Monday 5th August, 2019
  Categories: General

Why tennis elbow won't heal, and what you can do about it

Tennis elbow
Tennis elbow is described as an overuse injury, but why won't it heal


Tennis elbow is a painful and disabling condition that is said to develop through overuse, but why does it then refuse to heal and defy treatment? The reason is that there is an often overlooked issue that creates stress on the elbow that contributes to the condition developing, then prevents it from healing.

In this article we discuss what that is, and what you can do about it.


What is tennis elbow
The overlooked cause
Do you have this problem
What to do about it

What is tennis elbow

As the diagram above shows a large number of forearm muscles are attached to a small bony bump at the side of your elbow called the lateral epicondyle. With so many muscles attached to such a small area it creates an area of high stress. If the muscles are overused the attachment can become inflamed or injured. With the bony bump called the lateral epicondyle the condition is called lateral epicondylitis, but because it is common in tennis players the common name is tennis elbow.

Signs and Symptoms

There will be pain and tenderness at the outside of the elbow. Pain will be brought on by activities that work the muscles at the back of your forearms, such as gripping or twisting. Although called tennis elbow, it is common in people who do any sort of repetitive activity using their forearm muscles. Examples include: trades people, production workers, and those who use keyboards.

Trigger point tightening causes muscle tears, attachment pain and "overuse injuries"

The overlooked cause

Trigger points are those tender lumps in your muscles that therapists find. As discussed in our our article Trigger point basics these develop when muscles are over used, and when they do they cause the muscle to tighten abnormally. This creates tension in the muscle which causes it to pull abnormally on the attachment.

The problem put simply

Both the over use and the abnormal tension are pulling on the attachment causing it to become inflammed or injured. Because of that, even if completely rested the tension caused by the abnormal tightening will continue to pull on the the attachment, creating stress and not allowing it to heal.

Tennis elbow needling
Overlooking the source of abnormal tension and sticking needles in the inured area

What happens when this problem is overlooked

The tennis elbow either doesn't settle, or flares up again

Depending on how bad the problem is the elbow either:

  • will not settle down, or
  • will temporarily settle then flare up again when the forearm muscles are used.
Doctors will blame the elbow

When this happens too often the elbow gets blamed, and treatment will be directed at the injured area. This is where the injured elbow is often rubbed, poked with needles or zapped with laser. With the abnormal tension still on the area of course it can't fix the problem, and the treatment often ends up stirring it up.

Do you have this problem

We will show you a simple three step process.
Step one: do you have tennis elbow
Step two: do you have trigger points
Step three: are the trigger points contributing to your tennis elbow

Please note that this is for general information only, to be discussed with a professional familiar with your own needs.

Step one: do you have tennis elbow


You will likely have pain at the outside of your elbow that gets worse when you grip or twist.

Examine the outside of your elbow

If you have tennis elbow it will be tender at the bony bump at the outside of your elbow, and for about 1-2cm towards you wrist (the tendon of the muscle).

Stressing the injury

Doctors do two simple tests that stress the injury. These are pictured below. If they cause pain that is a sign of tennis elbow. When you do them you want just enough stress to confim that it produces pain. If you do too much you can further injure it.

Tension test for tennis elbow
Bending the wrist forward stretches the forearm muscles creating tension at the elbow
stress test for tennis elbow
Pushing back against resistance puts stress on the elbow

Step two: do you have trigger points

To do this you simply examine your muscles using your fingers as shown in this video. You start using the pads of several fingers to systematically examine the mucles looking for general tenderness and tightness. If found you then use one or two fingers to examine more deeply looking for:

  • tight bands in the muscle
  • tender lumps that shoot pain when pressed upon. These are the trigger points.

Often pain will shoot to your elbow, sometimes mimicing tennis elbow. This is another way trigger points add to tennis elbow so the pain doesn't go away.

Step three: are trigger points contributing to your tennis elbow

Trigger points are very common

The same repeated activities that stress the elbow also cause trigger points to develop, so trigger points are practically always a problem with tennis elbow, but we still check.

Referring pain

In the last step you may have found that pressing on a trigger point shoots pain to your elbow. If this is so, even if your elbow heals the trigger points will continue to cause elbow pain.

Does treating the trigger points relieve the tennis elbow.

To do this you:

  1. Do the tennis elbow tests in step one
  2. treat the trigger points using any of the methods shown in our video
  3. Repeat the tennis elbow tests in step one

If treating the trigger points has reduced the symptoms, tenderness or the amount of pain the stress tests produce that means that tension caused by trigger points is pulling on your elbow.

What you can do about it

We've got a separate article How to treat tennis elbow at home. It's got alternative treatment methods for those who have and have not got the good equipment. It's also got the general management strategies that which are well worth reading. However, by just using one of our General Purpose Massagers as shown below the problem is about 90% covered.

Simple care using a General Purpose Massager

The strategy

The simple strategy is to regularly use the General Purpose Massagers on the trigger points in the forearm muscles. This takes the tension off the elbow allowing it to heal, plus any referred pain will be elimintated.

As discussed in our article Why do trigger points keep coming back vibration massagers are the ideal solution to get rid of trigger points. As a bonus vibration has been shown to speed and improve healing so the vibration from the massager may also help the elbow heal faster and better.

Using a General Purpose Massager on the forearm muscles
Using a General Purpose Massager on the forearm muscles. Note that it is used through cloth to prevent skin irritation.

Using the massager

We have an article How to use a hand held massager with simple guidelines and precautions, but using a General Purpose Massager is extremely simple. You basically just sit the machine on the muscle and let the vibrations penetrate.

Special guidelines for tennis elbow
  1. Only massage the muscle. Do not massage the tender elbow.
  2. 30 seconds per spot
  3. You can either examine for trigger points then treat them as you find them, or alternatively you can systematically cover all of the muscles.
  4. You can use several applications a day. When it is feeling a lot better still use regular but less frequent applications to keep the muscles healthy.

Get a General Purpose Massager

Percussion vs vibration
Massage guns or percussion massagers don't deliver therapeutic vibrations. They jack hammer and cause damage.

Warning about massage guns

Massage guns or percussion massagers are a dangerous gimmick where therapeutic vibration massagers have been converted into mini jackhammers. Most are cheap knock off that do little, but if you get a serious one it won't do much good and you will easily damage your forearm muscles.


DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.

We are continually adding more information on research and uses. Subscribe below to have us email them to you "hot off the press".

Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more

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