Tennis elbow is a painful condition that affects athletes most often, especially those that use their arms frequently and in repetitive ways, like tennis players and golfers. Tennis elbow (the common name for the condition known as lateral epicondylitis) is caused by inflammation around the elbow, which causes stiffness, swelling, joint pain and trouble moving the arm normally.
Tennis elbow affects about 3 percent of Americans every year, especially those between the ages of 30 to 50, and it much more likely to develop in someone’s dominant arm. (1)
Key Facts About Tennis Elbow:
- Tennis elbow is characterized by pain around the elbow and forearm, especially following an injury or overuse. This causes damage to the tendons/joints around the elbow and forearm, and can also impact your ability to move your wrists or hands normally.
- Although tennis elbow is most common in tennis players (hence the name) and those who play similar sports like racquetball or squash, it also affects non-athletes, too. In fact, some research shows that only 5 to 10 percent of people suffering from tennis elbow even play tennis. (2)
- Anyone who overuses their arms can develop tennis elbow symptoms, especially if daily activities put a lot of stress on the arms.
- Most people will only experience tennis elbow in one arm, whichever one is dominant.
- It usually takes months for tennis elbow to develop before you’ll notice symptoms. At this point, pain can become intense.
- Once inflammation increases and symptoms set in, resting, icing, stretching and exercising the area are the best ways to start the healing process.
6 Natural Tennis Elbow Treatments
1. Use the “RICE Method” First (Rest, Ice, Compression & Elevation)
Once tennis elbow symptoms have become bad enough to cause you noticeable pain, the first step is to rest the area and stop repetitive movements that caused the condition in the first place. (3) You can use ice early on (especially following an injury) to help control swelling. Ice is most helpful within 24 to 48 hours after swelling sets in.
Try icing the elbow and forearm for 15 to 20 minutes at a time, several times per day. Compression and elevation also help keep inflammation from getting worse. It can helpful to temporarily wear a bandage, splint or brace to keep the inflamed tendon from becoming too swollen. Try tightly wrapping the area while also elevating it to reduce blood flow.
Once you do resume working out, be sure to rest properly between workouts. Rest is crucial for allowing worn-down tissue to repair itself. In fact, in between workouts is when we actually grow stronger.
2. Perform Tennis Elbow Exercises and Stretches
It might seem counterintuitive, but in most mild-to-moderate cases of tennis elbow, moving the arm and elbow carefully can actually help break up stiffness and resolve symptoms. In other words, it’s not necessary, or even beneficial, to totally immobilize the arm or elbow if you’re diagnosed with tennis elbow (unless you have severe inflammation). With severe damage and inflammation around the elbow, swelling will likely cause arm immobility.
Dr. Ernest W. Johnson, an American physiatrist from Ohio State University, initially created muscle-strengthening exercises and programs for tennis below. He showed that eccentric and concentric movements of the wrist can help relieve pain by stopping the production of a dense collagenous scar in the attachment area between the elbow muscle and joint/tendon. (4)
As long as you’re able to move your arm, try gently stretching and exercising the area to help break up tissue adhesions that actually make tennis elbow worse. At the same time, you want to be careful not to overexert the painful area. Always start these stretches and exercises slowly and be patient. Initially, aim to put the least amount of pressure on the elbow while still stretching it, and then increase resistance as time goes on. Keep an eye on your level of pain and only progress as your strength improves and symptoms decrease.
Stretches and exercises for tennis elbow include:
- Eccentric wrist stretch: Rest your forearm down on a table with your wrist hanging off the edge, palm up. Hold a very light weight (5 pounds or less) in your hand. Drop and lift your wrist slowly. Perform 10 repetitions, 3 times every other day. (5)
- Forearm extensor stretch: Keep your affected wrist bent in front of you. With your unaffected hand, reach over and grab the fingers of your affected hand, then pull them back to stretch the forearm. Hold for 30 seconds and perform twice daily.
- Tricep stretch: Bend your affected arm behind your back and put light pressure on the elbow using your good arm. Hold for 30 seconds and perform 3 times every other day.
- Ball squeeze hand-strengthener: Hold a tennis ball (or similar ball) in your hand. Practice gripping and squeezing. Start by squeezing for 3 second increments at a time, then work your way up to 10 seconds.
- As your strength increases, you can begin traditional bicep curls and hammer curls to keep the forearms strong.
A 2010 report published in the North American Journal of Sports Physical Therapy found that a new device called the FlexBar® could be used to perform exercises for tennis below. Researchers found that the bar could be even more effective than physical therapy or doing exercises on your own. In the study, patients used the Flexbar to perform 3 sets of 15 exercises each day, gradually gaining strength before increasing resistance intensity. On average, symptoms went away within 7 weeks. The study also found that patients performing the FlexBar exercises in addition to standard physical therapy enjoyed significantly more improvements than the group receiving only standard PT. (6)
3. Try Egoscue
The Egoscue Method focuses on a series of gentle stretches and exercises to correct misalignments in the musculoskeletal system that contribute to pain and poor posture. Egoscue helps reduce tendon or joint pain by focusing on proper form when exercising or using various muscles. In fact, according to Egoscue theory, improper form is the real reason for tennis elbow, even more so than overuse.
In the case of tennis elbow, Egoscue focuses on correcting form of the shoulder, back and forearm muscles so that the elbow joints don’t become compromised and lose their full range of motion. Egoscue exercises for tennis elbow are relatively easy to remember and easy to practice at home. No matter what type of activity you’re doing, learning proper form and posture though Egoscue helps you better protect yourself from future injury and future pain.
4. Consider Acupuncture Treatments
Acupuncture is a holistic health technique that stems from traditional Chinese medicine. It helps reduce pain by stimulating specific points on the body through the insertion of very thin, practically-painless needles. Studies show that compared to control groups, patients receiving acupuncture treatments report less pain, including fewer muscle aches and pain, osteoarthritis symptoms, and chronic headaches.
A 2001 study published in the Journal of Rheumatology found that after 2 weeks of acupuncture treatments, patients with tennis elbow experienced significant reductions in pain intensity. They also experienced better improvements in arm function compared to a control group. Even after 2 months, the acupuncture group continued to have better function than the group that didn’t receive acupuncture treatments. (7)
Similarly, acupuncture focuses on addressing the flow of energy around the body and bodily organs, dry needling focuses on stimulating a specific trigger point that is leading to pain and disability.
5. Control Pain Naturally
Other than icing the painful elbow, certain essential oils can help improve your condition and dull pain. For example, cypress essential oil works by improving circulation. Helichrysum oil helps repair damaged nerve tissue. Peppermint essential oil can also reduce pain, while frankincense increases healing by decreasing inflammation.
To use essential oils, mix several drops of one of the oils above with a carrier oil (like coconut oil) and apply the mixture to painful areas topically 3 times daily.
6. Manage Inflammation With a Healthy Diet
To help keep inflammation levels low, avoid processed foods including: added sugar, high-sodium foods (which increase water retention), foods high in saturated and refined fats, alcohol and processed grains (especially gluten-containing foods).
Anti-inflammatory foods that help your body repair damaged tissue include:
- All types of vegetables, especially green leafy greens
- High-quality “clean” proteins like wild-caught fish, raw dairy, cage-free eggs or grass-fed beef
- Berries, citrus fruits, melon and pineapple
- High-potassium and magnesium foods, including coconut water, avocados, greens, sweet potatoes and bananas
- Bone broth, which contains collagen to improve tissue health
The Causes of Tennis Elbow
Medically speaking, tennis elbow affects more than simply the elbow joint: It refers to inflammation and pain around the entire elbow, the joints and tendons in the mid-arm and even the forearm or wrist. For this reason, some doctors call tennis elbow by another name: “lateral elbow pain syndrome,” which might be a more accurate description of how the pain sometimes spreads outward from the elbow.
How do the joints and tendons around the elbow become damaged and inflamed?
- Tendons and joints are made of flexible, string-like tissues that connect muscles to bones. Repeatedly using tendons and joints can lead to strains, tears or inflammation because the tissue forming them becomes degenerated and worn-down over time (meaning the tissue experiences micro tears) (8)
- An injury to a tendon is called “tendinopathy.” In the case of tennis elbow, the tendon that is injured is the extensor carpi radiaslis reavis (or the ECRB). (9) The ECRB tendon controls movement of the wrists when the elbow is straight. If the elbow is straightened and bent over and over again, the tendon can become overworked. This is why tennis elbow is really a form of tendonitis.
- Inflammation then develops around the outer elbow muscle and tendon as your body’s way of attempting to heal these tiny tissue tears. The damaged tendon sometimes starts leaking fluid and even collagen, increasing inflammation. Sometimes the area forms hardened tissue to fix the damage.
- Tennis elbow is most common in people who use their elbows in the same manner day after day, for many weeks or months on end. For atheletes, it often affects people who don’t rest enough between workouts.
- Adults with professions that require consistent use of the upper arms and repeptitive movements are especially prone to developing tennis elbow. This includes athletes, personal trainers, gardeners, painters, auto workers, landscapers, carpenters, cooks or butchers and plumbers
- Even if your job doesn’t require much use of your elbows or arms, if you spend a lot of time typing on the computer, knitting, cooking, painting or playing an instrument, it’s still possible to suffer from tennis elbow.
Symptoms of Tennis Elbow & Diagnosis
Symptom of tennis elbow commonly include: (10)
- Pain, tenderness and swelling around the elbow. Some people find that pain is the first in the morning after getting up
- Shooting or intense pain that carries over to other parts of the forearm, especially when moving the arm
- Trouble moving the wrist normally and stretching the hand
- Pain when picking things up, gripping objects, typing on a computer and putting pressure on the lower arms in other ways
Usually symptoms of tennis elbow will develop slowly as more micro tears develop in the elbow’s tendon. At first, you might not notice this process happening, but at some point you’ll feel tenderness, especially when repeatedly moving the elbow. Many people with tennis elbow experience a weakening in their grip (like when they are holding a tennis racket or golf club); others have trouble picking up everyday things, like a toothbrush or phone.
Diagnosing Tennis Elbow:
Some experts recommend you perform a simple test to see whether you’re experiencing inflammation related to tennis elbow. If thes movements below trigger pain, there’s a good chance you have tennis elbow symptoms and can benefit from the treatment tips described below.
- First, place your palm down on a hard surface, cover your fingers with your other hand, and then lift the forearm. This stretches the wrist and will cause pain if you have tennis elbow.
- Flex your wrist back and forth, directing the fingertips up and then down, while observing any pain.
- Pick up several light things that would normally be easy while moving your wrist around. Observe any pain.
While you can always visit your doctor to get advice, keep in mind that many people resolve tennis on their own using natural treatments. With proper care, the body is usually able to repair minor to moderate injuries itself, without the need for medications, surgery or intense interventions. A good rule of thumb is to visit your doctor or physical therapist if the pain does not subside after 4 to 6 weeks of trying the natural remedies mentioned earlier.
Tennis Elbow Complications & Precautions
If left untreated, long-term damage caused by tennis elbow can cause chronic pain and loss of range of motion. One thing to mention here is that there’s a chance you could actually be suffering from “golfer’s elbow” (medial epicondylitis) and not actually tennis elbow.
Tennis Elbow vs. Golfer’s Elbow:
The two are very similar in terms of causes and symptoms, although there are some differences. Ultimately, you will want to manage and treat both problems the same way, but it’s still important to know which condition you have. The biggest difference is that in tennis elbow, the tendons affected attach to the outer (lateral) side of your elbow. They are used mostly when extending the wrist back. Golfer’s elbow affects tendons connected to the inner (medial) side of your elbow. They are most often used when flexing your wrist forward. (11)
If you’re wondering about surgery for tennis elbow, here’s what you need to know: (12)
- Surgery for tennis elbow usually is unnecessary because the tendon should be able to heal with rest and nonsurgical treatments.
- Still, tennis elbow doesn’t go away with rest and the treatments described above, some doctors recommend surgery. This procedure involves cutting (releasing) the tendon and removing the inflamed tissue.
- Recovery for tennis elbow surgery can take up to 6 months and is not always successful. To date, there haven’t been controlled trials that show surgery is better than other treatments.
- Risks of tennis elbow surgery include: loss of ability to straighten the arm, persistent pain, infection, blood loss and side effects due to anesthesia.
Final Thoughts on Tennis Elbow
- Tennis elbow is a condition caused by inflammation around the elbow and forearm. It makes it hard to grip things, go about work normally, pick things up and practice hobbies or sports.
- Tennis elbow is caused by overuse of the forearm, elbow and wrist. This stresses and damages tissue in the elbow joint and tendon. Improper form while exercising or doing other activities can also contribute to tennis elbow symptoms.
- Strategies for treating tennis elbow naturally include resting the area, icing the area to control swelling and stretching/exercising the forearm.
- Acupuncture, Egoscue, physical therapy, a healthy diet and using essential oils can also help reduce symptoms and prevent tennis elbow from reoccurring.