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Tennis Elbow (Lateral Elbow Tendinopathy)

Tennis elbow (AKA Lateral Elbow Tendinopathy or Lateral Epicondylitis) is a common cause of pain on the outside of the elbow. Despite the name, you don't need to play tennis to develop it. Repetitive gripping, lifting, tools, gym exercises, racquet sports and other activities that load the forearm muscles can all contribute. 

Dr. Michael Hoiles has prepared this page as a resource to help you better understand tennis elbow, what commonly causes it, and the steps that can help you return to work, exercise and the activities you enjoy. 

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Quick Facts 

✔ Tennis elbow causes pain and tenderness on the outside of the elbow. 

✔ It commonly hurts with gripping, lifting and twisting movements. 

✔ It is usually related to repeated or increased loading of the forearm tendons. 

✔ Complete rest is rarely necessary—activity can usually be modified while the tendon recovers. 

✔ Progressive strengthening is an important part of rehabilitation. 

✔ Persistent cases can take several months to fully settle. 

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Medical anatomy illustration comparing tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis), showing the affected tendon attachment areas on the outer and inner sides of the elbow.

Anatomy 

Several muscles that extend the wrist and fingers originate from a common tendon on the outside of the elbow near the lateral epicondyle. 

Tennis elbow most commonly involves this group of tendons, particularly where they attach near the outer elbow. When the tendon is exposed to more load than it can tolerate, it can become painful and less able to handle gripping and repetitive arm movements. 

Pain on the inner side of the elbow may instead be related to golfer's elbow, which affects a different group of forearm tendons.

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What Is Tennis Elbow? 

Tennis elbow is also called lateral elbow tendinopathy or lateral epicondylitis. It develops when the tendons on the outside of the elbow become painful and sensitive to load. 

It often develops gradually after repetitive activity or a sudden increase in gripping, lifting or exercise. Tennis is one possible cause, but many people with tennis elbow have never played a racquet sport. 

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​​Common Causes & Risk Factors:

  • Repetitive gripping or lifting 

  • Racquet sports 

  • Weight training 

  • Manual or trade work 

  • Repetitive use of tools 

  • Repeated wrist or forearm movements 

  • A sudden increase in activity or training 

  • Returning to an activity after time away 

  • Poor load management or insufficient recovery 

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Common Symptoms 

  • Pain on the outside of the elbow 

  • Tenderness over the outer elbow 

  • Pain extending into the forearm 

  • Pain or weakness when gripping 

  • Discomfort lifting objects 

  • Pain opening jars or turning handles 

  • Pain during racquet sports or weight training 

  • Reduced tolerance for repetitive arm activity 

Tennis elbow is one of several conditions that can cause elbow pain, and the location of symptoms can help distinguish it from other elbow problems.

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What Makes Tennis Elbow Worse?

Tennis elbow is usually aggravated by activities that repeatedly load the muscles and tendons on the outside of the forearm. Common triggers include:

  • Repetitive or forceful gripping

  • Lifting with the palm facing downward

  • Heavy pulling or carrying

  • Wrist extension against resistance

  • Racquet sports

  • Repetitive use of tools

  • Certain weight-training exercises

  • Suddenly increasing training or workload

You don't necessarily need to avoid these activities completely. Temporarily reducing or modifying painful movements while gradually rebuilding strength is often more helpful than prolonged rest. ​

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What Helps? 

Most cases can be managed conservatively. Treatment may include: 

  • Temporarily modifying aggravating activities 

  • Gradually rebuilding tendon strength 

  • Forearm and wrist exercises 

  • Adjusting lifting or gripping technique 

  • Manual therapy when appropriate 

  • A temporary brace or strap in selected cases 

  • Gradual return to sport or training 

  • Shockwave therapy for some persistent cases 

The goal is usually to reduce excessive irritation without completely avoiding activity, then gradually increase the tendon’s ability to tolerate load. 

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How Chiropractic Care Can Help 

Treatment should address more than just the painful area. 

Depending on your assessment, chiropractic care may include: 

  • Manual therapy to the elbow and surrounding joints 

  • Soft tissue treatment for the forearm muscles 

  • Advice on modifying painful activities 

  • Progressive wrist and forearm strengthening 

  • Grip-strength rehabilitation 

  • Assessment of the shoulder, wrist or neck when relevant 

  • Guidance for returning to work, gym activity or sport 

The emphasis is on restoring function while gradually increasing the amount of load the elbow can comfortably tolerate. 

 

Shockwave Therapy for Tennis Elbow 

For persistent or chronic tennis elbow, shockwave therapy may be considered as part of a broader rehabilitation program. 

Shockwave applies controlled acoustic pulses to the affected tendon and is generally combined with progressive strengthening and activity modification rather than used as a stand-alone treatment. 

It may be most appropriate when symptoms have persisted despite a reasonable period of conservative care. 

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Recovery Timeline 

Recovery varies depending on how long symptoms have been present and how heavily the tendon is being loaded. 

  • Mild cases: may improve over several weeks. 

  • Moderate cases: often require several weeks to a few months of progressive rehabilitation. 

  • Persistent cases: can take several months or longer to fully settle. 

Tendons often improve gradually, so consistent rehabilitation is usually more important than trying to eliminate symptoms immediately. 

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Exercises Commonly Recommended 

Phase 1 – Reduce Irritability 

  • Isometric wrist extension 

  • Gentle wrist mobility 

  • Forearm stretches 

  • Light pain-free gripping 

Phase 2 – Build Strength 

  • Wrist extension with resistance 

  • Eccentric wrist extension 

  • Forearm pronation and supination 

  • Progressive grip strengthening 

Phase 3 – Return to Activity 

  • Heavier wrist extensor strengthening 

  • Loaded gripping exercises 

  • Functional lifting 

  • Sport- or work-specific exercises 

Exercise selection and progression should be adjusted to your symptoms and activity goals. 

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Can I Still Exercise With Tennis Elbow? 

Usually, yes. 

You may need to temporarily reduce exercises involving heavy gripping, pulling or repetitive wrist movements. Training can often continue by adjusting weight, volume, grip or exercise selection. 

As symptoms improve, these activities can gradually be reintroduced. 

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When To Seek An Assessment 

Consider an assessment if: 

  • Symptoms aren't improving 

  • Pain is interfering with work or exercise 

  • Grip strength is noticeably reduced 

  • Pain keeps returning 

  • You aren't sure whether the pain is actually coming from the elbow 

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Common Mistakes That Slow Recovery 

  • Completely resting the arm for long periods 

  • Repeatedly testing painful gripping 

  • Returning to heavy lifting too quickly 

  • Ignoring training or workload changes 

  • Progressing exercises too aggressively 

  • Stopping rehabilitation as soon as pain improves 

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When Should I worry?  

Seek appropriate medical assessment if elbow pain follows significant trauma or is associated with marked swelling, redness or warmth, fever, significant weakness, persistent numbness or tingling, or a sudden inability to use the arm normally. 

 

Frequently Asked Questions 

Do you have to play tennis to get tennis elbow? 
No. Many cases are related to work, gym activities, repetitive gripping or other everyday activities. 

 

Should I completely rest my elbow? 
Usually not. Temporarily reducing aggravating activities while gradually rebuilding strength is generally more useful than prolonged rest. 

 

Can I still lift weights? 
Often yes, although exercises, weight and grip may need to be modified temporarily. 

 

How long does tennis elbow take to heal? 
Some cases improve within weeks, while persistent tendon problems can take several months or longer. 

 

Does a tennis elbow brace help? 
A brace or forearm strap can temporarily reduce symptoms for some people but should generally be used alongside rehabilitation. 

 

Can shockwave therapy help tennis elbow? 
It may be considered for persistent cases, particularly when symptoms haven't responded adequately to exercise and other conservative treatment. 

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Summary 

✔ Tennis elbow causes pain around the outside of the elbow. 

✔ Gripping, lifting and twisting are common aggravating activities. 

✔ Most cases can be managed without surgery. 

✔ Staying active while modifying painful activities is usually encouraged. 

✔ Progressive strengthening is an important part of recovery. 

✔ Persistent symptoms may benefit from assessment and a structured rehabilitation program. 

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Ready to Get Back to Moving Comfortably?

If elbow pain is limiting your work, workouts, sports or everyday activities, an assessment can help determine what is contributing to your symptoms and the most appropriate approach to recovery. 

Dr. Michael Hoiles is a Calgary chiropractor who provides evidence-informed care combining hands-on treatment, exercise-based rehabilitation and practical advice to help people recover from injury, move better and stay active. 

Book an appointment today to start your recovery and get back to the activities you enjoy. ​

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