Tennis Elbow: What It Is, Why It Happens, and How to Treat It

Despite the name, most patients we see for tennis elbow don't play tennis. Carpenters, manual labourers, gym-goers doing repetitive push-ups and dips, and desk workers using a mouse all day — they all show up with the same problem. Here's what's actually happening and what works for it.

What tennis elbow actually is

Tennis elbow — clinically called lateral epicondylitis or, more accurately these days, lateral epicondylopathy — is a tendon problem at the outside of the elbow. Specifically, it's at the origin of the extensor carpi radialis brevis muscle, one of the muscles that extends your wrist.

Try this: hold your arm out, palm down. Now point your fingers to the ceiling. That upward motion is wrist extension. Repeat that motion thousands of times under load — like in a tennis backhand, hammering nails, or running power tools — and the tendon at the elbow takes the strain.

Why "-itis" is misleading

It used to be called tendonitis, implying inflammation. The newer research shows that's mostly wrong. Long-standing tennis elbow isn't really an inflammatory problem — it's degenerative. The tendon itself starts to break down at a microscopic level. Blood supply changes, muscle coordination changes, and the tendon doesn't heal the way you'd expect simple inflammation to heal.

This matters because the treatment that works for inflammation (rest, ice, anti-inflammatories) often isn't enough on its own for this condition.

What causes it

Repetitive wrist extension and forearm rotation, especially under load. Common scenarios:

• Racquet sports — tennis, squash, badminton, pickleball
• Gym work involving lots of dips, push-ups, chin-ups, or grip-heavy lifts
• Manual trades — carpentry, especially with power tools
• Long hours of typing and mouse use, particularly with poor wrist posture
• Sudden increase in any of the above without time to adapt

Underneath the obvious cause, there's almost always a movement issue further up the chain. If your shoulder blade doesn't stabilize well, your forearm muscles end up doing more work than they should. That extra strain shows up at the elbow.

What the symptoms look like

• Sharp pain on the outside of the elbow
• Pain that gets worse with grip activities — opening jars, shaking hands, picking things up
• Reduced grip strength
• Pain when extending the wrist against resistance
• Often gradual onset; sometimes it shows up after a single overuse session

What actually works

Here's what we use at our Burlington clinic, in roughly the order we'd typically work through them:

1. Stop aggravating it. The hardest step, especially for athletes. Some time off — or significant modification — is usually necessary.
2. Bracing, fitted properly, for 4-6 weeks. We adjust style and frequency based on your specific case.
3. Hands-on physiotherapy — manual therapy and soft tissue work targeting the overworked extensor group, plus the upstream contributors.
4. Acupuncture. The evidence is reasonable here, especially with 2 visits per week for 3-4 weeks.
5. Progressive loading exercises. Eccentric and isometric work for the wrist extensors has the strongest research support.
6. Address the upstream movement issues. Scapular control, shoulder mobility, postural patterns. Without this, the elbow keeps getting overloaded.
7. If those don't work after a fair trial: anti-inflammatories (under your physician's direction), corticosteroid injection, or PRP injection. These are tools for stubborn cases — not first-line.

The assessment matters

If a healthy athlete develops tennis elbow, the cause usually isn't the obvious one. Volume might be a factor, but more often it's something about how they're moving — poor scapular stability, inefficient grip mechanics, postural habits that put the wrist in a stressed position.

A proper assessment finds those upstream issues and corrects them. Without that, the elbow keeps flaring up no matter how much rest and bracing you do.