Backhand Your Pain: An In-Depth Look at Tennis Elbow and How to Beat It

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Do you love playing badminton or any racket sports, but lately you've been experiencing discomfort around the outside of your elbow, especially when you hit your backhand? Don't worry, you're not alone! This is a common condition known as lateral epicondylitis, or more commonly, tennis elbow.

Tennis elbow is a common condition that affects many people, especially those who engage in repetitive arm motions or gripping activities. In this post, we're going to take a closer look at the anatomy and pathophysiology of lateral epicondylitis, how it's diagnosed, and the differential diagnoses that should be considered. We'll also take a closer look at the treatment options available, including self-tests that can be done at home.


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Your arm is made up of several muscles and tendons that allow you to move your wrist and fingers. The extensor carpi radialis brevis (ECRB) is a muscle in your forearm that helps to extend and abduct your wrist joint. Tennis elbow, or lateral epicondylitis, occurs when there is repetitive eccentric overloading of your ECRB tendon. This can lead to small injuries in the muscle and tendon, disrupting the production of collagen, which helps to make the tendon strong. Overuse and repetitive stretching of the muscle during activities like gripping or twisting can affect blood flow to the area and lead to the growth of new blood vessels, making the condition worse. This leads to inflammation, pain, and weakness in the forearm and wrist. Patients with lateral epicondylitis typically experience pain around the outside of the elbow, especially when performing activities that require wrist extension, such as a backhand swing in tennis or badminton. 

To diagnose tennis elbow, your doctor may perform a physical exam, which can include resisted wrist extension to recreate pain over the ECRB tendon. They may also use imaging tests such as X-rays or MRI to determine the extent of the injury. 

Other conditions that can cause similar symptoms include PIN irritation, radial tunnel syndrome, posterolateral rotatory instability (PLRI), osteochondral defect, and Little League elbow. Your doctor may perform further testing to rule out these conditions and determine the best course of treatment.

•    PIN irritation: Usually occurs in athletes who repeatedly exert grip strength with excessive pronation and supination movements. Symptoms include weakness of extensors (e.g., at the thumb) and a deep ache in the proximal forearm.

•    Radial tunnel syndrome: This occurs when the superficial radial nerve is compressed by structures in or near the radial tunnel (ECRB and brachioradialis). Symptoms include pain and tenderness in the forearm, wrist, and hand.

•    Posterolateral rotatory instability (PLRI): This is often caused by a complex injury to the lateral ulnar collateral ligament complex, resulting from a traumatic event such as dislocation of the radius on the capitellum. Symptoms include lateral elbow pain accompanied by mechanical symptoms such as clicking, snapping, or locking.

•    Osteochondral defect (osteochondritis dissecans): This condition occurs in overhead throwing sports or those that require repetitive valgus stress or compressive forces on the elbow. It results in a separation of an osteochondral fragment, which can cause locking, catching, or an inability to fully extend the elbow.

•    Little League elbow: This is a stress injury that occurs in young athletes who engage in throwing sports.

But don't worry, there's good news! With the right treatment, you can get back to enjoying your favourite activities pain-free. Here's how we can help:

Phase 1
This initial stage of rehabilitation focuses on relieving pain. Modalities such as TECAR/shockwave, manual therapies such as massages or cross frictions, dry needling, or a combination of these methods can be used to reduce inflammation and improve blood flow to the affected area.

PHASE 2 
With the pain subsiding, the focus shifts towards addressing faulty mechanics during sports-specific movements. This could involve analysing your movement patterns during badminton or tennis and identifying areas where you may be placing excessive stress on your elbow.

PHASE 3
In this phase, the focus shifts are towards strengthening and loading the wrist extensor muscles using weights and eccentric exercises. Eccentric exercises are effective in the treatment of lateral epicondylitis as they have been shown to promote collagen synthesis and remodelling of the tendons. 

PHASE 4
Treatment in this phase is centred around technique and power. Modifications of activities may be necessary to prevent re-injury. This involves optimizing form during racket sports and tennis, particularly the backhand stroke, and gradually increasing training intensity and duration while ensuring proper biomechanics.