This process of muscle restriction can take months or even years to develop.

    When the forearm extensors are chronically restricted, everyday activities at the gym, working out, picking up weights, and gripping exercise bars or dumbbells can unexpectedly trigger outer elbow pain without an apparent cause.

    Unfortunately, most people are often unaware of the restricted state of their forearm extensors until they experience this sudden onset of elbow pain during these activities.

    YouTube video

    I perform bench presses (while wearing elbow sleeves to manage pain) during a workout (2017).

    YouTube video

    I perform variations of bench presses (without elbow pain) during a chest workout (2021).

    Can muscle tension from lifting contribute to tennis elbow?

    Yes, muscle tension in the forearm from lifting can contribute to outer elbow pain. Muscle tension is one of the root causes of elbow pain.

    The forearm extensor muscles can become restricted when you lift weights over an extended period. This restriction occurs as the muscles shorten, tighten, and tense up due to muscular contraction, overuse, and a lack of myofascial release. 

    The shortened muscles exert increased tension on the common extensor tendon (the tendon on the outer part of the elbow), reducing its elasticity. As a result, the tendon becomes strained and inflamed, causing elbow discomfort.

    Further muscle tension in the forearm can contribute to related elbow issues like golfer's elbow (inner elbow pain) or triceps tendonitis (posterior elbow pain).

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    Impact of Tennis Elbow on Weight Lifting


    Is tennis elbow typical among weight lifters?

    Yes, tennis elbow is typical among individuals who lift weights.

    Popular exercises commonly performed by weight lifters, including bench press, overhead press, push-up, pull-up, tricep pushdown, tricep dip, and machine chest press, contribute to the development of this condition.

    According to the National Health Service, tennis elbow is the most prevalent cause of persistent elbow pain, accounting for two-thirds of cases.

    Back in the days when I experienced persistent elbow issues from lifting, I remember having more occurrences of tennis elbow than other types of elbow tendonitis (golfers elbow and triceps tendonitis).

    Will tennis elbow go away by itself?

    The acute symptoms of tennis elbow can go away unaided with rest.

    However, the underlying factors contributing to this condition, such as restricted and tense forearm muscles, do not resolve unassisted. In fact, for many athletes and weight lifters, it often worsens over time.

    Here's why: the root causes of tennis elbow pain include chronic inflammation, magnesium deficiency, and muscle restriction.

    Firstly, once a muscle becomes restricted and dysfunctional, it tends to remain in that state or worsen unless specifically addressed.

    Secondly, muscle dysfunction is often associated with magnesium deficiency. "The Magnesium Miracle," a scientific reference on the health effects of magnesium, highlights that around 40% of magnesium in the body is in the muscles. A significant portion of the population is magnesium deficient.

    Heavy exercise, physical activity, and various factors like caffeine, stimulants, diuretics, stress, and dehydration can deplete magnesium levels in athletes. These factors are one reason why restricted muscles persist and worsen.

    Thirdlychronically restricted muscles eventually become dysfunctional and stop working correctly. This condition leads to repeated injury and stress on the common extensor tendon, resulting in chronic tendonitis (i.e., chronic tennis elbow).

    Generally, when the injury first occurs, the elbow extensor tendon experiences micro-tear damage (medically known as tendonitis). As fitness training continues, the tendon condition deteriorates and degenerates (tendinosis).

    Nurudeen performs wide-grip pull-ups

    I'm performing the wide-grip pull-ups during a back workout (2022).

    Nurudeen performs cable tricep pushdown

    I'm performing the tricep pushdown during an arms workout (2023).

    What happens if tennis elbow is left untreated?

    1. Tendon deterioration - If left untreated, tennis elbow can progress and lead to the degeneration of the common extensor tendon. Collagen in the tendon deteriorates. The tendon weakens over time, resulting in loss of strength, which increases the risk of tendon tears or ruptures. Medically, this condition is known as elbow tendinosis.
    2. Elbow arthritis - untreated tennis elbow can contribute to autoimmune conditions like elbow arthritis.
    3. Forearm, wrist, and hand pain - When restricted muscles in the forearm are left untreated, they become dysfunctional and cause pain in the wrist, forearm, and hand.

    Ready to start lifting without pain or injury?

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    Nurudeen Tijani, founder of TitaniumPhysique

    Managing Outer Elbow Pain


    Can I still lift weights or work out with a tennis elbow?

    It depends on the severity of the pain. If it's mild, you can use conventional pain relief medicine or short-term remedies such as sports or kinesiology tape, elbow sleeves, braces, or straps to reduce discomfort during exercise. However, suppose it's chronic, severe, or causes sharp pain. In that case, it's best to treat the underlying cause of the tennis elbow before resuming exercise.

    Which exercises should I avoid if I have a tennis elbow?

    Avoid "pressing" or "push" exercises. These exercises require an overhand grip and can place excessive load on the forearm extensors and strain the common extensor tendon.

    Here's a list of 10 exercises to avoid, along with alternative exercises you can perform (see below):

    1. Bench Press
    2. Shoulder and Overhead Press
    3. Push-Ups
    4. Pull-Ups
    5. Tricep Dips
    6. Tricep Pressdown
    7. Reverse and Hammer Curls
    8. Heavy Upright Rows
    9. Lat Pulldowns (overhand grip)
    10. Overhead Tricep Extensions
    YouTube video

    Check out this 2017 video of me performing the tricep dips during an arms workout.

    What upper body exercises can I perform with a tennis elbow?

    If you're lifting while still recovering from tennis elbow, there are a few essential things to remember.

    1. Replace "push" and "press" workouts with "pull" and "fly" exercises.
    2. Opt for resistance band or cable machine variations of exercises instead of using barbells, dumbbells, and stationary machines.
    3. Consider performing partial reps, where you don't fully bend or extend the arm during the movement. This modification can help reduce strain on the tendon and alleviate pain.
    4. Use less resistance and focus on performing more repetitions.

    Here's a list of 26 upper body exercises you can try if you have tennis elbow. These exercises put a lighter load on the forearm extensors and elbow tendon while effectively engaging the upper body muscles.

    You can find most of these exercises on the JEFIT exercise database.

    Back Exercises:

    • Lat Pulldown (using Resistance Band)
    • Wide-Grip Lat Pulldown (with Palms Facing In)
    • Rows (using Resistance Band)
    • Machine Assisted Pull-Up (using Hammer Grip)
    • Full Cobra (Supermans)
    • Back Hyperextensions
    • Machine-Assisted Dead Hang Stretch
    • Back Fly (using Resistance Band)
    • Dumbbell Reverse Fly

    Shoulder and Arm Exercises:

    • Machine Deltoid Raise
    • Cable Upright Row
    • Dumbbell Shrugs (lower weight, higher reps)
    • Lateral Raises (with a Resistance Band)
    • Front Raises (with a Resistance Band)
    • Close Grip Dumbbell Press
    • Machine Tricep Extension
    • Machine-Assisted Tricep Dips
    • Cable Kneeling Tricep Extension
    • Bicep Curl

    Chest Exercises:

    • Cable Chest Fly
    • Cable Chest Crossover
    • Chest Fly (using Resistance Band)
    • Wall Push-Up or Kneeling Push-Ups (with Wide-Arm)
    • Dumbbell Pullover (with Straight Arm)
    • Machine Inner Chest Press (with Palms Facing In)
    • Machine Fly (using Pec Deck Machine)
    YouTube video

    Check out this 2023 video of me performing the wide-grip cable lat pulldown (with palms facing in).

    Can elbow compression sleeves help?

    Yes, elbow compression sleeves, such as elbow wraps, straps, and support braces, can alleviate outer elbow discomfort from exercise.

    However, it's essential to consider the pros and cons of using elbow sleeves to manage tennis elbow.

    Pros: Elbow compression sleeves provide compression, which improves blood flow, enhances joint position awareness (proprioception), and offers support to the muscles and tendons surrounding the elbow joint. The compression promotes better circulation, stabilizes the joint, reduces swelling, alleviates pain, and can help prevent further damage during intense workouts.

    Cons: Relying only on sleeves for pain relief can mask the underlying problem, allowing athletes to continue lifting without addressing the root cause of their pain. This masking will further perpetuate the injury and potentially lead to long-term degenerative conditions in the elbow.

    Nurudeen bench pressing with elbow sleeves (tennis elbow from lifting weights)

    I'm benching with elbow sleeves during a chest and back workout at the gym (2017).

    Healing and Prevention


    How long does it take to heal a tennis elbow?

    By combining post-workout treatments such as ICE therapy (to relieve burning pain), magnesium supplementation (to reduce inflammation), and self-myofascial release (to alleviate sharp or dull pain), it is possible to treat and heal tennis elbow within 7-10 days.

    It will involve performing self-myofascial release (SMR) on the forearm extensor muscles at least 2-3 times daily. Get step-by-step guidance with my TitaniumPhysique Program to ensure you do these exercises correctly and effectively. Click here to access the program now.

    Remember - resting the elbow (i.e., taking a break from physical activity) may provide temporary relief, but it will not fix the underlying cause of the pain - restricted forearm extensors that strain the elbow extensor tendon, leading to discomfort.

    What options do I have to stop tennis elbow?

    To stop outer elbow pain when lifting, you have two options: using short-term pain relief remedies for temporary relief or addressing the root cause of the pain to prevent its recurrence.

    Option #1: Short-term relief remedies. These include:

    • Using joint supplements and vitamins
    • Taking anti-inflammatory painkillers (NSAIDs)
    • Undergoing physical therapy
    • Incorporating stretching exercises
    • Applying ice and resting the affected area
    • Wearing elbow braces or straps
    • Using kinesiology tape
    • Applying topical anti-inflammatory solutions such as oils and creams

    Option #2: Fix the root cause to prevent tennis elbow from interfering with your workouts. Address muscle restriction by improving pliability in the forearm extensors.

    Learn how my TitaniumPhysique Program can help you quickly eliminate pain at its source. Click here to access the program now.

    References

    • Elbow pain
    https://www.mayoclinic.org/symptoms/elbow-pain/basics/causes/sym-20050874

    • Muscle Stiffness
    https://my.clevelandclinic.org/health/symptoms/25147-muscle-stiffness

    • Tennis elbow
    https://www.nhs.uk/conditions/tennis-elbow/

    • Pain-relief medicines
    https://www.healthdirect.gov.au/pain-relief-medicines

    • The Magnesium Miracle (Second Edition)
    https://books.google.com/books/about/The_Magnesium_Miracle_Second_Edition.html?id=2lBcDAAAQBAJ&source=kp_book_description

    • Elbow sprain - aftercare
    https://www.mountsinai.org/health-library/selfcare-instructions/elbow-sprain-aftercare#:~:text=Ice%20your%20elbow%20for%2015,ice%20can%20damage%20your%20skin

    • Arthritis of the Elbow
    https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/arthritis-of-the-elbow.html

    • Patient education: Elbow tendinopathy (tennis and golf elbow) (Beyond the Basics)
    https://www.uptodate.com/contents/elbow-tendinopathy-tennis-and-golf-elbow-beyond-the-basics

    • Elbow Compression Sleeve
    https://dunbarmedical.com/product-category/compression-wear/compression-sleeve/elbow-compression-sleeve/

    • JEFIT Exercise Database
    https://www.jefit.com/exercises/

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