How to Treat Tennis Elbow (Outer Elbow Pain)

Written by: Nurudeen Tijani (Wellness and Pain Relief Fitness Coach)

The primary cause of pain outside the elbow is restricted wrist extensors that strain the common extensor tendon during repetitive or strenuous activities. To prevent discomfort, maintain pliable forearms through self-myofascial release. These exercises can instantly relieve muscle restrictions and minimize the risk of injury, overuse, and inflammation.

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Table of Content:

Causes  |  Symptoms  |  Prevention  |  Treatment  |  Resources

Causes

Understanding Tennis Elbow

Tennis elbow, also known as lateral epicondylitis, is an overuse injury causing pain at the outer part of the arm joint due to inflammation of the common extensor tendon. It can develop gradually (chronic) or occur suddenly (acute). 

According to the National Health Service, this condition is the most prevalent cause of persistent pain in the arm, accounting for two-thirds of cases.

Various repetitive or strenuous activities can lead to this condition, including:

• Playing tennis or other racquet sports
• Painting or using hand tools
• Typing or using a computer mouse
• Gardening
• Lifting heavy objects
• Repetitive wrist or arm movements in daily tasks
• Carpentry or woodworking
• Knitting or sewing
• Playing musical instruments
• Cooking or baking (e.g., repetitive stirring or kneading)

Root Cause of Tennis Elbow

The wrist extensors can become restricted over an extended period. This restriction occurs as the muscles shorten, tighten, and tense up due to repetitive movements, muscular contraction, overuse, and a lack of myofascial release.

It is essential to understand that physical activities are not the underlying cause of this condition. For most people, the primary reason is restricted forearm and wrist extensors that strain the tendon due to a lack of myofascial release.

For a deeper understanding and guidance on tennis elbow exercises, check out my article on Elbow Tendonitis.

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Tennis Elbow from Weightlifting or Lifting Heavy Objects

Lifting weights can trigger or worsen tennis elbow, but it is not the root cause. The condition occurs when the extensor tendon on the outer elbow becomes overstressed and inflamed due to repetitive strain.

Over time, weightlifting tightens and shortens the forearm extensor muscles (ECRB), increasing tension on the extensor tendon and reducing its elasticity. This overloads the elbow joint, leading to pain during exercises like bench presses, shoulder presses, pull-ups, triceps extensions, and lat pulldowns.

Whether you should continue lifting depends on the severity of the pain. Mild cases may be managed with elbow sleeves or braces, but chronic or severe pain requires addressing the root cause before resuming weight training.

To learn more, check out this helpful guide to Lifter's Elbow.

Symptoms

Symptoms and Diagnosis

The symptoms of tennis elbow include:

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

Muscle Tension and Tennis Elbow

Muscle tension can contribute to tennis elbow by causing the wrist extensors to become restricted, which increases stress on the tendons. The muscle conditions that lead to pain on the outside of the elbow develop gradually over time due to repetitive use, causing the wrist extensors to become shortened, tight, and inelastic.

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

When the wrist extensors are chronically restricted, everyday activities that involve gripping or lifting can suddenly trigger pain without an apparent cause. This muscle restriction process can take months or even years to develop.

In the video below, I demonstrate how to perform the forearm pliability test to discover the hidden muscle tension that cause tennis elbow.

Prevention

Prevention Tips

The most important thing you can do to prevent tennis elbow is to 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, reducing the pulling tension on connective tissues and the joint. Other prevention tips include:

• Performing thorough warm-ups and stretching exercises before activities
• Incorporating regular rest days into your schedule
• Ensuring adequate recovery time between sessions
• Addressing muscle restriction by improving the flexibility of the forearms

Activities to Avoid or Modify

Avoid or modify activities that require repetitive or strenuous wrist and arm movements. They can place excessive load on the forearms and strain the joint. Examples include:

• Repetitive use of hand tools
• Typing or using a computer mouse for extended periods
• Heavy lifting without proper technique
• Playing racquet sports without proper form
• Painting for extended periods

Alternative Activities

If you're still engaging in physical activities while recovering from tennis elbow, consider the following:

• Opt for low-impact movements that do not strain the forearms
• Perform partial movements to reduce strain
• Use less resistance and focus on performing more repetitions

Here are some alternative activities and modifications:

• Stretching and flexibility exercises for the forearms
• Light aerobic exercises like walking or swimming
• Gentle yoga or Pilates
• Resistance band exercises with light tension
• Using ergonomic tools and equipment to reduce strain on the forearms

Compression Sleeves

Compression sleeves, such as elbow wraps, straps, and support braces, can alleviate joint discomfort from various activities. However, it's essential to consider the pros and cons:

Pros:

• Improved blood flow and joint support
• Enhanced proprioception and stability
• Reduced swelling and pain during activities

Cons:

• Masking the underlying problem without addressing the root cause can perpetuate the injury

Managing Pain Outside the Elbow During Activities

Whether or not you can continue engaging in physical activities depends on the severity of the pain. If it's mild, you can use conventional pain relief methods or short-term remedies such as sports or kinesiology tape, compression sleeves, braces, or straps to reduce discomfort. However, if the pain is chronic, severe, or causes sharp pain, it's best to treat the underlying cause before resuming activity.

In the video below, I demonstrate mobility exercises using a resistance band to warm up and strengthen the arm joint. These exercises can help with healing and recovery.

Treatment

Why Rest Alone Isn't Enough

The acute symptoms of tennis elbow can subside 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 individuals, it often worsens over time.

Here's why:

• Chronic Inflammation: Ongoing inflammation in the arm joint can exacerbate symptoms and hinder recovery.
• Magnesium Deficiency: 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 factors like caffeine, stimulants, diuretics, stress, and dehydration can deplete magnesium levels. These factors are one reason why restricted muscles persist and worsen.
• Muscle Restriction: Once a muscle becomes restricted and dysfunctional, it tends to remain in that state or worsen unless specifically addressed. Chronically 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).

Consequences of Untreated Tennis Elbow

• Tendon deterioration: Left untreated, this condition can lead to degeneration of the common extensor tendon, resulting in tendon tears or ruptures.
• Elbow arthritis: It can contribute to autoimmune conditions like arthritis in the joint.
• Forearm, wrist, and hand issues: Restricted muscles in the forearm flexors can cause pain in the wrist, forearm, and hand.

Short-Term Relief Methods

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

Check out this article for a complete list of short-term remedies and their pros and cons.

Addressing Underlying Causes

• Self-Myofascial Release (SMR): Use massage balls to release tight forearm muscles. SMR is the fastest and most effective way to eliminate muscle tension at the source of this condition. See the SMR exercise in the section below.
• Cold Therapy: Apply ice to relieve burning pain and reduce inflammation.
• Heat Therapy: Wrap or apply a heat pad around the forearm to help relieve muscle tension, which can promote healing.
• Magnesium Supplementation: Reduce inflammation and improve muscle function with magnesium.
• Rest and Recovery: Take breaks from physical activity to allow the tendon to heal.

Tennis Elbow Treatment Exercise

To perform this exercise, you'll need a peanut ball, available on Amazon or at sporting goods stores.

How to Treat Tennis Elbow (photos below):

Massage the Forearm Extensor Muscles:

1. Use a peanut ball.
2. Lean against a wall and place the ball on the forearm extensor muscles.
3. Roll out the muscles for 3-5 minutes.
4. Stretch the forearm extensor muscles.

Routine:

• Perform once a day.
• Rest the muscle the following day.
• For faster results, perform twice a day (morning and night).

Remember that the muscle conditions that cause pain are present in other parts of the forearm and triceps. As such, use a holistic approach and treat the entire arm to prevent other forms of tendonitis and achieve lasting relief.

If you'd like to see a demonstration of additional elbow relief exercises, click here to view photos.

Healing Time

With proper treatment, including cold and heat therapy, magnesium supplementation, and self-myofascial release, tennis elbow can heal within 7-10 days. Performing SMR on the forearm muscles at least 2-3 times daily is crucial for fast results.

Get step-by-step video guidance to ensure you perform these exercises correctly and see results as fast as possible.

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Additional Resources

For more information on managing tendon discomfort, explore these helpful articles:

• Elbow Bursitis
• Triceps Tendon Injury
• Golfer's Elbow
• Brachialis Tendonitis
• Distal Bicep Pain
• Elbow Mobility

Remember, addressing the root cause of the pain is crucial for long-term relief. Take proactive steps today to ensure your joints stay healthy and pain-free.

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