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What is tennis elbow?
Craig Smith
By Craig Smith
Nottinghamshire CCC physio

Tennis elbow may sound amusing, but it's not an injury to be laughed at.

It is a very painful injury that occurs to the outside of the elbow where the tendons that cock the wrist become inflamed.

These tendons attach to the bony part of the outer elbow bone called the "lateral epicondyle".

The scientific name for the injury is "lateral epicondylitis", meaning inflammation to the outside elbow bone.

But we refer to it as tennis elbow as it's mainly suffered by - surprise, surprise - tennis players.

Tim Henman has suffered from tennis elbow
When I was about 12, I had a problem with my elbow and I didn't play at all for six months
Tim Henman

It's caused by the repetitive nature of hitting thousands and thousands of tennis balls.

Tiny tears develop in the forearm tendon attachment at the elbow.

The pain starts slowly but increases to a point where hitting the ball, especially a backhand shot, becomes just about impossible.

If you rest your arm when the discomfort first appears, then these micro tears will heal.

However, if you keep on playing, the micro tears will become bigger eventually causing pain and swelling that prevents you from hitting a ball completely.

Pain can stretch down your forearm to your hand and simple things like holding a cup of tea or carrying your bag become painful, forcing you to use your other hand.


The first thing to do is rest from tennis to allow the micro tears to heal.

The main cause for the injury is playing too much, so you'll have to cut out ball-hitting altogether.

Other reasons may be equipment-related, such as too large a handle or a racquet that's strung too tightly.

These things may need minor adjustments from your coach.

The best treatment for tennis elbow is a combination of:

  • Ice to reduce swelling
  • Anti-inflammatory tablets from your doctor
  • Soft tissue massage to the tight forearm muscles and the injured tendons once the pain has gone down
  • Stretching the forearm muscles to help blood flow and tissue-healing ultrasound therapy
  • Strengthening exercises for the forearm muscles and tendons

    Sometimes top tennis stars require cortisone injections or an operation if the injury doesn't respond to rest and physiotherapy.

    Strengthening your forearm muscles that grip the racquet and stiffen the wrist during backhand shots should help to prevent the injury from happening again.

    Stretch the forearm muscles and tendons when warming up.

    You may want to try an elbow brace to take the pressure off the injured tendon.

    Technique adjustments may also help.

    For example, try playing the backhand shot more from the shoulders and less from the wrist.

    Also, try to reduce the amount of straight arm shots by bending your arm at the elbow.

    This will bring the shoulder and arm muscles more into play and take the pressure off the wrist and forearm muscles and tendons.


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