What Is Tennis Elbow? Causes, Symptoms, and Treatment Options
Key Takeaways
Tennis elbow is caused by an imbalance between what your tendon can handle (tissue capacity) and the stress you place on it.
Tennis Elbow is more likely to occur as you age
Complete rest slows recovery — controlled movement and progressive loading rebuild tendon strength.
Stretching or bracing alone won’t fix the problem — strength is the real solution.
What is the Best Treatment for Tennis Elbow
What Is Tennis Elbow?
Despite the name, most people who suffer from Tennis Elbow have never played tennis.
Tennis Elbow is the common term for a painful condition affecting the tendons on the outside of your elbow.
Tendons attach muscles to bones and are often the weakest part of the muscle-tendon chain, making them vulnerable to injury. Several muscles share a common attachment on the outside of the elbow, which increases the risk of overuse irritation.
Tennis Elbow also goes by medical terms such as Lateral Epicondylitis, Lateral Epicondylalgia, or Lateral Elbow Tendinopathy.
Common Symptoms of Tennis Elbow
Pain is usually located on the outside of the elbow and worsens with gripping or lifting.
Common signs include:
Sharp or burning pain on the outside of the elbow
Weak grip strength (shaking hands, opening jars, or holding a coffee mug)
Stiffness in the morning or evening
Pain with twisting, lifting, or gripping
Discomfort during activities like pickleball, tennis, or golf
How Is Tennis Elbow Diagnosed?
Lateral Elbow Tendinopathy is generally considered a clinical diagnosis meaning it can be made based on your history and current symptoms. Advanced imaging such as x-ray/MRI is not indicated unless there is a suspicion of a fracture, dislocation, or instability of the elbow.
There two types of Lateral Elbow Tendinopathy that have different presentations and causes.
1. Tendonitis
Common after a new activity or doing a lot of repetitive gripping activity. Feels hot, swollen with sharp significant pain after activity due to inflammation. This type of Lateral Elbow Tendinopathy heals very well with some rest and 2-6 weeks of healing time without any other intervention.
2. Tendinosis
Presents without a significant change in activity and gets slowly worse over time. Feels stiff, achey and weak and does not get better with just resting it for a few weeks. After multiple months, tendinosis can be stiff and sore at the beginning of activity, feel good while it’s warmed up, and get really sore after activity.
Tendinosis can occur after a Tenonitis that doesn’t get better or with only small changes in activity.
Image Credit E3 Rehab
What Causes Tennis Elbow?
The root cause of all tendon problems are an imbalance in the Tissue Capacity and Stress put on the tendon. When muscles and tendons are asked to handle more stress than it can tolerate.
Your tennis elbow is caused by an imbalance in Stress put on the tendon compared to what the tendon can tolerate known as Tissue Capacity.
Tissue Capacity= what your tendon can handle
Stress= things you do to put pressure on the tendon
Factors that decrease Tendon Tissue Capacity:
- Age (tendons lose elasticity with time)
- Previous Injury (neck, shoulder, elbow, or wrist)
- Poor Sleep and Recovery
- Hormones/health issues: Diabetes, thyroid problems, menopause, or certain medications
Factors that Increase Stress:
- Frequency - working, lifting, or playing sports
- Intensity- working, lifting, or playing sports
- Volume- changes to the amount of work, sports, or life activity
- External stress: Work, family, lack of recovery between sessions.
Tendon problems are never about just Stress put on the tendon or just Tissue Capacity, it’s multi-factorial. So don’t be surprised if you start having Tennis Elbow without significant changes in activity.
The two most common scenarios that cause Tennis Elbow is a recent spike in activity or multiple years of inactivity. Regardless the best treatment for chronic tendon problems is consistent tolerable movement.
The Best Treatment for Tennis Elbow
Activity Modification
When it comes to a tendon that can’t handle what you are asking it to do, it is best to TEMPOARILY SCALE BACK and modify aggravating activities. Notice you don’t need to stop doing everything and rest. Chronic tendon problems get better with frequent tolerable activity, not rest.
That could mean less frequent golf, tennis, or pickleball or playing for less time. Another good option is a forearm strap to help take the pressure off during activities combined with temporary decrease in overall weight and gripping. When it comes to weightlifting, use lifting straps, decrease the weight, change to an open handed grip, or change exercises that aggravate your elbow.
The main objective is to keep from ripping the scab off while you build your tissue tolerance back up.
Image Credit E3 Rehab
Understanding and Monitoring Pain
When it comes to pain with activity you need to ask yourself 2 questions:
Is my pain tolerable during exercise? There’s not a universally acceptable answer. You get to decide what tolerable means.
Is my pain better, worse, or the same the day after exercise? If you feel fine during and immediately after exercise, but you have a significant worsening of symptoms the next day, that’s an indication that you’re doing too much and need to back off a bit.
You can assess your next-day symptoms with your normal functional activities. Also, you can replace the word exercise with physical activity, work, or anything else that makes your elbow hurt.
The most frustrating part of chronic tendon problems is after it warms up it feels good during activity but feels worse the next day. This cycle only prolongs your problem and isn’t going to get you feeling better.
Targeted Exercise
To help build up the tissue capacity of your tendon and help with the pain. If you started with really heavy wrist curls, you can expect to get worse instead of getting better. Start with an exercise that you can tolerably perform without being sore the next day
Phase 1- Calm Down The Pain
Isometrics: 30–45 sec holds, 5 reps, moderate-high load.
These can help with pain control and resistance can easily be changed.
Once your elbow is feeling better and you can hold a weight to do a wrist curl, it’s time to move to next phase
Phase 2- Strengthen the Tendon
Slow, heavy wrist curls. (VIDEO)
Slow Controlled Wrist Rotation
Example: 3–4 sets, 8–12 reps, 2–3 sec eccentric/concentric.
Bands, dumbbells, or even a soup can is a good place to start.
This can take weeks to build daily strength to tolerate heavy gripping or forceful movements like pickleball, tennis, or golf.
Phase 3- Train and Adapt
Wrist Eccentric Strength (VIDEO)
Heavy Slow Resistance (HSR): 3–4 sets, 6–8 reps, 3-sec tempo. 2-3x a week
As time goes on and you start to feel better, it’s important to continue to build up strength with heavier weight less frequently.
At this point you can expect to feel better with only slight pain with higher intensity movements.
Physical Therapy
Tennis elbow is painful. You will likely ignore the discomfort and hope it will go away and in mild cases it will. Once you can’t grab your cup of coffee or water tumbler without sharp pain, you will decide to get help from physical therapy.
Physical Therapy will make an accurate diagnosis and determine if you have other contributing factors such as neck pain referring to the elbow, weakness in your shoulder, or limited mobility putting more stress on your elbow.
During the first phase of rehab when pain level is high, specific techniques such as muscle scraping and dry needling can help reset the pain cycle getting you feeling better faster.
A good physical therapist will also help you with activity modification and make suggestions on changes in frequency, duration or intensity of tasks that cause sharp pain on the outside of your elbow.
How Long Does Tennis Elbow Take To Heal?
Lateral Elbow Tendinopathy healing time will vary based on the type and how severity. Simple tendonitis can go away quickly with rest and time, more chronic cases with tendon degeneration can take much longer.
Mild Cases- 4-8 weeks
Moderate Cases- 3-6 months
Severe Cases- 6-12 months
Research is clear that over 90% of people with Tennis Elbow have a full resolution in symptoms after 12 months. So even if you stopped reading this post and did nothing, your elbow will most likely feel better in a year.
Common Mistakes with Tennis Elbow
1. Only using a Tennis Elbow Brace
Using a brace without a change in activity modification or targeted exercises is unlikely going to let the tendon fully heal over time.
2. Stretching and Not Strengthening
Stretching the muscles can definitely help temporarily decrease pain in your Tennis Elbow but the longer you have pain, the more important it is to fully strengthen and build Tissue Capacity of the tendon.
This is also the best way to prevent Tennis Elbow from coming back.
3. Getting a Shot as the Only Treatment
A local injection like a cortisone shot is sometimes required if your pain does not resolve with activity modification, bracing, and targeted exercise. While it does a great job decreasing local pain, if you don’t work on building up your Tissue Capacity you have a high likelihood of reinjury leading to degenerative breakdown of the inside of your tendon.
If you do get a shot, do the strength work. You will thank yourself 10 years from now.
Key Takeaways
Tennis elbow is caused by an imbalance between what your tendon can handle (tissue capacity) and the stress you place on it.
Tennis Elbow is more likely to occur as you age
Complete rest slows recovery — controlled movement and progressive loading rebuild tendon strength.
Stretching or bracing alone won’t fix the problem — strength is the real solution.
Ready to Get Rid of Your Elbow Pain?
If elbow pain is stopping you from enjoying workouts, golf, pickleball, or even daily tasks — let’s fix it before it becomes a long-term issue.
At REV Health and Wellness, we specialize in helping active adults restore strength, move better, and get back to doing what they love — without unnecessary visits or downtime.
Book your Free Strategy Call today. We’ll talk about your goals, identify what’s really causing your pain, and create a clear plan to get you back to full strength.
Dr. Ryan
