Tennis Elbow in Athletes: Symptoms, Causes, Treatment, and Prevention

Tennis elbow is one of the most common upper-limb injuries in active people. Despite it's name, it affects far more than just tennis players. Indeed, there is no shortage of literature online for individuals who develop tennis elbow from their occupations, be it plumbing, carpentry, or even office work. While such resources are perfectly valid, many miss critical points for athletes specifically.

From racquet sport athletes to throwers, or swimmers to regular gym-goers, tennis elbow is an insidious condition that threatens to affect (if not entirely derail) training and performance. Understanding why it happens, how to deal with it, and how to prevent it altogether are key to ensuring big training blocks are not interrupted, enabling you to optimise your athletic performance.

1. What is Tennis Elbow?

Tennis elbow, or lateral epicondylitis, refers to pain on the outside of the elbow, where the extensor tendons in your forearm attach to the bone.

These tendons are responsible for helping control wrist extension and gripping - movements that are common in many sports.

Is Tennis Elbow Actually Inflammation?

Despite its name (-itis typically denotes inflammation), tennis elbow is not always a true inflammatory condition. This is especially true of longer-term cases.

In the early stages, inflammation might involve:

• increased blood flow;

• swelling; and

• heightened nerve sensitivity.

This may cause:

• pain;

• heat;

• tenderness; and

• reduced functionality.

In longer-lasting cases, the condition might more accurately be described as tendinopathy. This involves:

• microscopic tendon damage;

• reduced tissue quality;

• poor healing responses; and

• increased sensitivity of local nerves.

In such cases, pain is driven less by inflammation, and more by repeated overload, poor force distribution, and compensation patterns elsewhere in the body.

Common Symptoms

Athletes with tennis elbow often report:

• Pain or tenderness on the outside of the elbow;

• Reduced grip strength;

• Stiffness; and

• Discomfort while performing such activities as:

  • lifting a cup, kettle, or dumbbell;

  • turning a door handle;

  • opening a jar;

  • shaking hands; or

  • sport-specific movements.

Pain might also spread down the forearm towards the wrist.

A Simple Self-Test

If you're unsure if you have tennis elbow, here's a simple test you can perform at home:

1. Extend your arm straight out in front of you.

2. Ball your hand into a fist.

3. Lift your wrist upwards, against a small resistance if possible.

If this produces pain on the outside of your elbow, you may have tennis elbow. (This is not a diagnosis, but it is a useful clue.)

2. How Athletes (Not Just Tennis Players) Get Tennis Elbow

Tennis elbow develops when the forearm tendons are repeatedly asked to do more work than they can tolerate with insufficient recovery or load-sharing.

Sports and Activities that commonly cause Tennis Elbow:

🎾 Racquet Sports

• Tennis (especially single-handed backhands)

• Squash

• Badminton

Poor technique, gripping the racquet too tightly, or relying heavily on the arm instead of the trunk and hips significantly increases elbow load.

⚾ Throwing Sports

• Baseball

• Javelin

• Cricket

High-speed arm actions place enormous stress on the elbow, particularly when shoulder control and trunk rotation are poorly connected and coordinated.

🏊 Swimmers

• Excessive resistance work (using paddles, for example)

• Overuse of forearm and elbow muscles

• Limited shoulder and core integration

Even without gripping equipment, repetitive loading can irritate the tendon over time, especially with poor pull technique.

🏋️ General Gym-Goers

• Heavy gripping (deadlifts, pull-ups, kettlebells)

• High-volume push/pull programmes

• Poor wrist and/or elbow positioning

• Sudden increases in training load

🧰 Daily and Occupational Load

• Manual or trade work

• Gardening

• Repetitive mouse or tool use

Often, it is not any one activity, but rather the combination of sport, gym, and daily load that tips the tendon over the edge beyond its maximum capacity.

3. What Should You Do If You Have Tennis Elbow?

If the Pain Just Started (First 1-3 Days)

• Reduce aggravating activities

• Avoid heavy gripping and repetitive wrist extension

• Keep the elbow moving gently - complete rest is rarely beneficial

• Ice may help with the pain

If Pain Lasts Longer than One Week

• Begin progressive loading exercises (not total rest)

• Modify sport and gym training rather than stopping completely

• Heat may help stiffness, particularly before movement

• Consider a physiotherapy assessment to guide loading and technique

If Pain Lasts Longer than 3-4 Weeks

Structured rehab is now strongly recommended. At this stage, treatment should address:

• Tendon loading capacity

• Shoulder, trunk, and hip contribution

• Grip strategy and movement patterns

• Neuromuscular control and coordination

When Should You Be Concerned?

Seek professional assessment if:

• Pain is worsening rather than improving

• Pain occurs at night or at rest

• Grip strength is significantly impaired

• There is swelling, redness, numbness, or tingling

• Symptoms persist beyond 4-6 weeks

These may indicate a more complex affliction than simple tennis elbow and warrant a structured, tailored rehab plan.

4. Why Tennis Elbow Keeps Coming Back in Athletes

Many athletes treat tennis elbow by focusing on the elbow alone. While this may create temporary relief, it fails to address the underlying cause.

The Load-Sharing Problem

Efficient athletic movement relies on integrated force transmission, not isolated muscle effort. The body is organised through myofascial meridians - continuous lines of connective tissue that allow force to travel smoothly from the ground, through the trunk, into the upper limbs.

Functionally, the "core" comprises much more than just the abdominals. It includes:

• Chest

• Abdominals

• Adductors

• Lats

• Glutes

• Hamstrings

Together, these structures form the central engine linking lower-body force to upper-body expression.

What Happens When This System Breaks Down?

Many injured athletes can generate power from the ground - they feel their feet and glutes working - but the force fails to transmit effectively through the trunk. Instead, it leaks into smaller structures, including:

• Elbows

• Wrists

• Forearms

• Shoudlers

This leads to:

• Plateaued performance despite increased training

• Slow recovery and recurring flare-ups

• Higher injury risk due to repeated overload of smaller tissues

5. How to Prevent Tennis Elbow (and Improve Performance)

What Pain-Free Athletes Feel

High-performing, pain-free athletes often describe their movement as:

• Initiated from the feet and glutes

• Flowing through the trunk, chest, and lats

• Expressed through relaxed arms and hands

The racquet, barbell, or implement should feel like an extension of the body, not something being forced through space.

The Fascial Advantage

Elite athletes rarely rely on brute strength alone. Instead, they use the elastic properties of the fascia to store and recycle energy:

• From pushing off the ground,

• Through trunk rotation,

• Into ball contact or object control.

This elastic energy transfer allows:

• Higher speeds and power output

• Greater efficiency

• Reduced fatigue

• Lower injury risk

How Physiotherapy Can Help

Rehabilitation and performance training can restore this integrated system. By improving neuromuscular connection and core-fascial awareness, athletes can:

• Increase tendon tolerance

• Reduce elbow strain

• Improve recovery

• Unlock higher performance ceilings

At beMaverick Physiotherapy, we help athletes of all levels reconnect their movement systems, teaching the body how to distribute loads efficiently rather than overworking vulnerable tissues like the elbow. Book your first session now and let us help you be the best athlete you can be!