Causes of Tennis Elbow

Introduction

Tennis Elbow, medically known as Lateral Epicondylitis, is one of the most common overuse injuries that affects millions of people every year. Despite its name, this condition is not limited to tennis players. Anyone who repeatedly strains their forearm muscles and tendons can develop this painful condition. Understanding the root causes of Tennis Elbow is the first step toward preventing it, managing symptoms, and protecting long-term arm function.

Causes of Tennis Elbow

1. Overuse of Forearm Muscles (The Most Common Cause) :- The primary cause of Tennis Elbow is overuse and repetitive strain of the forearm muscles that help extend the wrist and fingers. These muscles connect to the lateral epicondyle of the elbow through small tendons. When they are overworked, tiny microtears develop within the tendon.

How overuse leads to the condition

• Repeating the same wrist or arm motion puts excessive load on the tendons.
• Over time, the small tears fail to heal properly.
• Scar tissue builds up, decreasing flexibility and strength.
• The tendon becomes inflamed, leading to pain and tenderness.

Even simple movements such as gripping a tool, typing for long hours, or lifting uneven weight can cause this condition if the muscles are strained continuously. Overuse remains the biggest contributing factor in 80–90% of cases.

2. Repetitive Motions in Sports :- Tennis may have popularized the condition, but many sports involve similar repetitive arm motions that increase the risk.

Common sports activities that cause Tennis Elbow

• Tennis and Badminton :- Poor backhand technique or improper racket grip.
• Squash and Table Tennis :- Sudden wrist flicking or forceful strokes.
• Golf :- Repeated gripping and swinging motions.
• Rowing or Weightlifting :- Intense forearm engagement and improper form.

Athletes who train frequently without proper warm-ups or adequate rest are more likely to experience tendon overload. Incorrect equipment such as a heavy racket or tight strings further increases stress on the elbow.

3. Occupational Strain and Manual Work :- Tennis Elbow is extremely common among working professionals who use their hands for repetitive tasks. Jobs that involve forceful gripping, lifting, twisting, or vibration can strain the forearm muscles just like sports.

High-risk professions include

• Plumbers
• Carpenters
• Electricians
• Construction workers
• Mechanics
• Painters
• Chefs
• Gardeners
• Factory workers using tools like screwdrivers, hammers, or drills

Continuous use of tools or machinery puts pressure on the tendons that eventually leads to microtears. Even an incorrect wrist position repeated all day can trigger inflammation.

4. Poor Technique in Household Activities :- Many people are surprised to learn that routine household tasks can cause Tennis Elbow. This includes activities that require gripping, twisting, or repeated wrist extension.

Everyday causes include

• Using scissors for long periods
• Cooking tasks like chopping or kneading dough
• Vigorous cleaning or scrubbing
• Carrying heavy shopping bags
• Gardening activities like trimming or raking

Incorrect hand posture and repetition combine to overload the tendons, especially when performed daily.

5. Weak Forearm Muscles and Poor Conditioning :- Weak or underdeveloped forearm muscles cannot tolerate stress, making them more vulnerable to injury. When the muscles fatigue quickly, the tendons absorb more force, increasing the risk of microtears. Lack of stretching, poor warm-up routines, and ignoring muscle strengthening exercises contribute significantly to the development of Tennis Elbow. People who return to physical activity after a long break are more likely to experience this condition due to weak muscles.

6. Age-Related Tendon Degeneration :- Tennis Elbow is most common in adults between 30 and 50 years old. As we age, our tendons naturally lose elasticity, hydration, and the ability to repair themselves.

How aging contributes

• Reduced blood flow to tendons
• Slower healing capacity
• Progressive weakening of collagen fibers
• Higher likelihood of inflammation after minimal strain

Even moderate activity can damage fragile tendons, especially in individuals who are not physically active.

7. Sudden Injury or Trauma :- Though rare, a sudden impact or unexpected force on the elbow can also lead to Tennis Elbow. This may include

• Lifting something too heavy
• Sudden jerking motion
• A fall that strains the elbow joint
• An overstretch of the wrist or forearm

Trauma can create immediate microtears in the tendon, and if not treated properly, the condition may become chronic.

8. Incorrect Posture and Ergonomics :- Poor posture, especially during office work, puts unnecessary stress on the forearm and elbow. Long hours at a desk with improper hand positioning can strain the tendons even if the activity seems light.

Ergonomic causes

• Typing with bent wrists
• Using a mouse without wrist support
• Slouching, causing shoulder and arm misalignment
• Repetitive movements without breaks
• Poorly designed workstations

Without correcting posture, the strain accumulates over time, eventually leading to Tennis Elbow.

9. Using Improper Equipment :- In both sports and work settings, using equipment that is not suited to your body can cause excessive stress on the elbow.

Examples include

• A tennis racket that is too heavy
• Oversized or tight grips
• Tools that require excessive force
• Old, worn-out sports gear
• Vibrating machinery without cushioning

The wrong equipment means the forearm muscles must work harder, increasing the risk of overuse injuries.

10. Medical Conditions that Increase Risk :- Though uncommon, certain health conditions can weaken tendons, making them more prone to injury.

These include

• Rheumatoid arthritis
• Diabetes
• Thyroid disorders
• Previous arm or elbow injuries
• Connective tissue disorders

Such conditions slow the healing process, making even minor repetitive tasks harmful.

Conclusion

Tennis Elbow is not caused by a single factor; it usually develops due to a combination of overuse, poor technique, weak muscles, repetitive movements, and age-related tendon changes. While athletes often experience it, the condition is equally common among office workers, manual laborers, and people performing daily household tasks.