Medical consultation: Hoang Van Ban, MSc, MD, Department of Orthopaedics, Trauma Surgery and Neurosurgery, Hong Ngoc Phuc Truong Minh General Hospital.
Medical disclaimer: The information provided in this article is for reference purposes only and does not replace direct medical examination, diagnosis or treatment by a physician. Patients should not self-medicate or continue exercising when the cause of pain has not been clearly identified.
Why does playing tennis often cause elbow pain?
When playing tennis, the muscles and tendons in the forearm are continuously engaged to grip the racket, rotate the wrist and perform strokes. Excessive training or improper technique can place repetitive stress on the tendons attached to the outer side of the elbow, leading to irritation and pain.
Factors that may contribute to elbow pain during tennis include:
- A rapid increase in training frequency or time spent on the court.
- Performing backhand strokes that require excessive wrist tension to generate force.
- Gripping the racket handle too tightly throughout play.
- Using an inappropriate racket grip size or string tension.
- Insufficient forearm strength compared with the intensity of play.
- Returning to high-intensity training after a long break.
- Inadequate warm-up before performing powerful strokes.
Recognizing tennis elbow symptoms in tennis players
Tennis elbow typically causes pain around the bony prominence on the outer side of the elbow, which may sometimes extend down the forearm. The pain worsens when gripping the racket, performing backhand strokes, rotating the wrist or carrying out activities that require grip strength. Symptoms usually develop gradually and become more noticeable if players continue high-intensity activities.
Common signs include:
- Pain on the outer side of the elbow when performing backhand strokes or powerful shots.
- Pain when gripping the racket tightly, shaking hands, carrying bags or opening bottle caps.
- Tenderness when pressing on the bony prominence on the outer side of the elbow.
- Faster arm fatigue and reduced grip strength compared with before.
- Increased pain when extending the wrist or lifting objects.
What should you do when experiencing elbow pain after playing tennis?
When elbow pain begins, players should temporarily reduce or stop activities that worsen the symptoms, allowing the tendons time to recover. Appropriate rest, cold therapy and avoiding forceful gripping can help relieve discomfort during the early stage.
Common home management measures include:
- Rest: Temporarily stop playing tennis or reduce movements that increase elbow pain, especially powerful backhand strokes.
- Cold therapy: Apply cold packs to the painful area for 15–20 minutes each time, 3–4 times daily. Wrap the cold pack in a towel to prevent skin damage.
- Use of support braces: Forearm straps or appropriate braces may help reduce stress on the affected tendons during certain activities.
- Avoid forceful gripping: Avoid lifting heavy objects, excessive wrist rotation or hitting the ball while the elbow remains painful.
- Pain medication: Patients should consult a physician or pharmacist before using pain relievers or anti-inflammatory medications, especially if they have underlying medical conditions or are taking other medications. Medication should only be used when necessary and according to instructions.
When should you seek medical attention for tennis-related elbow pain?
Players should seek medical evaluation if the pain does not improve after rest and reducing activities that trigger symptoms, or if the condition begins to affect racket grip and daily activities.
Early medical assessment is recommended when the following signs appear:
- Pain that progressively worsens or persists over multiple playing sessions.
- Reduced grip strength when holding the racket and faster arm fatigue.
- Difficulty bending, straightening or rotating the elbow.
- Swelling, warmth or redness around the elbow.
- Severe pain after a fall, impact or powerful stroke.
- Numbness, tingling or weakness extending into the hand.
- Pain occurring at rest or affecting sleep.
How is tennis elbow treated and managed?
Tennis elbow can be treated through various approaches, including medical treatment, physical therapy and rehabilitation, and surgery when indicated. The goals are to relieve pain, improve forearm function and strength, and help patients gradually return to daily activities and sports safely.
Conservative treatment
In the early stages, patients should reduce activities that worsen pain and modify factors that place excessive stress on the elbow. Depending on the severity of the condition, physicians may recommend one or a combination of the following approaches:
- Adjusting the duration and intensity of tennis activities.
- Using pain relievers or anti-inflammatory medications when indicated.
- Wearing forearm support straps.
- Physical therapy and rehabilitation.
- Adjusting racket grip, playing technique or sports equipment.
Forearm strength rehabilitation exercises
Rehabilitation exercises help improve the strength of the muscles and tendons around the elbow, supporting more stable racket grip and stroke performance. Exercises should begin at a low intensity and gradually progress based on each individual’s ability.
Suitable rehabilitation exercises include:
- Gentle forearm stretching.
- Wrist flexion and extension exercises with appropriate resistance.
- Forearm pronation and supination exercises.
- Squeezing a soft ball to improve grip strength.
- Gradually returning to forehand, backhand and serving techniques once the arm becomes stronger.
If elbow pain worsens after exercise or symptoms persist into the following day, patients should reduce exercise intensity and allow more time for tendon recovery.
When can you return to tennis and reduce the risk of recurrence?
People with elbow pain should not rush back to the court as soon as symptoms improve. Tennis should be resumed only when players can grip the racket, rotate the wrist and perform strokes without discomfort in the elbow.
Before returning to tennis, players should meet the following criteria:
- Daily activities and gripping objects are no longer difficult.
- Elbow and wrist movements have returned to normal.
- Grip strength has recovered.
- Wrist and forearm exercises can be performed without pain.
- Forehand, backhand and serving techniques can be practiced without discomfort once the arm has recovered.
- No elbow pain occurs after a trial training session.
When returning to the court, players should start with shorter sessions and lower-intensity strokes, then gradually increase activity based on their ability. To reduce the risk of recurrence, players should warm up properly before playing, maintain forearm strengthening exercises, keep a suitable training schedule and adjust technique if excessive wrist tension is required during strokes.
The racket, grip size and string tension should also be selected according to the player’s physical condition and playing style.
Diagnosis and treatment of tennis-related elbow pain at Hong Ngoc General Hospital
Patients experiencing tennis-related elbow pain can seek medical evaluation at the Department of Orthopaedics, Trauma Surgery and Neurosurgery, Hong Ngoc Phuc Truong Minh General Hospital. The department provides diagnosis and treatment for conditions and injuries involving muscles, tendons, bones and joints, while coordinating rehabilitation care to help patients restore mobility.
For tennis players, the examination process focuses on the location of pain, grip strength, wrist and elbow mobility, and movements that trigger symptoms. Depending on the severity of the condition, specialists develop individualized treatment plans and rehabilitation exercises to improve function, strengthen the forearm and gradually help patients safely return to racket grip and stroke activities.
Frequently asked questions about tennis-related elbow pain
How can elbow pain be relieved at home?
Players should temporarily stop playing tennis if strokes worsen elbow pain. During this period, they can continue light activities that do not cause pain and begin rehabilitation exercises once symptoms improve.
Should I wear an elbow brace and continue playing tennis while experiencing elbow pain?
An elbow brace may help reduce stress on the painful area, but it should not be used as a way to continue playing before the elbow has recovered. If hitting the ball causes pain, players should rest and complete rehabilitation before returning to the court.
How long after pain disappears can I return to tennis?
Players should not return to the court immediately after the pain subsides. They should start with shorter sessions and lower-intensity strokes, gradually increasing activity once gripping the racket, rotating the wrist and hitting the ball no longer cause discomfort.
Conclusion
Tennis-related elbow pain often occurs when the muscles and tendons of the forearm are subjected to repetitive stress over a prolonged period. Players should reduce painful movements, perform forearm rehabilitation exercises and adjust their playing technique before returning to the court.
If pain persists, grip strength decreases, the elbow becomes swollen, movement is limited or numbness develops, players should seek specialist evaluation to identify the underlying cause and receive appropriate treatment.
References
- American Academy of Orthopaedic Surgeons (AAOS). Tennis Elbow (Lateral Epicondylitis). https://www.orthoinfo.org/en/diseases--conditions/tennis-elbow-lateral-epicondylitis
- Lucado AM, Day JM, Vincent JI, et al. Lateral Elbow Pain and Muscle Function Impairments: Clinical Practice Guidelines. Journal of Orthopaedic & Sports Physical Therapy. 2022;52(12):CPG1–CPG111. https://pubmed.ncbi.nlm.nih.gov/36453071/
- Karanasios S, Korakakis V, Whiteley R, et al. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis. British Journal of Sports Medicine. 2021;55(9):477–485. https://pubmed.ncbi.nlm.nih.gov/33148599/
- Mayo Clinic. Tennis elbow – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987
- Mayo Clinic. Tennis elbow – Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/tennis-elbow/diagnosis-treatment/drc-20351991
