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Tennis Elbow aka Lateral Epicondylitis

You don't have to be Rafael Nadal to get tennis elbow. This condition can be caused by the backhand in tennis but also repetitive gripping, twisting of forearm and lifting. Even repetitive mousing while working on a computer can cause tennis elbow.

It is called tennis elbow since it is very common in tennis due to the backhand. This puts excess strain on the forearm extensor muscles, particularly the extensor carpi radialias brevis or ECRB for short. This can lead to microtears of the tendon and subsequent inflammation. The inflammation of the tendon will lead to pain. If left to heal on its own properties of the tendon change leading to weakness and stiffness of the tendon. At this point the patient is stuck in a cycle where every time they use the arm and stress the tendon they are in pain. This is no longer a tendonitis. This is known as a tendinopathy and is very common.

During the acute stages a physiotherapist can tape the elbow to reduce strain on the tendon to promote healing. Once swelling and pain have improved, manual techniques such as Mulligan mobilizations, joint manipulation and friction massage can be beneficial. A physiotherapist will also teach a home exercise program of stretching and strengthening to improve flexibility and strength of the forearm.

If you have had tennis elbow for awhile you may have a tendinopathy as decribed above. A tendinopathy rarely involves inflammation (Kahn and Taunton, 2000). This explains why rest, ice and anti-inflammatories don't work well at this stage. One form of exercise that has been shown to help is eccentric training of the elbow and forearm to improve strength of the tendon. Eccentric exercises place emphasis on the lowering movement of an exercise. This requires the control of the weight or resistance as the weight is lowered. The eccentric phase of exercise has been shown in research to increase the strength of the tendon. This is known as remodeling the tendon. Over time the tendon will be more flexible and stronger and able to handle more load and stress with less pain.

To make this condition a bit more confusing, a pinched nerve in the neck can cause the feeling of elbow pain. C5/C6 can refer to the outside of the elbow giving the impression that a person has tennis elbow. A physiotherapist will always assess the neck first to rule out this neck issue and make a diagnosis of tennis elbow.

So as you can see the diagnosis and treatment of tennis elbow is not straight forward. Our Physiotherapists will perform a detailed examination to determine the cause of your elbow pain and formulate the right treatment plan specific to you.


Kahn, K and Taunton, J. The Physician and Sports Medicince. Vol 28 (5); May 2000.

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