Why your Tennis Elbow isn't getting better(even with strength training)

Go on YouTube, TikTok, or Instagram and look up exercises for tennis elbow and you’ll find video after video that usually tells you to do specific strengthening exercises called eccentrics or negatives. For some, these are helpful but for most, they miss a lot of the potential underlying causes of tennis elbow which can cause months or years of lost time exercising, playing tennis or pickleball, or even just using your arm. Why is this? Well one of the more difficult conditions to figure out exactly what is going on is Tennis Elbow. Tennis elbow, also known as Lateral Epicondylitis or Lateral Epicondalgia, can have quite a few causes. From tears to the tendon, joint instability, and even nerve entrapment, it helps to understand exactly what is wrong BEFORE trying to treat it as doing negatives/eccentric exercises can make some of these issues worse. This doesn’t mean you have to go out and get expensive imaging(that usually doesn’t help tell you what to do anyway), but rather use movement and very specific tests that can tell the difference between joint problems, tendon problems, and nerve issues that then give you the best chance at beating tennis elbow.

So, what are the different things that can give you tennis elbow pain?

First, we’ve gotta understand what’s going on at the elbow. The elbow, while it looks like a pretty simple joint, is actually 3 separate joints. What you usually think of the elbow is the humeroulnar joint(your ulna is the bone on the pinky side of your forearm). The upper arm also has a joint with the radius(the thumb side of your forearm). While the radius and ulna have a joint up by the elbow that lets you rotate your palm up and down. If you make a fist, you’ll notice the muscles on the top of your forearm get tense. These attach just above the elbow and are commonly the muscles targeted with eccentrics/negatives for strengthening. In traditional tennis elbow, the tendon of those forearm muscles can get injured either traumatically or with micro-tears over time. With long term tennis elbow, if we had a microscope to look at the tendon, we’d see that what should look like little fibers all going in the same direction now are going all over the place, we’d also see nerves growing into the tendon(which makes it more tender) along with new blood supply as the body tries to heal the problem. Now, with eccentrics, we often end up overloading these tendons which fires up the pain, reducing our grip strength and making holding stuff more painful. These are better first treated with treatments such as dry needling, manual therapy, and active release to start knocking the pain down before starting strengthening. 

But, what if it isn’t the tendon but rather a joint issue, how do we know the difference? First, our therapists at Body Mechanix use the most recent science to know which tests help tell the difference between joint causes, muscle and tendon causes, and nerve causes of tennis elbow(not to mention neck and shoulder, and thoracic outlet causes).  If it ends up being joint or nerve, the eccentrics will actually make your pain worse(though won’t usually cause further damage). If your therapist finds that it is joint pain behaving like tennis elbow, they’ll usually help it feel better and heal using specific joint movements to treat the joint capsule while if it is nerve related, they’ll figure out which nerve it is that is causing the pain and start to do specific stretches to free it up so it is not so sensitive. What’s more, your therapist will also show you how to do these treatments for yourself so that you can help heal yourself even when you’re not in the clinic. Plus, your therapist will also check to make sure that your neck and shoulder aren’t the true causes of your elbow pain(so we actually treat the right body part). 

Confused about where to start? Book a call from the comfort of your home or office and  on your schedule with one of our Pain Specialists. You can schedule your call here.  Need help now? Come by and talk with one of our Doctors of Physical Therapy at no charge. We offer FREE consultations, which give you the opportunity to come in and meet us and see for yourself how we can help you.

Here are just a few of the things you will learn in one of our free consultation:

• What is the underlying cause of your pain? (hopefully nothing too serious!)

• Roughly, how long will it take to fix the problem?

• What to do to help – which doesn’t include painkillers, resting or surgery etc.

• What other, natural, drug free methods are there to speed up recovery alongside treatment?

Our consultations are great for anyone that may be “unsure” if physio is right for them, and they give you the opportunity to ask questions and see for yourself if we can help you.

If you’d like one of our limited free consultation sessions, please click here to schedule your free consultation or CALL us on 850-765-2779 to make a no-obligation enquiry.

About the Author

Dr. Brandon is the owner and a Physio at Body Mechanix Physiotherapy and Fitness. Four of his favorite people call him daddy while he's been married to his other favorite person for 20 years. He enjoys teaching martial arts and is a Mestrando in Capoeira while in the mornings, he can be found working out with the guys in F3 around town.  He's the author of 4 pain relief guides for sciatica, low back, shoulder, and knees and the lead contributor to the Active Tallahassee Blog.