Tennis Elbow: Why It Happens and How to Get Rid of It

Tennis elbow is the injury most likely to remove a club player from the court for months, and the one most commonly mismanaged.

The mismanagement usually takes the same shape: rest until it stops hurting, return at the same intensity with the same equipment and technique, and be injured again within three weeks.

What it actually is

Pain on the outside of the elbow, at the point where the wrist extensor tendons attach. Despite the traditional name, it is not primarily an inflammation. In persistent cases the tendon shows degenerative change, disorganised collagen and poor tissue quality.

That distinction matters because it changes the treatment. Inflammation responds to rest and ice. Degeneration responds to progressive loading.

The usual causes

• A sudden increase in volume. Going from once to four times a week in a fortnight is the single most common trigger.
• Late contact on the backhand, especially a one-hander struck behind the body with a leading elbow, which loads the extensors heavily.
• Excessive wrist activity, gripping too tightly and trying to steer with the forearm.
• Stiff strings. Full polyester in a stiff racquet is a reliable elbow irritant for players who do not swing fast enough to need it.
• A grip that is too small, which encourages over-gripping.
• Off-court factors. Heavy computer mouse use, DIY, or a new gym programme, all loading the same tissue.

What to do first

1. Reduce, do not stop. Cut volume to the level that causes no pain during and no more than mild ache for 24 hours afterwards. Complete rest is only for the acutely severe.
2. Fix the equipment. Switch out of full polyester to a multifilament or a soft hybrid, drop tension by two to three kilos, check the grip size, and consider a slightly heavier, less stiff racquet. This alone resolves a surprising number of cases.
3. Start isometrics. Hold a light weight in wrist extension for 45 seconds, five repetitions, twice daily. Isometric holds often reduce tendon pain and can be started early.

The loading programme

After a week or two of isometrics, move to slow, heavy, controlled work. This is the part that actually rebuilds the tendon.

• Eccentric wrist extension. Lift the weight with the other hand, lower slowly over three to four seconds with the injured side. Three sets of fifteen, every other day.
• Progressive load. Increase the weight when three sets are comfortable. The exercise should feel demanding, and mild discomfort during it is acceptable.
• Grip strength work. Squeeze a ball or use a gripper. Extensor and flexor balance matters.
• Shoulder and upper back. Weakness further up the chain pushes work down to the forearm. Rows, external rotations and scapular work belong in the programme.

Give it twelve weeks. Tendon remodelling is slow, and the most common reason for failure is stopping the exercises the week the pain goes.

Coming back

Return in stages: mini tennis, then baseline rallying at reduced intensity, then serves last, since serving loads the arm most. Add one element per week. If pain returns, drop back one stage rather than stopping entirely.

And fix whatever caused it. Returning to the same string, the same grip and the same late backhand contact will produce the same result.