tennis elbow tennis player

Tennis elbow is one of the most common elbow injuries people experience – even for those who don’t play tennis !  In fact, statistics indicate that only 5% of people who have tennis elbow actually play tennis.

Tennis elbow is generally considered an over-use injury, where muscles in the forearm are affected.  These muscles attach to the lateral epicondyle – thus, the true name for tennis elbow is lateral epicondylitis.

Let’s take a look at the elbow and how it may become injured, and how Bowen Therapy can help.

tennis elbow anatomy bones

a little elbow anatomy

The elbow is a complex hinge joint, formed between the humerus of the upper arm, and the ulna and radius of the forearm.  The bones of the elbow are held together by a range of ligaments to help maintain joint stability and cope with mechanical stresses.

Bones of the elbow

There’s a few bony markings to note.  The most pointed part of the elbow is the most proximal end of the ulna, and is called the olecranon.  On each side of the olecranon are prominent rounded bony parts – these are on the distal end of the humerus, and are called epicondyles.  The medial epicondyle is the bigger of the two, on the inner side of the elbow (the same side as the ulna and little finger).  The lateral epicondyle is on the outer side (the same side as the radius and thumb).

When the elbow flexes (bends) and extends (straightens), the joint acts as a simple hinge.  Having two bones in the forearm, the elbow can allow more complex movements.  Supination and pronation is possible, where the forearm can rotate to allow the hand to face in different directions.

tennis elbow anatomy upper arm muscles

Muscles around the elbow

A wide range of muscles attach around the elbow to enable our range of movement.  

In the upper arm biceps brachii, brachialis, brachioradialis, triceps brachii and anconeus play a large role in flexion and extension.  

Supinator and pronator muscles in the upper forearm assist in that rotatory capability of the forearm.

Forearm muscles that control wrist movements also originate at the elbow.  Wrist flexor muscles originate on the medial epicondyle and run through to the palm-side hand.  These muscles allow the wrist to bend “forward”.  Wrist extensor muscles mostly originate on the lateral epicondyle, and run through to the top of the hand.  Extensors allow the wrist to extend, like when you’re holding up your hand to say stop.

tennis elbow anatomy forearm muscles

what is tennis elbow ?

Tennis elbow is generally considered an over-use injury.

The injury usually comes about when muscles and tendons in the forearm are strained.  This is normally through repetitive or strenuous twisting of the forearm and wrist.

As the muscles are strained, inflammation and small tears can develop near the lateral epicondyle, on the outer side of the elbow.  This strain can be the result of doing a certain activity that the forearm muscles aren’t used to, or through long-term muscle strain.

The pain from tennis elbow often develops gradually.  It often takes a number of days between injury and when the pain appears.

Pain felt may range from mild discomfort while using your arm, through to severe pain that’s still felt at rest.  Pain is normally felt on the outside of the upper forearm near the elbow.  Some may experience pain that extends down the arm to the wrist.

Generally the pain is worse when using the arm – especially when making twisting movements.  Writing or gripping small objects, turning a door handle, or shaking hands can increase pain.  Straightening the arm may also cause increased pain.

tennis elbow injury diagram

what causes tennis elbow ?

Very few people who suffer tennis elbow actually play tennis.

Everyday activities around the home can bring on tennis elbow.  Using a screwdriver, wringing wet clothes, shovelling or using cutters in the garden.  DIY activities such as painting and decorating, bricklaying, or assembling flatpack furniture can also cause tennis elbow.  Even less-strenuous actions such as typing or using scissors, using fine repetitive hand motions, can also be a cause.  For some, the actions may be so innocuous that the cause of injury feels unknown.

Of course, people who play tennis (or badminton or squash) can experience tennis elbow, especially if they haven’t played in a while.  Players of other sports that involve throwing (javelin, discus or a ball) may also experience tennis elbow pain.

My memory of suffering tennis elbow was from about 10 years ago.  I was giving my back garden a make over, doing some bricklaying.  A day of putting mortar on each brick, supinating my forearm repeatedly, took it’s toll – by the following day, I was in agony and struggled to function.  Trying to hold an SLR camera to take photos at a friend’s function left me in tears from pain.  Why didn’t I think about Bowen at the time ?  It took a number of weeks of rest, ice, and anti-inflammatories before that acute injury subsided.

Unsurprisingly, tennis elbow is sometimes known as bricklayers elbow or painters elbow.

tennis elbow DIY cause

tennis elbow treatment

Tennis elbow will eventually get better without any treatment.  Key to this is resting the arm, and stopping doing the action that caused the injury.

For minor, acute tennis elbow injuries, rest, ice and some anti-inflammatories (medication or cream) may speed up recovery.

However, if the pain doesn’t subside or is a chronic issue, then further treatment options need to be considered.  That may be with a physio, or your favourite Bowen Therapist.  These therapists can help take the body out of it’s painful state, and begin to help prevent the muscles and ligaments from being irritated.

If the action that caused the pain needs to be continued, it’s important to look at how that action is being done and how it could be modified to prevent re-injury.

In absolutely extreme cases, cortisone injections or surgery is considered.

tennis elbow elbow wrist move at forearm

bowen therapy to help tennis elbow

Gentle Bowen moves are fantastic for helping people recover from tennis elbow pain.

Shoulders (and thus arms) are often at the mercy of what’s going on in the rest of the body.  Therefore it’s important that the whole body still be addressed, even when arms are where pain is felt.

The muscles involved with tennis elbow follow the back arm fascia lines.  These extend across the upper back and neck, through the shoulders, and along the biceps and forearms to the hand.  Bowen moves through the upper back and neck, around the scapula, and shoulder moves over the deltoids help balance the upper areas of these fascia lines.  The Bowen elbow-wrist sequence helps restore tensegrity along the remainder of this line, and is wonderful for helping to bring relief.

A recent client was experiencing mild tennis elbow, although he really wasn’t sure why.  His shoulder appeared to be pulled high, and during treatment I could feel that neck muscles on one side were firm – I dealt with those before we proceeded to the arm.  Shoulder and infraspinatus moves, then a lovely elbow-wrist sequence had him starting to feel noticeable relief in-session – I’ll see how he’s feeling in his next treatment.

For more painful cases, or chronic problems, resolution will likely require a number of sessions.

For tradies, where work causes the elbow issue, the best time to have treatment is at the end of the working week – let those Bowen moves continue to work over the weekend while resting.  Weekend DIY-ers are best to seek treatment early in the week helps the body recover from the weekend’s work – and be in better shape for the next weekend’s DIY activities.

tennis elbow elbow wrist move at wrist

Image credits:

tennis elbow = BruceBlaus [CC BY-SA 4.0 (]