Tennis Elbow and Chiropractic Treatment

Tennis elbow, medically known as lateral epicondylitis or lateral elbow tendinopathy, is a common overuse injury affecting the tendons that attach the forearm extensor muscles to the outside of the elbow. Despite its name, only a small percentage of cases occur in tennis players. The condition is more commonly seen in people who perform repetitive gripping, lifting, typing, painting, carpentry, plumbing, or manual labor. Current research indicates that tennis elbow is primarily a degenerative tendon condition (tendinopathy) rather than an inflammatory disorder.

What Causes Tennis Elbows?

Tennis elbow develops when repetitive wrist extension and gripping movements place excessive stress on the tendons of the forearm, particularly the extensor carpi radialis brevis (ECRB) tendon. Repeated microtrauma can lead to tendon degeneration, reduced healing capacity, and persistent pain.

Common risk factors include:

• Repetitive gripping or lifting
• Racquet sports such as tennis or pickleball
• Manual occupations (electricians, mechanics, carpenters, painters)
• Frequent computer or mouse use
• Poor lifting mechanics
• Sudden increases in activity level

Most patients are between 35 and 60 years old, although the condition can occur at any age.

Common Symptoms

Symptoms typically develop gradually and may include:

• Pain on the outside of the elbow
• Tenderness over the lateral epicondyle
• Pain when gripping objects
• Weak grip strength
• Pain during lifting, twisting, or opening jars
• Pain when shaking hands
• Forearm stiffness

Symptoms often worsen with repetitive activity and improve with rest during the early stages.

How Is Tennis Elbow Diagnosed?

Diagnosis is usually based on:

• Medical history
• Physical examination
• Tenderness over the lateral elbow
• Pain with resisted wrist extension
• Pain during gripping tests

Imaging such as ultrasound or MRI is generally reserved for persistent or atypical cases.

Chiropractic Treatment for Tennis Elbow

Chiropractic care can be part of a multimodal conservative treatment program for tennis elbow. Rather than focusing only on the painful tendon, chiropractors often assess the entire upper-extremity kinetic chain, including the wrist, elbow, shoulder, and cervical spine, to identify movement restrictions or biomechanical factors that may contribute to symptoms.

Treatment may include:

• Joint mobilization or manipulation of the elbow, wrist, or cervical spine
• Soft tissue therapy
• Instrument-assisted soft tissue mobilization (IASTM)
• Myofascial release
• Active Release Techniques (ART)
• Stretching
• Progressive strengthening exercises
• Ergonomic advice
• Activity modification

Current evidence suggests that manual therapy combined with exercise can improve pain, grip strength, and function in many patients with lateral elbow tendinopathy.

Potential Benefits of Chiropractic Care

When incorporated into an evidence-based rehabilitation plan, chiropractic treatment may help:

• Reduce pain
• Improve grip strength
• Restore joint mobility
• Improve forearm flexibility
• Reduce muscle tightness
• Improve movement mechanics
• Support return to work or sports

Manual therapy is generally considered an adjunct to exercise rather than a stand-alone treatment.

Exercise Is a Key Part of Recovery

Research consistently shows that exercise therapy, particularly progressive loading and eccentric strengthening of the wrist extensors, is one of the most effective conservative treatments for tennis elbow.

Common exercises include:

• Wrist extensor stretches
• Eccentric wrist extension exercises
• Grip strengthening
• Forearm pronation and supination exercises
• Shoulder and scapular strengthening

Exercise programs should be progressed gradually based on pain tolerance and functional improvement.

Additional Conservative Treatments

Depending on symptom severity, treatment may also include:

• Activity modification
• Ice after aggravating activities
• Counterforce braces
• Wrist splints (short-term in selected cases)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for symptom relief
• Physical therapy
• Shockwave therapy (mixed evidence)
• Platelet-rich plasma (PRP) injections (variable evidence)
• Corticosteroid injections (may provide short-term relief but have less favorable long-term outcomes)

Most patients improve with conservative treatment within 6 to 12 months, although recovery times vary.

When to Seek Medical Evaluation

Consult a healthcare provider if you experience:

• Severe pain after trauma
• Inability to straighten or bend the elbow
• Significant swelling or deformity
• Persistent weakness
• Numbness or tingling into the hand
• Symptoms lasting several weeks despite conservative care

These signs may indicate another condition requiring further evaluation.

Preventing Tennis Elbow

To reduce the risk of recurrence:

• Warm up before sports or repetitive work
• Strengthen the forearm and shoulder muscles
• Improve grip and lifting mechanics
• Use properly fitted sports equipment
• Take regular breaks during repetitive tasks
• Gradually increase activity levels
• Maintain flexibility of the forearm muscles

Key Takeaway

Tennis elbow is a common overuse tendon condition that causes pain on the outside of the elbow and reduced grip strength. Most cases respond well to conservative management, particularly a combination of therapeutic exercise, activity modification, and manual therapy. Chiropractic care may help improve pain, mobility, and function when integrated into a comprehensive rehabilitation program, but the strongest evidence supports combining manual therapy with progressive exercise rather than relying on passive treatment alone.

References

1. Kinney WR, et al. Nonoperative Management of Lateral Epicondyle Tendinopathy: An Umbrella Review. Journal of Shoulder and Elbow Surgery. 2023.
2. Academy of Hand & Upper Extremity Physical Therapy and Academy of Orthopaedic Physical Therapy. Clinical Practice Guideline: Lateral Elbow Pain and Muscle Function Impairments. 2022.
3. Gliedt JA, et al. Chiropractic Treatment of Lateral Epicondylitis: A Case Report Utilizing Active Release Techniques. Journal of Chiropractic Medicine. 2014.
4. Kaufman RL. Conservative Chiropractic Care of Lateral Epicondylitis. Journal of Manipulative and Physiological Therapeutics. 2000.
5. PEDro Database. Randomized Clinical Trial Comparing Chiropractic Care and Ultrasound for Lateral Epicondylitis.
6. Creekside Chiropractic. Evidence Summary for Lateral Epicondylitis Management. Moderate evidence supports elbow, wrist, and cervical mobilization/manipulation alongside rehabilitation exercises for improving pain and grip strength.