What causes Tennis Elbow? Why does it occur?

The Fix My Elbow team have put together this helpful guide to explain the causes of tennis elbow.

Causes and Symptoms of Tennis Elbow


You’ve likely heard of tennis elbow before. Still, unlike its name, tennis elbow can be triggered by all kinds of activities. Between 1% and 3% of the population in the United Kingdom suffers from tennis elbow and those between the ages of 35 and 55 are most often affected.


Tennis elbow is common among people who put excessive strain on their wrist and forearms. Similar to other stresses on the body, experiencing elbow pain just once increases your likelihood of experiencing it again.


This Fix My Elbow article will outline the symptoms and the causes of tennis elbow to help you avoid or reduce activities that contribute to the condition.

What is Tennis Elbow?

The medical term is tennis elbow lateral epicondylitis. It most often occurs when tendons in the elbow are overworked or under too much stress – often from strenuous and repetitive motion by the arm or hand. It can last anywhere from a few weeks to months.


Although it may sound like only athletes suffer from the condition, it’s more common than you think. 

Tennis Elbow Symptoms

Patients that develop tennis elbow describe pain, soreness, or tightness around the elbow, forearm, wrist, and top of the hand.


Tennis elbow often affects manual workers who spend a lot of time exerting pressure on their forearms and wrists carrying out repetitive motions. Plumbers, carpenters, and other labourers often report experiencing elbow pain. 

Symptoms of tennis elbow include: 

  • Weakened grip

  • Difficulty turning a doorknob, holding a cup, or gripping an object 

  • Pain or tenderness near the elbow joint

  • Pain that worsens with movement of the upper or lower arm, or forearm

  • Loss of range of motion 

  • Some patients have reported pain in their neck that is associated with tennis elbow


Symptoms of tennis elbow can often vary from person to person. For example, some patients report head and neck pain, in addition to pain in their elbow and wrist. Doctors find that these varying symptoms require more research to help improve how elbow treatment can relieve pain.

What causes tennis elbow?

The most common activities linked to tennis elbow are excessive movements of the wrist over time.


Playing tennis and other racket sports – a person is repetitively moving their hand and forearm – is how the condition got its name. However, studies show just 5% of patients diagnose tennis elbow from tennis or racket-related activities.


Activities like cutting or sawing, typing, gardening, plumbing, and other manual labour in which people repeatedly twist their arm or bend their elbow using their forearm muscles over long periods - often under strenuous conditions – may cause elbow pain.

Other actions that can cause tennis elbow



Weightlifting or any sports-related exercise using a poor form that puts extra strain on the wrist or forearms.


Hyperextending your arm – for example, holding plank or downward dog (more common among double-jointed people).


Playing the piano, violin, or other instruments that strain the forearm.


Typing, knitting, excessive use of scissors.


Banging your elbow hard against a wall or hard surface - often by accident. This is rarer but can lead to degeneration of the healthy muscle and tendons over time.


Tennis elbow was originally believed to be an inflammatory condition, but studies have found it is more degenerative.


Degeneration can be a significant cause of recurring pain in the elbow for patients. However, recently medical experts have also found that under-use of the elbow and muscles can weaken the joint, which can also cause the condition.


Often, doctors don’t recommend patients stop moving their arms altogether when they experience pain. Instead, they should reduce their movement to keep the joint moving without weakening it.

What makes the tennis elbow joint worse? 

For athletes, if you have experienced tennis elbow, you should avoid some activities or actions to ensure you don’t cause more pain.


Some of those actions include:


  • Playing a sport for too long or playing through pain 

  • Playing too often using the same muscle without any variation 

  • Playing with equipment that is too big or too small (like a racquet) can cause you to over-extend your wrist or arm 

  • Playing with equipment that is too heavy or using tools that are too heavy and can cause muscle strain 

Tennis elbow anatomy - lateral epicondylitis

The elbow is a joint that includes three other bones, including the upper arm bone (humerus) and two bones in the forearm (radius and ulna). The bump on the outside of the elbow is called the lateral epicondyle, which is why it is is called tennis elbow lateral epicondylitis.


The elbow is held together by muscles, ligaments, and tendons. The tendon usually involved is the Extensor Carpi Radialis Brevis (ECRB), which helps stabilise the wrist when the elbow is straight.


The extension of the wrist and fingers is controlled by the forearm, specifically the forearm tendons attached to muscle and bone.


When those muscles, ligaments, and tendons become stretched past their ability from excessive motion, it can contribute to straining or even tiny tears of tendons, which leads to pain and difficulty controlling the movement of the hand and fingers, otherwise known as tennis elbow


How to prevent Tennis Elbow - avoiding forearm muscles strain

Tennis elbow is the most common overuse condition for the elbow. As outlined, it is a degenerative condition. Often, once the tendons in the forearm and elbow are strained in patients, it increases the likelihood of developing tennis elbow again.


This means patients must be vigilant of any arm pain or tightness and take appropriate measures to treat the condition without contributing to it. This is best undertaken using the guidance of physio or physical therapy, like Fix My Elbow.


As mentioned, doctors don’t recommend ceasing all activity as that can prolong the condition.


Instead, there are alternative treatments recommended to help reduce pain and improve both recovery time and use.


For more information about treating and preventing tennis elbow, including with physical therapy, visit our article Tennis Elbow Treatment. 


This article outlined what tennis elbow is, its symptoms, the anatomy of the elbow, and what causes the condition.


It provided details to help patients better identify when they might be putting extra strain on their elbow and what activities to avoid to help reduce tension or tearing. 

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