Tennis Elbow: When Your Favorite Activity Starts Talking Back

There is a particular kind of betrayal that happens when something you love starts hurting you.

Maybe it is tennis.

Maybe pickleball.

Maybe woodworking, gardening, painting, lifting weights, or spending an afternoon turning a screwdriver over and over again.

You have found something that makes you feel alive, and then one day your elbow starts complaining.

At first it is barely noticeable.

A little tenderness on the outside of the elbow.

Maybe your backhand feels slightly different. Then you notice it when you pick up a coffee cup. Eventually you start thinking about your elbow while you are playing, which is generally not where anyone wants their attention to be.

Welcome to tennis elbow.

The strange thing about tennis elbow is that it isn't really a tennis problem. In fact, most people who develop tennis elbow don't play tennis at all. It is more accurately described as lateral elbow tendinopathy, a condition involving the tendons of the forearm where they attach near the outside of the elbow.

Repetitive loading of the wrist and forearm can contribute to the problem, but there isn't always one obvious cause.

And this is where things get interesting.

Your elbow isn't necessarily broken

The word “injury” can make us imagine a single catastrophic event.

Something tore.

Something snapped.

Something went wrong.

But tendinopathy often doesn't work that way. It can develop gradually as the demands placed on a tendon begin to exceed its current ability to adapt.

Think about what happens when you suddenly decide you are going to get serious about pickleball.

You play twice a week.

Then three times.

Then your friend convinces you to play Saturday morning.

Then Sunday.

Then you discover that your forehand has apparently become a matter of personal destiny.

Your body is adapting to all of this.

Your muscles adapt. Your nervous system adapts. Your technique adapts. And your tendons are adapting too.

Sometimes the workload increases faster than the tendon can comfortably handle.

The result may be pain, tenderness, weakness, or stiffness around the outside of the elbow. These symptoms can extend into the forearm and can make gripping, turning a doorknob, shaking hands, or holding a cup uncomfortable.

The body is not necessarily failing.

It may simply be asking for a different conversation.

The problem may not be where the pain is

This is one of the things I find most interesting about working with bodies.

The place that hurts is not always the whole story.

The outside of the elbow is where you feel the pain, but the muscles and tendons of the forearm are part of a larger movement system. What your shoulder is doing, how you grip your racket, how much your wrist moves, how quickly you've increased your activity, and how much recovery you're getting can all matter.

And then there is the wonderfully complicated fact that every body develops its own strategies.

You may have been moving a certain way for twenty years.

Your body may have become extremely good at it.

It may also have become extremely good at compensating for things you don't even notice anymore.

This is why I don't think of massage as simply finding the one tight muscle and attacking it until it gives up.

The body is not a knot that needs to be defeated.

It is a living system.

So what actually helps?

There is no single magic treatment for tennis elbow, and current research doesn't give us a simple “do this one thing and your elbow will be fixed” answer. A 2024 systematic review found that many treatments studied for lateral elbow tendinopathy have relatively limited or uncertain evidence, while exercise and physical therapy approaches have some of the more useful support, particularly over the longer term.

This is actually good news.

It means we don't have to go hunting for a miracle.

We can work with the body.

1. Adjust the workload

If an activity is repeatedly provoking your elbow, changing the amount, intensity, frequency, or technique can be an important part of recovery.

That doesn't necessarily mean you have to stop everything you love.

Sometimes it means doing a little less for a while.

Sometimes it means taking a day off between sessions.

Sometimes it means looking at your equipment or technique.

Sometimes it means admitting that playing three hours of pickleball after six months of not playing much was perhaps an optimistic interpretation of your current fitness level.

Bodies like gradual increases.

Tendons especially tend to appreciate them.

2. Build strength

One of the important pieces of rehabilitation is gradually rebuilding the capacity of the muscles and tendons to tolerate load.

Exercises that strengthen the forearm and improve its endurance can be an important part of recovery. The American Academy of Orthopaedic Surgeons specifically includes stretching and strengthening exercises in its therapeutic exercise program for tennis and golfer's elbow, with the goal of improving endurance and resistance to repetitive stress.

This is one reason I like the idea of rehabilitation rather than simply symptom reduction.

We don't just want the elbow to hurt less.

We want to gradually create a body that can handle more.

3. Pay attention to the rest of the arm

Your forearm doesn't exist in isolation.

When I work with someone experiencing tennis elbow, I'm interested in the forearm, of course, but I'm also interested in the surrounding structures and in the movements that are asking the forearm to work.

Where is the tension?

How are you gripping?

What is your wrist doing?

What is your shoulder doing?

What movements reproduce the discomfort?

What movements don't?

Sometimes the most useful information comes from simply paying attention.

Where does massage fit?

Massage is not a magic eraser for tendinopathy.

And I don't think it should pretend to be one.

The research on massage specifically for tennis elbow is much less definitive than the marketing language around massage sometimes suggests. Reviews of deep friction massage have found that the evidence is limited and that its isolated effectiveness has not been firmly established. More recent research on manual therapy has found some potential benefits from certain techniques, but also emphasizes that the evidence varies by approach and outcome.

So why use massage?

Because sometimes changing the experience of the surrounding tissues can be useful.

Because a forearm that has been gripping, working, and protecting itself for weeks can become a very different landscape from a relaxed forearm.

Because massage can provide an opportunity to explore movement and sensation without asking the body to perform.

And because sometimes you need someone else to put their hands on the problem and help you notice things you can't easily notice yourself.

That is where I think massage can have a meaningful place in a larger recovery process.

Not as the entire answer.

As part of the conversation.

Don't forget the person attached to the elbow

There is another part of this that gets lost when we talk exclusively about tendons.

People don't actually care that much about their tendons.

They care about what their tendons prevent them from doing.

They want to play tennis with their friends.

They want to win the pickleball match.

They want to garden.

They want to build something in their workshop.

They want to pick up their grandchild.

They want to swing a golf club without thinking about their elbow.

The purpose of recovery isn't simply to produce a pain-free elbow sitting quietly on a table.

The purpose is to help you participate in your life.

That changes the question.

Instead of asking:

“How do I get rid of this pain?”

we can also ask:

“What does my body need so that I can return to doing what I love?”

Those are similar questions.

But they lead us in somewhat different directions.

And sometimes the best thing you can do is get another set of eyes

Not every case of elbow pain is tennis elbow.

Elbow pain can come from a number of different structures and conditions, and symptoms can sometimes be related to the neck, shoulder, nerves, joints, or an acute injury rather than lateral elbow tendinopathy.

If you've had a sudden injury, significant swelling or bruising, severe pain, numbness or tingling, difficulty moving the arm, or pain that isn't improving with reasonable self-care, it's worth getting evaluated by an appropriate healthcare professional.

A massage therapist can work within their scope.

A physical therapist can assess movement and build a rehabilitation program.

A physician or other qualified healthcare professional can evaluate conditions that require medical diagnosis or treatment.

There is no prize for trying to solve everything yourself.

Sometimes wisdom looks like knowing who to ask.

The elbow is talking. Let's listen.

One of the things I love about working with active people is that most of them don't actually want to stop moving.

They want to keep playing.

They want to keep climbing.

They want to keep golfing.

They want to keep gardening, lifting, paddling, building, throwing, swinging, running, and generally making use of this strange collection of bones, muscles, tendons, nerves and connective tissue that we have been given.

Tennis elbow can be frustrating because it can feel like your body is standing between you and something you love.

But perhaps there is another way to look at it.

Perhaps the elbow isn't betraying you.

Perhaps it is giving you information.

The body is constantly adapting to the demands we place upon it. Sometimes those demands need to change. Sometimes the body needs more strength. Sometimes it needs more recovery. Sometimes it needs a different movement strategy. Sometimes it needs skilled hands, thoughtful exercise, or another professional set of eyes.

And sometimes it simply needs us to pay attention.

That is where recovery begins.

Not with defeating the body.

With listening to it.

If tennis elbow or persistent forearm tension is keeping you from the activities you love, massage may be one useful part of your recovery process. At Open Way Healing and Massage in Durham, I work with active adults who want to keep moving, keep playing, and understand their bodies a little better along the way.