Tennis Elbow: How to Prevent It

Tennis elbow (lateral epicondylitis) is the single most common tennis injury in players over 35. It's also almost entirely preventable — and the causes are usually technical or equipment-related, not physical. Here's what a coach looks for.

Quick answer

Tennis elbow at the recreational level is usually caused by three things: a bent-arm backhand hitting off-center, polyester strings on a stiff frame, and an eastern grip on the serve. Fix those three and you'll never get it. If you already have it, stop playing, ice, rehab, and don't come back until you've fixed the root cause.

The three technical causes

1. Off-center one-handed backhand

The classic culprit. A one-handed backhand hit off the sweet spot — with a bent arm, wrist collapsing — sends the vibration straight into the outside of the elbow.

The fix:

• Straighten the elbow through contact (a "punched" backhand, not a "wrapped" one)
• Contact the ball out in front, not late
• If you keep hitting late, switch to two hands — this alone fixes 40% of chronic tennis elbow

2. Poor serve mechanics

An eastern-grip serve or a serve without pronation produces massive wrist and elbow torque at contact.

The fix:

• Continental grip only (see the second-serve article)
• Full arm extension at contact
• Pronation through the ball — the hand rotates from palm-out to palm-toward-target

3. Late-contact forehand

Adults who hit a forehand behind their front foot use the wrist to compensate. Wrist load on a topspin forehand = elbow load.

The fix:

• Contact out in front of the front hip
• Body rotation drives the swing, not the arm

The three equipment causes

1. Polyester strings

The #1 preventable cause of recreational tennis elbow. Polyester strings are stiff, they lose tension fast, and they transfer massive vibration to the arm.

The fix: switch to multifilament or hybrid strings. If you must use poly, use it in the mains only with a soft synthetic in the crosses.

2. Stiff frames

Stiff racquets (RA 68+) hit harder without you swinging harder — but they also transfer more shock. Any racquet marketed as "explosive power" or "maximum stiffness" is a candidate cause.

The fix: switch to a flexible frame (RA under 65). The Wilson Clash is a common tennis elbow rescue racquet, as is the Yonex VCore Pro.

3. Overtight strings

Tension in the mid-60s and above is a common tennis elbow trigger, especially with poly strings.

The fix: drop tension by 4–6 lbs. Restring at 52–56 lbs and see how the arm feels.

The three physical causes

1. Weak wrist extensors

The muscles on the top of your forearm that extend your wrist are usually undertrained. When they're weak, the tendons take the load.

The exercise: eccentric wrist extensor lowers. Hold a 3–5 lb dumbbell, wrist palm-down, and slowly lower it over 4 seconds. 3 sets of 12, 3 times a week.

2. Poor grip strength overall

Weak grip = wrist compensates = elbow inflames.

The exercise: squeeze a tennis ball for 30 seconds, 3 sets, daily. Simple, effective.

3. Poor warm-up

Cold muscles are stiff muscles. Playing tennis without a warm-up is a top-3 cause of elbow flare-ups.

The fix: 5 minutes of light rally + 20 easy serves before any real hitting.

What to do if you already have it

Days 1–7: stop playing tennis. Ice for 15 minutes, 3 times a day. NSAIDs if your doctor okays it.

Days 8–21: start eccentric wrist exercises. Very light — pain-free reps only.

Weeks 3–6: gradual return to tennis. Half-length sessions, no matches, all groundstroke feeds — no serving or backhand rally until pain is fully gone.

Weeks 6+: full tennis, but only with the technical or equipment fixes in place. If you go back to the same racquet, strings, and technique that caused the injury, it will come back.

When to see a professional

• Pain persists past 4 weeks despite rest
• Pain wakes you up at night
• Weakness in gripping objects (can't hold a coffee cup)
• Tingling or numbness down the arm

At that point, see an orthopedist or a sports PT. Don't self-treat chronic tennis elbow — it becomes a 6-12 month recovery instead of a 4-week one.

What NOT to do

• Don't wear a tennis elbow brace as a substitute for fixing the cause. The brace helps in the short term but hides the real problem.
• Don't play through pain. Every match played on an inflamed tendon deepens the injury.
• Don't ignore the racquet. If your elbow flared up on your current setup, changing the racquet or strings is often more effective than any physical treatment.
• Don't get cortisone shots as a first move. They provide short-term relief but weaken the tendon long-term. Save them for chronic cases.

Coach-side prevention

I check three things in a lesson when a student mentions elbow discomfort:

1. Their racquet stiffness and string setup
2. Their contact point on the backhand
3. Their serve grip

Nine times out of ten, the fix is on that list. If you're on the south side of Indianapolis and have recurring elbow pain, bring your racquet and your current strings to a private lesson — we can usually diagnose it in one session.