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Tennis Elbow – Lateral Epicondylitis: Symptoms, Causes, Risk Factors, Healing Cycle & Treatment

What is Tennis Elbow?

Tennis elbow is medically termed lateral epicondylitis, which is characterized by a painful condition that happens when the muscles and tendons in the elbow become overloaded due to which the pressure on the extensor carpi radialis braves (ECRB) is damaged or ruptured from the overuse of the muscles and tendons. This muscle is located at the outer part of the elbow and forearm that often become painful by repetitive movements of the wrist and forearm. Tennis elbow pain usually occurs when the tendons of the forearm muscles attach to the outer bone mass of the elbow. Pain can also spread to the forearm and wrist as it is radiated when ECRB is rubbed against the bony structures of the elbow [1].

The tennis elbow name is also not limited to athletes because there are different groups of people who are susceptible to tennis elbow including plumbers, painters, carpenters, and butchers [1].

Symptoms of Tennis Elbow

The primary symptoms of the tennis elbow are pain, weakness, and soreness in the outer condyles of the elbow. In this protruding section, the damaged tendons are connected to the bone and the ECRB. The pain can also radiate to the upper or lower arm even though the injury lies in the muscle near the elbow but there is a high probability of getting hurt while lifting things, punching or grabbing something like a tennis racket, opening the doors, shaking hands, raising arms, or straightening wrists. It is also observed that pain associated with the tennis elbow is also felt passively during the flexion of fingers and wrist [2].

Causes of Tennis Elbow

Tennis elbow is a muscular injury caused by overuse and stretching and repeated contractions of the forearm ECRB muscle which is used to stretch and raise hands and wrists. The repetitive movement of the elbow and writs causes the pressure on the tissue can cause a small tear in the tendons, which connects the muscles of the forearm to the bony crest on the outside of the elbow

As the name implies the common cause of tennis elbow is playing tennis, especially the frequent misuse of a backhand punch with improper technique and angles. According to a study, playing tennis with wrong angles is one of the possible causes of tennis elbow. Some of the more common tennis elbow causes include using plumbing tools, painting, frequent working with a screwdriver, prolonged chopping of the seasonings, especially the meat while cooking, and continuous use of the computer mouse [3].

Risk Factors of Tennis Elbow

Factors that can increase the risk of tennis elbow include:

  1. Age: Tennis elbow is more common in adults between the ages of 30 and 50.
  2. Profession: People associated with a profession in which they have to move their wrists and arms repeatedly are more likely to develop tennis elbow, for example, plumbers, painters, butchers, carpenters, and cooks.
  3. Certain sports: Racket sports may increase the risk of tennis elbow injuries, especially if someone can’t hit the ball properly [4].

Healing Cycle of Tennis Elbow

The healing cycle of tennis elbow is completed by following the three stages that are described below:

  1. Inflammation: This stage includes detection of the damaged or ruptured part of the tendon or muscle where the temperature, swelling, and redness are increased so that the white blood cells can be accumulated.
  2. Proliferation Stage: This stage includes the scar tissue release at the injured area so that the damaged part can be covered and healed. At a trigger point, fascia tissue has released that covers up the scar tissue and the damaged area through its superficial and deep layers.
  3. Maturation: This stage involved shedding of the scar tissue and maturation of the fascia release so that the injury could be healed. However, in a chronic tennis elbow, the continuous damage in the ECRB due to repetitive movements does not allow the scar tissue and the fascia to be released hence the first two stages are continuous [5].

Not Effective Treatment of Tennis Elbow

Various physiotherapeutic treatment interventions could be used for tennis elbow, but the majority of them are not effective to stop tennis elbow. As heating and icing are considered to be effective for tennis elbow pain but it only soothes the pain temporarily. Moreover, electronic stimulation of tennis can also lower the feeling of pain but that recurs when the estim is stopped. Similarly. Massage, stretching, and foam roller are also not effective because they could increase the rubbing of ECRB against the bony structures [5].

Effective Treatment of Tennis Elbow

Treatment of tennis elbow is different for each stage of the healing cycle as if the tennis elbow is only in the inflammation stage, pressure is applied with an instrument specifically designed to assist the healing process. The treatment plan of the tennis elbow is based on the following stages.

During the inflammation stage, rest is the most needed treatment intervention because tennis elbow is specifically caused by repetitive motion and rest can provide the time to heal for the elbow. Moreover, MagnaHeal is another wearable device that uses a magnet to align the tendons and bones in the elbow. Furthermore, an anti-inflammatory diet and restoring deficiencies are also considered effective treatments for tennis elbow [6].

As the proliferation stage involves scar tissue accumulation and fascia tissues at the injured site, therefore, they need to be released so that the maturation stage could be reached. To release scar tissue at the superficial layers, the A3 tool is used, whereas, for deep layers of scar tissue, the A5 tool is used. Similarly, fascia release at superficial layers. A1 tool is used to apply pressure whereas pressure through A5 is effective for the four deeper layers of the fascia including aponeurotic, epimysium, perimysium, and endomysium, and pressure is applied through A5 to release fascia layers [6].


  1. Lenoir H, Mares O, Carlier Y. Management of lateral epicondylitis. Orthopaedics & Traumatology: Surgery & Research. 2019 Dec 1;105(8):S241-6.
  2. Duncan J, Duncan R, Bansal S, Davenport D, Hacker A. Lateral epicondylitis: the condition and current management strategies. British Journal of Hospital Medicine. 2019 Nov 2;80(11):647-51.
  3. Ma KL, Wang HQ. Management of Lateral Epicondylitis: A Narrative Literature Review. Pain Research and Management. 2020 May 5;2020.
  4. Nabil BA, Ameer MA, Abdelmohsen AM, Hanafy AF, Yamani AS, Elhafez NM, Elhafez SM. The Impact of Tennis and Golfer’s Elbow on Shoulder External Rotators and Abductors’ Peak Torque. Journal of sport rehabilitation. 2019 Nov 26;29(4):469-75.
  5. Meunier M. Lateral Epicondylitis/Extensor Tendon Injury. Clinics in Sports Medicine. 2020 Jul 1;39(3):657-60.
  6. Ahmad Z, Siddiqui N, Malik SS, Abdus-Samee M, Tytherleigh-Strong G, Rushton N. Lateral epicondylitis: a review of pathology and management. The bone & joint journal. 2013 Sep;95(9):1158-64.

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