Tennis Elbow | Cause, tests and treatment with 3 exercises

A tennis elbow is the most common cause of elbow pain. It’s often a painful and long-lasting problem.

Fortunately, you can treat it efficiently by yourself with just three exercises.

You have to know what to do.

And that’s what I will teach you in this post.

I’ll explain to your the cause of the pain and why it often doesn’t disappear by itself.

I’ll also show you how you can break this vicious cycle with just three simple exercises.

This way, you will be sleeping without pain within a few days again.

And the rest of the pain will disappear soon after.

The first thing you have to do is buy a tennis elbow brace. It will reduce the pressure on the damaged tendon and support it. That way you’ll feel pain during the day and the tendon can recover.

Tennis elbow treatment plan:

  • Use a tennis elbow brace to reduce the forces on the elbow
  • Limit painful acitivties as much as possible to rest your elbow
  • Stretch and train the tendon to aid it’s repair

In fact: This is what you will learn today:

  1. What is tennis elbow?
  2. What are the symptoms of a tennis elbow?
  3. What causes a tennis elbow?
  4. Tennis elbow tests
  5. Tennis elbow treatment
  6. Tennis elbow surgery
tennis elbow treatment

What is tennis elbow?

tennis elbow anatomy

A tennis elbow is also known as an epicondylitis lateralis.

That means that there is an inflammatory reaction of the outer side of your elbow. But actually, there is no inflammatory reaction. Instead, it’s a degenerative process of the tendon due to overuse.

I’ll describe the cause later.

But before we start with your tennis elbow treatment, it’s essential to know the anatomy of your elbow. When you know this, you will understand the cause of your tennis elbow and why it doesn’t recover by itself.

After that, you will also understand why our treatment works so well.

Three bones together form your elbow:

  • Humerus
  • Radius
  • Ulna

The humerus is also known as the upper arm. The ulna is also known as the cubit bone.

The primary connection of your elbow forms between your humerus and ulna. When you bend and extend your elbow, these are the bones that move.

Your radius only connects to your ulna, both in your elbow joint and in your wrist. When you rotate your forearm, just these bones move when performing this movement.

Your radius locates at the side of your thumb where your ulna locates at the side of your pinkie. When you rotate your forearm, your radius moves over your ulna to the other side, and your ulna stays in the same position. You can feel this movement in your wrist area.

Your arm is in the neutral position when the palm of your hand faces up. In this position, your ulna and radius lay next to each other.

When you rotate your arm, you can even feel the head of your radius rotate on the lateral side of your elbow. The head of your radius stays at the same position but can rotate in that position.

On the outside of your elbow, the muscle and tendon that are the cause of your tennis elbow attached. The muscle is called the extensors carpi radialis longus.

This muscle attaches through the tendon on the outer side of your elbow. This tendon is damaged, which causes the pain in your elbow.

Also, neck pain often accompanies a tennis elbow.

What are the symptoms of a tennis elbow?

The following symptoms may indicate that you have a tennis elbow:

  • Pain in your elbow at the lateral side
  • Pain in the morning or after a long time of inactivity of your elbow
  • Stiffness in your elbow
  • Radiating pain in your forearm and sometimes in your hand.
  • Loss of power in your hand.

The most prominent symptom is the pain on the lateral side of your elbow. That is the location of the damaged tendon. The pain is one of the signs of the degeneration that is taking place.

The second sign of degeneration is the stiffness and sometimes a little swelling. The stiffness can be in your elbow as well as in your wrist.

Also, the radiating pain in your forearm and fingers is a prevalent problem for tennis elbow patients. You’ll feel the radiating pain in your thumb and index finger.

The damaged tendon causes the loss of power in your hand. Because of the pain and the damage of the tendon, the muscles in your forearm lose their functionality. It’s like when you’ve trained to heavy, and you’re sore the next day. You don’t have as much power as you usually have. In a tennis elbow, this is the case every day.

So now you know the symptoms, it’s time to talk about what is causing your tennis elbow and why it doesn’t go away by itself.

What is the cause of a tennis elbow?

A tennis elbow is a complex injury and becomes more complex the longer you have it. The problem with it is that it gets into a vicious cycle very quickly.

To follow the tennis elbow treatment, you’ll first have to understand this cycle because this is also how we’ll treat it. We will explain now which factors contribute to this vicious cycle.

Damaged tendon

Everything starts with the damaged tendon. Overuse of your arm usually causes this damage.
That doesn’t necessarily have to come from playing tennis.
Rotation of your forearm for an extended period or with a lot of force causes this damage.

Typical examples are ironing, painting or mason.

When you play tennis, you make these movements as well to give a little spin to the ball. It is where the tennis elbow got his name.

Also, a lot of heavy lifting can cause a tennis elbow.


Stiffening of the muscle

The damaged tendon now causes pain in your elbow. The muscle attached to this tendon stiffens because of this pain. You can feel this stiffness very well in your forearm.

You can probably feel a little knot in your muscle, a trigger point.

The pain in your damaged tendon activates this trigger point. The trigger point also causes the radiation into your hand and fingers. The trigger point also disturbs the function of the muscle, causing the lack of strength in your hand that you can experience. Because of the trigger point, your arm feels stiff, especially when you haven’t moved it for a long time. When you move your elbow for a while, you’ll experience that the stiffness lessens.

tennis elbow muscle

The stiffness of the joint

The third aspect of the vicious cycle is the stiffness of the joint. The stiffness of your muscles reduces the mobility of your forearm, especially rotation.
When you bend your elbow to 90 degrees, you’ll see that you can rotate your healthy arm more than your sore arm.

You’re joint now adjusts to this new range of motion. It doesn’t need as much range of motion as it did before, so your body decreases the range of motion. We call this phenomenon “use it or lose it.” If you don’t use your muscles anymore, you’ll lose them. The same goes for the range of motion.


Vicious cycle

These three factors contribute to the vicious cycle of a tennis elbow injury. The vicious cycle is the reason your tennis elbow does not recover by itself.

To successfully treat your tennis elbow, you’ll have to break the cycle. That’s why we’ll address all three parts of this cycle.

But first, you have to make sure that you have a tennis elbow indeed. You can do this with the following three tests.

Tennis elbow tests

When you think that you are suffering from a tennis elbow there are three tests that you can do to be sure.

When these three tests are positive, you can be pretty sure that you have a tennis elbow and that our exercises will offer fast relief.

    1. Mill’s Test
    2. Cozen Test
    3. Maudsley’s Test

Tennis elbow test 1: Mill’s Test

The first and most reliable tennis elbow test to diagnose it is Mill’s Test.

This test looks very much like the stretching exercise that I will discuss later.

Perform the test like this:

  • Extend your elbow
  • Now flex your wrist through the pressure of your other hand
  • Rotate your hand to the outer side
  • Against the resistance of your hand, extend the wrist of your injured arm and rotate your palm up
  • If this causes pain in your elbow, the test is considered positive
tennisarm test 2 Mill's Test

Tennis elbow test 2: Cozen Test

The second tennis elbow test is designed to test the strength of the extensor carpi radialis muscle.

Perform the test like this:

  • Bend your elbow and keep your wrist straight with the back of your hand facing up
  • Place your other hand over your injured hand
  • Extend the wrist of your painful hand when resisting this with your healthy hand
  • When you feel pain in your elbow, the test is considered positive
tenniselleboog test 1 Cozen test

Tennis elbow test 3: Maudsley’s test

The third tennis elbow test is also designed to test the strength of the extensor carpi radialis muscle.

Perform the test like this:

  • Bend your elbow and keep your wrist straight with the back of your hand facing up
  • Bend your middle finger
  • Now extend your middle finger under pressure of your other hand
  • When you feel pain in your elbow, the test is considered positive

Now that you know that you indeed have a tennis elbow, it is time to heal it with the following home exercises.

Tennisarm test 3 Maudsely's test

Tennis elbow treatment with three exercises

The natural way of tendon repair takes about six weeks. That means that after about six weeks the damage of the tendon is restored, solving the pain.

But with a tennis elbow, the overuse of the tendon keeps damaging the tendon. That’s why a tennis elbow doesn’t heal within six weeks.

But with the three exercises, I’ll show you now; you’ll break this cycle. That will help you get rid of that nasty tennis elbow fast.

But together with these exercises, you’ll also have to give the tendon as much rest as possible.

Through this rest, the tendon will repair faster reducing your recovery time.

elbow brace

Unfortunately, it’s hard to give your elbow the proper rest when you’re still working.

You can solve this problem by wearing a tennis elbow brace.

This brace supports the damaged tendon and muscles, which reduces the load

It will give them a chance to recover.

If you buy it right here, you will also support our website.

When the pain diminishes, it is time to start stretching the muscle. That is important because the tension of the muscle pulls on the damaged tendon.

Tennis elbow exercise 1: Stretching the tense muscle

The first tennis elbow stretching exercise is also the most important one. It will stretch the muscle to reduce the tension it is putting on your damaged tendon. When the stress reduces, the tendon will be able to repair.

The exercise goes like this:

    • Grab the hand of the painful elbow with the hand of your healthy one.
    • Extend your elbow
    • Now bend your wrist of your painful elbow with your other hand.
    • Now rotate your hand until you feel the tension in your elbow at the painful spot.

You can also find the stretching exercise on this YouTube video. Perform it a few times a day.

Tennis elbow exercise 1 stretching

Tennis elbow exercise 2: Improving mobility of your elbow

The purpose of this second tennis elbow exercise is to increase the movement of your lower arm.

Increasing the mobility of your lower arm reduces the overuse and tension of your lower arm muscles even further.

The stretching exercise goes as follow:

  • Place your painful elbow in bending position in front of you with the palm of your hand faced up on a table.
  • Localize the head of your radius with the thumb of your other hand. It feels like a little knot.
  • Now apply pressure on the radius head with your thumb towards the table.
  • Finally, place the elbow of your health arm against the thumb of your sore arm and also push it down towards the table.
  • Hold this for 20 seconds. Now you should feel the tension and the pain in your elbow.

You can find the stretching exercise also in this YouTube video. Perform this exercise several times a day.

tennis elbow mobilisation

Additionally, you should also increase the mobility of your wrist. You can do this by bending your elbow and then bend your wrist in every possible direction. Usually, flexion will be the movement that is limited the most and often painful.

Tennis elbow exercise 3: Training the muscles of your lower arm

When the tension and pain in your elbow reduces, it’s time to start restoring the strength in your lower arm muscles.

This way, you will increase the loadability of the tendon, which will cure the final part of your tennis elbow. That will also make sure that the problem doesn’t return in the future.

Perform this exercise as follow:

  • Place your forearm on a table with your hand just over the edge.
  • The palm of your hand should face the ground.
  • Now lift your hand ten times without moving your forearm.
  • Now turn your hand with the palm facing up.
  • Again lift your hand ten times.

Repeat this exercise 3 times and two times a day. When it feels easy, try to add some weight, as you can see in this YouTube video.

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tennis elbow exercise 3 training

Dry Needling

Together with these three exercises, Dry Needling can be a great addition to your tennis elbow treatment. It will help you to reduce your pain within two weeks to 50% of what it was before.

After that, your elbow feels a lot looser and will recover faster.

Here is how this works:

A skilled physical therapist will insert an acupuncture needle inside the trigger point that is active in your extensor carpi radialis muscle. The pain of the damaged tendon activates the trigger point.

This trigger point is the reason for the stiffness of the muscle.

When you insert the needle, the trigger point receives a large amount of pressure. This pressure will relax the trigger point. It usually happens with a small shock that passes through the muscle.

It feels like a little cramp attack.

You do not feel the insertion of the needle, and nothing will be injected. The reaction may be a stiff feeling in your forearm for a few days, but then the pain of your tennis elbow is significantly reduced.

It also results in less tension on the damaged tendon, speeding up the recovery. Therefore it’s a great addition to your tennis elbow exercises program.

Dry Needling

 Tennis elbow taping

Also taping your tennis elbow can reduce your pain.

Taping will support your extensor carpi radialis muscle in its function. It results in less tension on the damaged tendon.

And less tension gives it the time to recover.

It works a little like rest for the damaged tendon.

A skilled physical therapist can also do tennis elbow taping, but with a little research and training, you can also do it yourself.

All these treatment options for tennis elbow help you to recover within eight weeks fully.

However, sometimes it just doesn’t want to heal because the tendon is too much damaged. That only happens to very few people.

In those rare cases, surgery is the only available option. That’s why I’ll explain how this surgery is performed.

tennis elbow taping

Tennis elbow surgery

When all non-surgical treatments have been tried to restore your tennis elbow, your last option is surgery.

Tennis elbow surgery can be performed using arthroscopy, traditional open surgery, or a combination of the two techniques, depending on the type of problem and the method the doctor prefers to use. He will operate under general or regional anesthetic.

The doctor then has three options:

  • Cutting the tendon
  • Repairing the tendon
  • Removing the inflamed tissue from the tendon

The most frequently used option is cutting through the tendon and then reattaching it. This way, the tension disappears, giving it a better chance to recover. Usually, the doctor will also remove some inflamed tissue and clean your elbow during this procedure.

The last option is to repair the tendon. With this procedure, the damaged tendon is stitched together. That improves the chances for recovery.

The tennis elbow surgery usually is a one-day procedure. You will visit the hospital in the morning and leave in the afternoon.

The recovery period takes about 3 to 6 months. Unfortunately, not everyone recovers entirely resulting in a slight permanent lack of function of the elbow.


A tennis elbow is very well treatable with a series of tennis elbow stretching exercises. However, some patients will need surgery for their tennis elbow pain. So when you have a tennis elbow, first try the activities as described above for a few weeks.

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