An Osteopathic Approach to Preventing and Healing Tennis Elbow
What is Tennis Elbow?
Tennis elbow, or lateral epicondylitis, is pain and tenderness on the outside of the elbow. This area, known as the common extensor origin, is where many of the muscles that extend your wrist attach.
People with tennis elbow often experience:
Pain when gripping objects
Pain when rotating the forearm
Discomfort during wrist movements
Pain when straightening or bending the elbow
The condition is usually caused by repetitive movements that overload the tissues. While it’s most famously linked to racquet sports (tennis, pickleball, squash), it can develop from many activities, including:
Golf
Weight training
Fly fishing
Manual labour involving repeated gripping
Prolonged typing or mouse work
Tennis elbow can be surprisingly debilitating, affecting daily life, limiting recreational activities, and even preventing people from working.
What Causes Tennis Elbow?
The cause is almost always multifactorial, meaning several factors combine to create the problem. To recover, multiple areas usually need to be addressed, including:
Properly fitted equipment
Load management (how much activity your body can tolerate)
Efficient movement of the forearm, wrist, and shoulder
Metabolic health
Sleep quality
In this article, we’ll focus on three of the most impactful areas: properly fitted equipment, load management, and movement quality.
1. Choose Properly Fitted Equipment
If you play racquet sports or golf and suffer from tennis elbow, the gear you use can significantly impact your condition.
Racquet sports:
Weight: Racquets and pickleball paddles come in various weights, designed for different swing speeds. Choosing one that’s too heavy or too light for your strength and style can strain your elbow.
Grip size: Larger hands may need a thicker grip, while smaller hands do better with a thinner grip. The right grip size optimizes muscle function and reduces strain.
Golf:
Club weight: The weight of the shaft and club head should match your swing speed and strength.
Grip size: Just like racquets, golf grips should fit your hand size; thicker grips (or extra wraps under the grip) for larger hands, thinner grips for smaller hands.
Practice surface: Hitting off mats can be harder on your wrists and elbows than hitting off grass because mats sit over concrete, increasing impact forces.
2. Manage Your Load
Load management is about matching your activity level to what your body can handle, not just in a single session, but over weeks and months.
For example, a golf professional might play four days a week and practice extensively in between. They can tolerate this because they’ve built tendon resilience over the years, starting as a child and gradually increasing their training volume.
By contrast, someone who takes up golf later in life hasn’t had years to strengthen their tendons. Playing four times a week right away could overload tissues, even if it feels fine in the moment. Tendon pain often shows up long after the overload. Listen to early warning signs (stiffness, mild soreness) and adjust before pain worsens.
Thus, your tolerance depends on factors including how long you’ve been playing, strength, technique and overall conditioning. To manage your load effectively, make sure you are:
Starting gradually: If you’re new to golf or pickleball, avoid jumping into daily play. Tendons adapt slowly.
Tracking frequency: Limit play to 2–3 times per week at first, increasing slowly.
Strengthening forearms and shoulders: Build tendon resilience with progressive resistance exercises.
Resting strategically: If your elbow is sore, swap in lower-impact activities like swimming, cycling, or walking instead of pushing through pain.
3. Proper Movement of the Forearm and Wrist
Many people with tennis elbow have lost some basic movement control in the wrist and forearm. Common issues include:
Wrist movement: Inability to extend or flex the wrist without overusing the thumb muscles or keeping fingers tightly clenched. Relearning these motions can be a powerful first step in recovery.
Forearm rotation: Limited pronation (palm down) or supination (palm up) often forces other forearm muscles to overwork, stressing the tendons. True pronation and supination involve the radius bone rotating over the ulna, not compensatory shoulder or wrist movement.
Improving these movement patterns can reduce unnecessary strain and help tendons heal more effectively. The mobility drills in this video are a great place to start to build correct flexion, extension, pronation and supination.
Key Takeaway
Tennis elbow recovery isn’t just about resting or stretching, it’s about identifying and adjusting the factors that are overloading your tendons. By fine-tuning your equipment, managing your activity load, and improving your movement patterns, you can give your elbow the best chance to recover and prevent future flare-ups.
Colin is an Osteopathic Practitioner with a strong background in biomechanics and efficient movement, having worked extensively with professional golfers on the LPGA Tour.
Whether helping elite athletes or everyday clients, Colin focuses on reducing pain, restoring mobility, and building resilience through manual treatment and tailored exercise programs.
