Tennis elbow: symptoms, causes and choosing equipment

Tennis elbow, medically lateral epicondylitis (or lateral epicondylopathy), is wear in the forearm tendons that attach to the bony bump on the outside of the elbow. The name comes from tennis, but it is also common in desk workers and manual workers. This guide focuses on the equipment side; for diagnosis and treatment you should see a doctor or physiotherapist.

This article is general information and not a substitute for medical advice.

Symptoms

• Pain on the outside of the elbow. It often gets worse when you lift the wrist back or grip something hard.
• Pain when holding a cup, turning a door handle or shaking hands.
• Pain when gripping the racket hard, especially on the backhand.
• Tenderness when you press on the outside of the elbow.

Causes

• Overload: Suddenly increasing playing time or frequency.
• Technique: Late contact, wrist-driven backhands, not hitting the centre of the strings.
• Equipment: A grip that is too small, a stiff frame, very high string tension, stiff strings (especially polyester) and a very light racket.
• Conditioning: Weak forearm and shoulder muscles.

Do not overstate equipment: most pain comes from load and technique. But equipment changes the vibration and shock the arm takes on every shot, and that is something you can control.

Equipment checklist

To find the right grip, see the grip size guide. For strings use the string selection guide and the tension guide; for racket measurements see the guide to choosing a racket, head size and weight and balance.

What to do

• Manage the load: Reduce playing time and frequency when pain rises. Complete rest is often not needed; staying active at a level that does not increase the pain helps the tendon recover.
• Combine: Soften the equipment, but do not rely on equipment alone.
• Strengthen: Strengthening exercises for the forearm and wrist can help the tendon recover. A physiotherapist decides the right exercise.
• Elbow strap: A strap worn on the upper forearm eases the pain in some people. It does not work for everyone.
• Check technique: Work on backhand and contact timing with a coach.

When to see a doctor

• If the pain has not gone in a few weeks.
• If the pain wakes you at night or continues at rest.
• If you have numbness, tingling or loss of strength in the hand.
• If the elbow is swollen or red.

Common mistakes

• Playing on through the pain. Loading a tendon before it recovers prolongs the problem.
• Only changing the racket. Technique and load matter just as much.
• Buying a very light racket. A light racket damps vibration less.
• Staying with polyester. If your arm hurts, going back to multifilament or natural gut is safer.

Tell the Racket Finder that your arm hurts and the rules in this guide kick in: very light frames are left out, stiff frames move down the list and rackets with a big head and enough mass come first. If the pain lasts, also see a doctor.