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What is Tennis Elbow? (And Why Some Treatments Keep You in Pain)

Luke Ferdinands


Elbow pain can be from a variety of causes, but if you engage in activities that involve repetitive arm motions, gripping, or lifting, you could be suffering from Tennis Elbow.

You might have been advised to rest and avoid any activity that involves your elbow. But is that really the best approach? As the old joke goes, "The patient says, 'Doctor, it hurts when I do this.' The doctor says, 'Then don't do that!'" That's not how it should be.

In this post, we'll explore why a passive approach to healing Tennis Elbow is not the best strategy, and dive into the more effective strategy: the Alleviate Method.

What is Tennis Elbow?

Tennis Elbow is a common, chronic, and often debilitating condition that affects the elbow tendons. Despite the sport-specific name, it's a repetitive stress injury that can affect anyone.

Many people with Tennis Elbow aren't getting the proven, effective treatment that already exists. Instead, they stop doing what they love or grit their teeth and power through pain for months or years. If this sounds like you, it doesn't have to stay this way. By actively targeting the root cause and building strong defenses against flare-ups, most people with Tennis Elbow can recover fully, faster, and for the long run.

Not Just Tennis Players: Studies estimate that as many as half of tennis players develop this condition , but tennis players account for just 10% of people who develop Tennis Elbow . That's why some experts prefer to use the term Lateral Epicondylitis or Lateral Epicondylosis and avoid the misconception that it's exclusively a tennis injury. These alternate names come from lateral epicondyle, the bump on the outside of your elbow.

Even in the general population, 1-3% of us are affected by Tennis Elbow annually. That's almost 10 million people in the United States alone! This repetitive strain injury can happen to anyone who uses their arms often for activities that involve repetitive motions, especially where the wrist is flexed.

Forearm muscles and tendons involved in Tennis Elbow
Forearm muscles and tendons involved in Tennis Elbow. Image by OpenStax, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons

How Tennis Elbow develops

Repetitive Motion and Microtears: Tennis Elbow often arises due to repetitive wrist and forearm movements like gripping, twisting, or lifting objects. Over time, these activities can cause microtears in the extensor carpi radialis brevis (ECRB) tendon and the surrounding tissues. This repeated microtrauma can lead to inflammation and pain.

Degenerative Changes: When these tiny tears heal, scar tissue forms, leading to a degenerative change in the affected tendons and the tissue around them. Scar tissue formation is a natural way our bodies recover from injuries. However, because scar tissue is weaker, messier, and stiffer than healthy tissue, build-up of scar tissue can reduce the tissue's stress tolerance. The microtears have healed, but the tendon can now take less load. This increased susceptibility creates a vicious cycle of further damage, inflammation, and pain.

Causes of Tennis Elbow and risk factors

Common Causes : Activities that can lead to Tennis Elbow include playing racquet sports, using hand tools, typing on a keyboard with poor ergonomics, painting, cooking, butchering, and other tasks that involve repetitive gripping and wrist movement.

Risk Factors : Aside from specific activities, several factors can increase the risk of developing tennis elbow. These include:

  • Age. Tennis Elbow is more common in adults aged 30 to 50

  • Poor technique or subpar equipment in sports

  • Inadequate warm-up and stretching

  • Pre-existing conditions that affect the elbow or forearm

Symptoms of Tennis Elbow and pain location

Pain outside of your elbow: The main symptom of Tennis Elbow is pain felt on the outer side of the elbow (at the lateral epicondyle, the bony prominence on the outside of the elbow). The pain location of Tennis Elbow is usually concentrated near the ECRB tendon, but it may radiate down the forearm.

Weakening grip: Many people with Tennis Elbow also have reduced grip strength. Holding thin items like a pencil often feels more painful than thicker items like a cup.

How do you know if your elbow pain is Tennis Elbow?

Maudsley's Test : Physical therapists typically use a test called Maudsley's Test to diagnose Tennis Elbow, which is quite easy to self-administer. Here's how to do this simple Tennis Elbow test yourself (with video).

Testing for Tennis Elbow
Testing for Tennis Elbow

The (problematic) common treatments for Tennis Elbow

Wait-and-see Approach: Many doctors recommend a wait-and-see approach to Tennis Elbow, because they often consider the condition mild enough, believing it will improve without treatment. This treatment approach can include resting, stopping activities that cause pain, using pain relief medications, and icing. Few lucky patients get a referral for physical therapy.

There are multiple problems with this passive approach:

  • Resting, pain medications, and icing can provide temporary symptom relief, but they don't actually solve the problem. As soon as you go back to your normal life, the pain can come back because the condition is still there, unresolved.

  • Taking a break from painful activities isn't always possible, particularly when the activities are occupational necessities. Imagine asking a carpenter to stop using hand tools, or a nurse to stop maneuvering patients.

  • The condition may technically be “mild enough,” but bracing yourself for jolts of pain, modifying how you live because of pain, or constantly powering through discomfort is not how we want to live life. It takes a physical, emotional, and social toll, too.

  • Tennis Elbow pain can last for months, if not years, if left untreated. In fact, only about 80% of people with Tennis Elbow recover within a year from the onset of symptoms. In our opinion, that's far too long to live with treatable pain.

An effective treatment method already exists. Developed in physical therapy, the gold standard of Tennis Elbow treatment focuses on root cause resolution, rather than symptom relief. And it works; Tennis Elbow patients who follow the multimodal PT treatment method are more likely to experience real, lasting recovery, rather than temporary relief.

Alleviate was founded to change this status quo, by bridging the gap between the gold standard of care and the care most Tennis Elbow patients actually get.

The Alleviate Method to resolve Tennis Elbow

​Take control of Tennis Elbow at home and get back to doing what you love.
Take control of Tennis Elbow at home and get back to doing what you love.

We developed the Alleviate Method to help people recover from Tennis Elbow in the comfort of their homes, using the current best practices. This method focuses on resolving the root cause of pain, building fundamental defenses against recurrences, and removing guesswork from the path to full recovery.

The Alleviate Method consists of three components: load management, soft tissue mobilization, and progressive strengthening.

  • Load Management: Using a well-designed elbow brace can reduce the stress that goes through the elbow tendons, providing immediate pain relief, both at rest and while using your arm. The Alleviate Elbow Brace is a dual-purpose device that relieves pain and transforms the problematic tissue.

  • Soft Tissue Mobilization: Physical therapists use deep tissue massage to break up scar tissue, increase blood flow, and speed up tissue recovery. The Alleviate Elbow Massager lets you easily replicate this effective PT massage at home.

  • Progressive Strengthening: The ECRB works together with other muscles and tendons to move your fingers, hand, and wrist. By strengthening the whole chain of movement and improving flexibility through the six levels of the Tennis Elbow Guided Recovery Program, you can build a strong foundation that reduces pain now and prevents flare-ups for the long run.

Evidence from physical therapy literature indicates that with the right treatment, most people can recover from Tennis Elbow relatively quickly and fully. With the Alleviate tools, you can do so at home. Reclaim what moves you - we are here to help.

Key Takeaways from "What is Tennis Elbow?"

Tennis Elbow is a common repetitive stress injury of the elbow tendons that affect more than just tennis players.

The common "wait-and-see" approach keeps people in pain for months, but with the proactive, multimodal Alleviate Method, you can treat Tennis Elbow effectively at home.

The Alleviate Method incorporates 1) load management, 2) soft tissue mobilization, and 3) progressive strengthening to resolve the root cause and prevent flare-ups for the long term.

Bring home the Tennis Elbow treatment that works

Alleviate was founded by a patient-and-clinician duo to bring the effective chronic pain treatment from physical therapy offices to everyone's home. With our Tennis Elbow System, you can use the Alleviate Method to recover from Tennis Elbow at home and stay symptom-free. No physical therapy training required!

Luke Ferdinands, physical therapist and Alleviate co-founder

Luke Ferdinands, Physical Therapist & Co-Founder

A New Zealand-trained physical therapist with over 20 years of experience, Luke developed the Alleviate Method to bring the gold standard of physical therapy care to everyone's home. Luke leads the development of physical tools and digital physical therapy content, focusing on driving clinical outcomes for people with chronic musculoskeletal pain conditions like Tennis Elbow, Plantar Fasciitis, Runner's Knee, and more.