How to Fix Tennis Elbow: Why Strengthening—and Checking Your Neck—Matters
Pain on the outside of your elbow when you grip, lift, or swing a racket? It might be tennis elbow. And despite the name, you do not have to play tennis to get it.
For many people, the problem comes down to a mismatch: how much you are asking your wrist and forearm to do versus how much they can currently tolerate.
Fixing that mismatch means adjusting the activities that aggravate it and gradually building strength. But first, we need to make sure the elbow is actually the source of your symptoms. Your shoulder—and especially your neck—deserve attention, too.
What causes tennis elbow?
Your wrist extensors are the muscles that lift your hand backward and help keep your wrist steady while you grip. Their tendons attach near the outside of your elbow. When the demands on this system exceed its current capacity, that area can become painful.
That can happen after more tennis, heavier gym workouts, repetitive work, or a weekend of yard projects. Sometimes the change is less obvious: a new racket, a new stroke, or a technique that asks more of your wrist. AAOS
The goal of rehab is to help your arm tolerate what you want to do again.
Is it really tennis elbow—or is your neck contributing?
You do not need to have neck pain for your neck to contribute to arm pain or weakness. Irritation of a nerve in the neck can cause symptoms farther down the arm. Some people have a local elbow problem, some have symptoms coming from the neck, and some have both. AAOS
At Summit Physical Therapy, we believe every tennis elbow evaluation should include screening for a neck contribution. Otherwise, you may spend weeks strengthening your wrist while an important part of the problem goes untreated.
A skilled physical therapist can examine your neck movement, arm strength, sensation, and reflexes when indicated. We can also test and retest a painful movement or strength measure after changing neck position or performing a neck-directed movement. Sometimes the response is apparent within the same visit.
These changes are useful clues, interpreted alongside the rest of your examination. If the neck is contributing, your treatment plan needs to address it.
How physical therapy helps fix tennis elbow
1. Calm symptoms and adjust the workload
First, we identify what aggravates your elbow and what helps it settle. That may mean temporarily changing your lifting technique, reducing tennis volume, taking breaks from repetitive gripping, or adjusting an exercise.
Hands-on treatment can help reduce pain while we work on rebuilding capacity. The plan is to keep you active at a level your arm can manage and progress from there.
2. Restore motion and improve coordination
We check wrist and elbow range of motion, shoulder mobility, and how these areas work together. Restrictions or difficulty controlling a movement can change how you load the arm.
Your exercises should address the limitations we actually find. That includes neck-directed treatment when your examination shows a neck contribution.
3. Strengthen the wrist, grip, and shoulder
Most tennis elbow rehab centers on progressively loading the wrist extensors. That is physical therapist speak for strengthening them, starting with a manageable challenge and gradually increasing it.
Depending on your symptoms, that might begin with holding a resistance still, then progress to lifting and lowering a weight. We also build grip strength and tolerance for carrying and lifting.
When shoulder weakness is present, we strengthen the shoulder blade muscles, including the trapezius muscles, and the shoulder external rotators—the muscles that rotate your upper arm outward. Wrist strengthening and shoulder exercises selected for identified weaknesses are supported by physical therapy clinical practice guidelines. orthopt.org
The right resistance and progression matter. An exercise that is appropriate later in recovery may be too much at the beginning. We monitor your response during exercise and afterward to guide the next step.
4. Build strength into real movements
Wrist exercises are a starting point. We then work toward the movements you need: lifting at the gym, carrying groceries, using tools, or swinging a racket.
When appropriate, we use VALD strength testing to measure relevant strength deficits and track progress. Objective measurements help us make decisions beyond whether your elbow feels better that day.
5. Restore speed, power, and endurance
For tennis players and other athletes, rehab should eventually include faster movements, controlled impact, and repeated efforts. We gradually build toward the demands of your sport, including footwork and changes of direction when relevant.
Your arm needs to tolerate more than one good repetition. It needs the endurance to get through a match, workout, or workday without symptoms steadily building.
Your tennis stroke and racket may matter
We also look at how you use your arm. If your stroke relies heavily on the wrist and gets little help from your legs and trunk, it may place more demand on the painful area.
A new racket or a new stroke can change that demand, too. Those details are worth discussing, especially if your symptoms began around the same time. When appropriate, we can coordinate with your tennis coach to help you adjust technique while rebuilding strength.
Get a plan that addresses the whole problem
Tennis elbow treatment should start with a thorough evaluation and progress toward the activities that matter to you. That means checking the neck, shoulder, wrist, and grip—not simply handing everyone the same elbow exercise sheet.
As one Summit PT patient shared about their experience:
“From the initial online contact to my evaluation, and through every session, the atmosphere was welcoming.”
Summit Physical Therapy serves Summit, Short Hills, Millburn, Maplewood, Chatham, Florham Park, New Providence, Springfield, and South Orange. We will help identify what is driving your symptoms and build a plan to get you back to lifting, working, and playing with confidence.