Tennis elbow is a condition of overuse/repetitive strain that over time produces pain on the outside of the elbow that can lead to decreased grip strength and painful movements of the wrist and arm. Many individuals report the inability to take the lid off a jar, hold a cup of coffee, and pain with shaking hands. While the name suggests it is a condition of athletes it is commonly seen in non-athletes as well. Individuals who do a lot of computer work, painters, carpenters, plumbers, and even butchers commonly get tennis elbow.

The Cause

Tennis elbow is caused by micro trauma to the extensor tendons during repetitive wrist and finger extension (cocking the wrist and fingers back). The wrist and finger extensors attach on the bony aspect on the outside of the elbow, and this is where most individuals report pain with many being able to pinpoint the spot with their finger. Repetitive tasks not only cause micro-trauma to the extensor tendons, but trigger point development in the forearm extensor muscle group. When trigger points are present it is common for muscles to be weak, and explains why people notice decreased grip strength and trouble holding a cup of coffee.

 Common Trigger Points of the forearm extensors and their referral pattern.

Common Trigger Points of the forearm extensors and their referral pattern.

We also have to look higher up to make sure other areas are not contributing to what brought the problem on in the first place. Like we talked about in our blog Traditional Diagnosis vs Functional Diagnosis the area of pain isn’t always the source of the problem. We have to assess the scapula and thoracic spine since they have an effect on the mechanics of the elbow.


As with many tendinous conditions, research has shown that rest and avoiding load can actually prolong healing. It is being found that staying active and loading tendons help to speed up the healing process. When treating tendinous issues we need to create change and adaptation in the tendon. Loading the area using isometric and eccentric exercises help to create the change and adaptation needed in the tendons.

 Towel Drill used to eccentrically load the extensor tendons.

Towel Drill used to eccentrically load the extensor tendons.

Loading tendons combined with manual therapies such as ART and FAKTR/IASTM help to jump start the healing process. Dry needling helps to reduce trigger points and create acute inflammation to help with the healing process. As well as assessing and addressing any contributing factors such as poor thoracic spine mobility and scapular stability.


At TROSS we combine both evidence based care and our experience to provide patients with the most effective care for each individual. We are trained in many techniques to ensure we provide our patients with the best care we can. If you have any questions or would like a complimentary consultation contact TROSS today! TROSS proudly serves the Cottleville, St. Peters, St. Charles, O’Fallon, and St. Louis area!