Tennis Elbow - Lateral Epicondylitis

Elbow Pain from Lateral Epicondylitis, Tendonitis, and Tendinopathy

Woman with ice pack on elbow
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Tennis elbow, also referred to as lateral epicondylitis, is a common cause of elbow pain in athletes. Tennis elbow is considered a cumulative trauma injury that occurs over time from repeated use of the muscles of the arm and forearm.

The pain of tennis elbow is thought to be related to small tears and damage to the tendons that attach muscles of the forearm to the lateral epicondyle of the elbow. In most cases of chronic elbow pain, it is believed to be due to tendinopathy rather than tendinitis.


More frequently, physicians are using the term tendinopathy to describe the classic pain of tennis elbow. Tendinopathy is a term used to describe tendon injuries due to long-term overuse, and deterioration of the tendon rather than an acute injury that causes inflammation of the tendon. The distinction is important because the inflammation of tendinitis is treated differently than tendinopathy. Inflammation in tendinitis typically responds quickly to medication or anti-inflammatory treatment. However, with chronic tendon injuries due to degeneration, treatment may be quite lengthy and focuses on improving the strength of the tendon and rebuilding tissues.


In racket sports, overuse of the forearm extensor muscles, particularly the extensor carpi radialis brevis, along with repeated impact can increase the risk of tennis elbow. Other factors that may contribute to tennis elbow include lack of strength, poor technique, and increases in duration or intensity of play.

There is some concern about racket string tension leading to higher impact forces on the forearm muscles, which may increase stress on the tendons. Although some believe racket grip size can reduce tennis elbow, there is little evidence to support the theory. (See: Tennis Elbow Linked To Technique Not Grip Size).

In some cases, damage to the tendon is caused by a direct impact which causes the muscles and tendons to partially tear.


Pain on the outside of the elbow, usually during or after intense use, is the first sign of tennis elbow. In some cases, lifting or grasping objects may be difficult, and some have pain that radiates down the arm.


Rest is the first treatment for tennis elbow. Stop all activities that cause the pain and use the RICE treatment method to reduce pain and swelling. Conservative treatments are often all that is needed for a full recovery of a tendinitis which usually resolves in a few days to a few weeks.

If tennis elbow pain is due to a deterioration of the tendon (tendinopathy), it can take from two to six months to fully recover. Many cases of lateral epicondylitis become chronic problems that progressively get worse if the athlete continues activity despite nagging elbow pain.

If elbow pain lasts more than a few days despite rest and conservative treatment, you should see a physician for an evaluation and referral to physical therapy.

A physical therapist may use ultrasound or other modalities to help heal tendinopathy. The specific rehab for lateral epicondylitis depends upon the exact cause of the injury and the diagnosis. However, the most common rehab methods include ultrasound, medications, massage, braces or splints.

Once the tendon has healed, strengthening and flexibility exercises may be prescribed. Your therapist will help determine the best rehab path for you. Keep in mind that beginning any exercises before the tendon has healed may make the problem worse, so follow your therapist or physician's recommendations.

Anti-inflammatory medication may help reduce inflammation and pain in some cases of tendinitis. If you have a particularly difficult or severe case, your physician may consider using cortisone injections to help relieve the discomfort.

Eccentric Exercise May Relieve Tennis Elbow Pain

A recent development in the treatment of tennis elbow and other tendon injuries, such as Achilles tendonitis has focused on specific eccentric exercises targeting the involved muscles and tendons. Eccentric contractions are those in which the muscle lengthens as it contracts.

One simple exercise has been showing promising and immediate results for many tennis elbow sufferers. The exercise is a simple eccentric wrist extensor movement using a flexible rubber bar. The exercise involves twisting a rubber Flexbar with one hand and resisting the bar as it untwists using the injured arm. The result is an eccentric contraction of the wrist extensor muscles on the injured forearm. One well-publicized study found positive outcomes when patients performed three sets of five repetitions each day and increased to three sets of fifteen repetitions every day over time.

  • Watch a video of the exercise on YouTube.

Research continues to support the notion that eccentric exercises are effective in treating tendon injuries such as Achilles tendonosis, tennis elbow and golfer's elbow.

Because recurrence of this condition is common, return to activity should not occur too quickly, and preventive exercises that stretch and strengthen the muscles should be done consistently.

Surgery for Tennis Elbow

If these conservative and nonsurgical forms of treatment do not work, surgery may be recommended as a final option. A hand specialist may offer advice regarding potential treatments and the possible outcomes for surgery. Left untreated, lateral epicondylitis is often a nagging or chronic condition that may progressively get worse and require many months to heal. Prompt diagnosis and treatment are important for anyone suffering from elbow pain.


Whether your elbow pain is from tendonitis or tendinopathy, immediate treatment should include rest. If you can determine the cause of the injury and make a correction, that is your next move. If your pain is from overuse, reduce or stop that activity and find a substitution. If the pain is from poor sports technique or poor form, consult a coach or trainer for skills training. If you can eliminate the offending factors, you have a much greater likelihood of a quick and full recovery.

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Article Sources

  • American Academy of Orthopaedic Surgeons, Patient Information, Tennis Elbow (Lateral Epicondylitis).
  • Coombes, et al. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. The Lancet, Volume 376, Issue 9754, Pages 1751 - 1767, 20 November 2010
  • Jobe, et al. "Lateral and Medial Epicondylitis of the Elbow" J. Am. Acad. Ortho. Surg., Jan 1994; 2: 1 - 8.
  • Regan, et al. Tendinopathies around the elbow. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2009. . Accessed Jan, 2011