Tennis elbow (Lateral Epicondylitis) is the inflammation of the tendons on the outside of the elbow, caused by repetitive wrist extension. Over time, this creates tiny micro-tears at the tendon attachment, leading to a sharp pain while gripping or swinging. It’s common in tennis, golf, and padel players. If left untreated, it can become a chronic condition.
 

Why Are Racket Sports a Potential Risk?

Sports like tennis, golf, and padel involve repeated arm and wrist movements, particularly swinging and striking, which places continuous stress and vibration on the elbow. Over time, this leads to tendon irritation and small tears at the outer elbow.
 

From Just Fatigue to Real Pain

Imagine preparing for a backhand shot. The racket meets the ball and suddenly, a sharp pain shoots through your outer elbow. You shake it off and keep playing, thinking it’s just fatigue. However, this cannot be ignored as it could lead to a chronic condition. 
 

Warning Signs You Should Not Ignore:

• Week 1: Mild discomfort while playing
• Week 2: Pain worsens, even while resting
• Chronic stage: Pain interferes with daily activities (even lifting a glass hurts)

Tennis elbow is one of the most common yet most overlooked injuries in racket sports. It is one of the most common injuries among racket sports athletes. It is also one of the most overlooked and treated too late.
You’ll learn what it is, how it develops, and how to take care of it properly before it becomes a long-term problem.
 

What Exactly is Tennis Elbow?

Tennis elbow, medically known as lateral epicondylitis, is an overuse injury. It’s caused by repeated use of the muscles and tendons on the outer elbow, leading to in microscopic tears in the tendons, which results in sharp or aching pain during movement.
 

Who is at risk?

Despite the name, it also affects:

• Golfers
• Padel players
• Anyone with repetitive arm use (e.g., office workers, manual laborers)

 

Common symptoms:

• Pain on the outside of the elbow
• Sharp pain when gripping or lifting
• Pain when extending the wrist or twisting the forearm
• Reduced grip strength
• Pain that worsens after activity

Medical advice:

If the pain begins to affect your daily activities or does not improve with rest, it’s important to seek an assessment from a sports medicine specialist. Early assessment helps ensure an accurate treatment plan and prevents the condition from progressing to a permanent injury.

Category	Tennis Elbow (Outer Elbow Pain)	Golfer’s Elbow (Inner Elbow Pain)
Pain location	Outer elbow (lateral)	Inner elbow (medial)
Symptoms	Pain when bending the wrist or swinging the forearm outward	Pain when gripping or bending the wrist downward
Main cause	Inflammation of wrist extensor tendons	Inflammation of wrist flexor tendons
Pain trigger (sports)	Backhand shots or wrist flicking	Forehand shots, golf swings, or serves
Common sports	Tennis, padel, badminton, squash	Golf, baseball, weightlifting
Everyday activities	Using a computer mouse, turning doorknobs	Lifting heavy objects, hammering, carrying bags
Prevalence	~70% of elbow-related issues	~30% of elbow-related issues

Check If You Have Tennis or Golfer’s Elbow

• Tennis elbow: Place your forearm on a table with your palm facing down. Try to move your hand upward while using your other hand to resist the movement. If you feel a sharp pain on the outer elbow, it’s likely Tennis elbow.
• Golfer’s elbow: Extend your arm with your palm facing up and try to curl your fist inward. If you feel pain on the inner elbow, it may indicate Golfer’s elbow.

 

Why Does Tennis Elbow Occur in Tennis?

Repetitive actions like:

• Swinging the racket
• Backhand shots
• Gripping the racket tightly

These create repeated pulling motions on the tendons, leading to irritation and pain.
 
Risk Factors for Tennis Elbow

• Technique: Poor backhand form or excessive wrist flicking
• Physical condition: Inadequate warm-up or muscle fatigue from overuse
• Equipment: Using a racket that’s too heavy, improper string tension, or incorrect grip size

 
4 Stages of Tennis Elbow: Which Stage are You In?
Tennis elbow doesn’t happen overnight, it gradually develops over weeks or months. Understanding each stage helps guide what you should do next.

• Stage 1 (Early Warning): Mild pain after playing that resolves within 24 hours → Rest and apply ice
• Stage 2 (Developing): Pain during play (especially using a backhand or smashing), lasting 1–2 days after activity → Reduce training intensity and begin rehabilitation
• Stage 3 (Significant): Pain affects performance and daily activities (e.g., opening a bottle) → Consult a doctor or physiotherapist
• Stage 4 (Chronic): Persistent pain even at rest, possibly with swelling or warmth → Stop playing and seek specialized medical treatment

Medical Advice: Many athletes ignore stages 1–2, which can lead to a chronic injury. Early diagnosis with ultrasound or MRI allows for more precise treatment and faster recovery.
 

Risk Factors: Are You at Risk of Tennis Elbow?

Tennis elbow doesn’t occur only from intense sports activity. In many cases, it results from a combination of smaller contributing factors, including:
 

Activity Factors (Technique & Play)	Equipment Factors	Personal & Lifestyle Factors
Increasing training volume or intensity too quickly before the body adapts	Incorrect grip size (too large or too small)	Age 35–50 (reduced tendon elasticity)
Skipping proper warm-up, leaving muscles and tendons vulnerable to strain	Excessive string tension, transmitting more vibration to the elbow	Weak core and shoulder stabilizers, placing more load on the elbow
Poor backhand technique, overusing the wrist and “leading with the elbow” instead of engaging the shoulder and core	Racket that is too heavy	Repetitive hand/arm use (e.g., office work, cooking, manual labor)
Playing continuously without adequate recovery, leading to cumulative fatigue	Narrow sweet spot on racket, increasing impact shock on off-center hits	History of elbow injury

 

Warm-up: The Key to Preventing Tennis Elbow

One of the most effective ways to reduce your risk of tennis elbow is a proper warm-up before playing. Preparing your body helps your muscles and tendons handle movement and impact more efficiently, reducing strain and the chance of injury.
A good warm-up routine should include:

• Stretching: Focus on arm and shoulder muscles
• Elastic band exercises: Activate and engage key muscle groups
• Light hitting: Gradually building up intensity before playing

 

Treatment and Management of Tennis Elbow

If you experience elbow pain from sports, getting an assessment is essential. Treatment for tennis elbow typically begins with:

• Rest: Avoid activities that trigger pain
• Physical therapy: Restore muscle function and promote healing
• Strengthening exercises: Improve arm and shoulder stability
• Technique adjustment: Correct movement patterns to reduce strain

Consult a sports medicine specialist to assess your condition and develop a personalized treatment plan tailored to your needs.

   

Frequently Asked Questions (FAQ)

Q: Can tennis elbow fully heal?
A: Yes, if treated properly and completely. This includes muscle strengthening, technique correction, and addressing risk factors. It’s not something that improves by just waiting it out. Around 80–90% of cases recover without surgery within 6–12 months.

Q: Do tennis elbow braces actually help?
A: A counterforce brace or elbow strap can help reduce strain on the tendon during activity, making it less painful to play. However, it’s a support tool — not a cure. It should be used alongside proper rehabilitation, not as a way to continue playing intensely without adjustment.

Q: Can padel cause tennis elbow too?
A: Yes. Padel has been growing rapidly in Thailand, and many new players develop symptoms quickly. Solid padel rackets tend to transmit more vibration to the elbow compared to strung tennis rackets. Proper warm-up and technique are especially important.

Q: How do I know if I need PRP or just physical therapy?
A: PRP (platelet-rich plasma) is usually considered when symptoms don’t improve after 8–12 weeks of consistent rehabilitation, or when imaging (MRI/ultrasound) shows clear tendon degeneration. The decision should be made with a sports medicine specialist based on proper evaluation.


By Dr. Wichan Kanchanatawan, Sports Medicine Specialist and Director of the Bumrungrad Sports Medicine & Joint Center