How to Treat Tennis Elbow (and What Tennis Elbow Actually Is)

If you’ve been noticing sharp or aching pain on the outside of your elbow, especially when gripping, lifting, carrying, or even opening a jar. There’s a good chance you’re dealing with Tennis Elbow, also known as lateral epicondylitis.

Despite the name, you don’t need to play tennis to get it. Most cases occur in people who don’t play racquet sports at all.

The good news: It is very treatable, and most people recover fully with the right rehab plan. At Rival Physical Therapy, we help athletes, active adults, and weekend warriors overcome tennis elbow every single week.

Let’s break down what it is, why it happens, and how to fix it.

What Is Tennis Elbow?

Tennis elbow is an overuse injury of the forearm extensor tendons, especially a tendon called the extensor carpi radialis brevis (ECRB). These muscles help extend your wrist and stabilize your grip.

When these tendons are repeatedly stressed through gripping, lifting, typing, working out, or sports they can become irritated and develop tiny microtears. Over time, this turns into tendinopathy, a degenerative condition that causes pain and reduced strength.

Common symptoms include:

• Pain on the outside of the elbow

• Pain with gripping or lifting objects

• Weakness when carrying anything

• Discomfort when rotating your forearm

• Pain that travels down the forearm

Research shows that tennis elbow is most often a degenerative tendon issue rather than pure inflammation (Coombes et al., 2015, Lancet). That’s why strengthening not rest is key.

Why Does Tennis Elbow Happen?

Some of the most common causes include:

1. Repetitive gripping or lifting

This includes:

• Weightlifting

• Racquet sports

• Pickleball

• Manual labor and carrying

• Typing or mouse work

2. Weakness in the forearm or shoulder

When the wrist and shoulder aren’t strong enough, the forearm takes on too much load.

3. Poor lifting mechanics

Using your wrist instead of your whole arm can overload the tendon.

4. Volume spikes

Sudden increases in training, work demands, or sports participation.

How to Treat Tennis Elbow Yourself

Most cases improve significantly with proper loading and mobility work. Here’s how to start recovering at home:

1️⃣ Start With Activity Modification (Not Rest)

You don’t have to stop using your arm.Instead:

• Reduce painful gripping

• Avoid heavy wrist/finger extension

• Switch to neutral-grip lifting temporarily

Rest alone is NOT a long-term solution.

2️⃣ Build Tendon Strength (The #1 Fix)

Eccentric and isometric strengthening is the foundation of treatment.

Try these exercises:

• Wrist Extensor Isometric Holds

Hold a light weight (1–3 lb) with your wrist slightly extended. 30–45 seconds x 3–5 sets, daily

• Eccentric Wrist Extensions

Lift the weight with both hands → slowly lower with the injured arm. 3 sets of 12 reps, 3–4x/week

• Grip & Finger Strengthening

Use putty, grippers, or a towel squeeze.👉 2–3 sets daily

Studies show progressive loading of the tendon is the most effective treatment (Stasinopoulos & Johnson, 2005, Br J Sports Med).

3️⃣ Improve Mobility in the Surrounding Area

Tightness in the wrist, forearm, or shoulder can contribute to overload.

Do this daily:

• Gentle forearm stretches

• Triceps stretch

• Wrist flexion/extension mobility

• Soft tissue work to the forearm (light, not aggressive)

4️⃣ Support the Tendon When Needed

Tools that can help (temporarily):

• Forearm counterforce strap

• Wrist brace (for acute flare-ups)

• Ice after activity to calm symptoms (This is not recommended, but use when you can to take some of the pain away)

These are helpful adjuncts, not the main treatment.

5️⃣ Gradually Reload Into Your Sport or Training

As pain decreases and strength improves, slowly add:

• Grip work

• Lifting movements

• Racquet sport drills

A physical therapist at Rival PT can help guide this progression safely and avoid re-injury.

What We Do at Rival Physical Therapy for Tennis Elbow

At Rival PT, we take a 1-on-1, evidence-based approach to fully resolve tendon pain.

Treatment may include:

✔️ Progressive tendon loading program

✔️ Soft tissue and joint mobilization

✔️ Dry needling (highly effective for tendon pain)

✔️ Blood flow restriction training (BFR) — Dry needling followed by BFR is a deadly combination!

✔️ Biomechanics and grip-strength testing

✔️ Sport-specific return-to-play plan

Because we specialize in sports physical therapy, we don’t just treat the pain you also get a long-term plan to prevent it from returning.

🚩 When Tennis Elbow Needs Professional Help

You should seek evaluation if:

• Pain persists for more than 6 weeks

• Grip strength is significantly reduced

• Pain radiates down into the hand

• You feel weakness during lifting

• Home exercises aren’t helping

If this sounds like you, the sooner you address it, the faster you recover.

The Bottom Line

Tennis elbow is common, frustrating, and painful but it’s also very treatable. With proper strengthening, mobility work, and guidance, most athletes recover fully and come back stronger.

If you’re struggling with elbow pain, we’re here to help you recover, rebuild, and get back to doing what you love pain-free.

📍 Rival Physical Therapy — Wyckoff, NJ

1-on-1 Sports Injury Rehab | Return-to-Sport | Performance Coaching

Recover. Rebuild. Rival.