Tennis with elbow pain and what is driving it beyond the obvious
Nicola Tik
Elbow pain in tennis players is so common that it has its own name, but the name can be misleading. Lateral elbow pain in tennis is not simply about the elbow itself, and understanding what is actually driving it tends to open up more useful options than just resting the arm and hoping it settles. This article looks at what tends to be behind elbow pain in recreational tennis players and what makes a genuine difference.
The tendons on the outside of the elbow attach the forearm muscles that control the wrist and hand to the bone. During tennis, those muscles are working hard with every shot, absorbing the impact of ball on racket and controlling the racket face through the swing. When the load on those tendons exceeds what they can comfortably manage, they become sensitised and painful.
The pain tends to build gradually rather than arriving from a single incident. It often starts as a mild ache after playing that clears up relatively quickly, and progresses over weeks or months to something more persistent if the load is not adjusted.
The elbow is where the pain is felt, but it is often not where the problem originates. Several factors beyond the elbow itself consistently contribute to lateral elbow pain in tennis players.
Grip technique is one of the most significant. A grip that is too tight, particularly on backhand shots, increases the load on the forearm muscles and tendons considerably. Many recreational players grip the racket harder than necessary, particularly when under pressure or when the ball is coming faster than expected. Consciously reducing grip pressure between shots and at the start of each swing is a small adjustment that can make a meaningful difference over the course of a session.
Racket setup also plays a role. A racket that is strung too tightly or that is too heavy for the player increases the vibration and impact transmitted to the forearm with every shot. If elbow pain has developed or worsened after a change in racket or restring, that connection is worth considering.
Backhand technique in particular is worth reflecting on. A backhand hit with a leading elbow, where the elbow is driving the shot rather than the shoulder and trunk, places significantly more strain on the lateral elbow than a shot driven from the body. This is a common pattern in recreational players and one that a coach can often identify and address relatively quickly.
Reducing total court time temporarily rather than stopping altogether is the most sensible approach for most people. Shorter sessions with more recovery time between them allows the tendon to settle without losing your game entirely.
Warming up the forearm and elbow before playing, with some gentle wrist rotation and forearm stretching, helps prepare the tendons for the demands ahead. Applying some heat to the area before playing and cold afterwards is something many players find helps manage the discomfort around sessions.
Tendons respond well to progressive loading. Specific strengthening exercises for the forearm and wrist, done consistently over several weeks, build the capacity of the tendon to manage the demands of tennis more effectively. This tends to produce more lasting improvement than rest alone, which removes the load but does not build the resilience needed to return to playing without recurrence.
If you would like to try a guided exercise for the elbow and forearm, VIDA has a short video you can follow at your own pace.