Tennis Elbow

What is Tennis Elbow?

Tennis elbow, or lateral epicondylitis, is an overuse injury of the common extensor tendon on the outside of the elbow.^[1] It mainly results from repeated gripping and wrist extension, which strain the tendon where it attaches to the bone. Despite the name, many people with tennis elbow have never played tennis.^{[1, 2]}

Common symptoms

The main symptom is pain on the outer elbow that gets worse with gripping or lifting. Pain can travel down the forearm, and grip strength may drop.^[2]

• Tenderness over the bony bump on the outside of the elbow
• Pain when shaking hands, lifting a cup or turning a screwdriver
• A weak grip
• Some stiffness in the elbow

Causes and risk factors

Tennis elbow develops from repetitive strain on the extensor tendon, including from racquet sports and from work or hobbies that involve repeated wrist extension, such as using tools.^[1] Under the microscope, the tendon often shows degeneration, called tendinosis, rather than pure inflammation, and the exact mechanism is still not fully understood.^[2]

How it is diagnosed and treated conventionally

Tennis elbow is usually diagnosed from your history and a physical exam, and imaging is added only when another cause is suspected.^[2] Most cases settle on their own over time, but the best treatment for long-lasting cases is still debated.^[2]

Exercise is a core treatment. A meta-analysis of 30 trials found that exercise did better than passive treatments, including corticosteroid injections, though the effects were small and the evidence low in certainty.^[3] A meta-analysis of platelet-rich plasma (PRP) versus corticosteroid injection in tendinopathy found better mid-term pain relief with PRP, with long-term results still unclear.^[4]

Why Tennis Elbow calls for a whole-person approach

Tennis elbow is more than a sore tendon. The load on the arm, the state of the tendon and how the body handles pain all contribute, which is why exercise, activity changes and symptom relief are usually combined.^{[2, 3]}

Complementary care can help with comfort while you rebuild strength, but it does not replace rehabilitation.

Repetitive load

Repeated gripping and wrist extension overload the tendon.^[1] Changing technique, tools and workload is therefore part of care.

Tendon health

The tendon in chronic cases shows degenerative change rather than only inflammation.^[2] This is one reason that treatments aimed only at inflammation may not help everyone.

Pain processing and inflammation

Laboratory studies suggest acupuncture may act on inflammatory signaling and pain pathways, although most of that work was done in animals.^{[5, 6]}

Strength and grip

Exercise outperformed passive treatments in a meta-analysis, which supports building strength as a core part of recovery.^[3]

Acupuncture for Tennis Elbow

What the research shows

The research is limited and mixed. Several reviews lean positive but note low-quality trials, while others find little or no benefit.

A 2020 meta-analysis of 10 trials (796 people) found acupuncture appeared better than medicine and injection (blocking) therapy, but the difference from sham acupuncture was not statistically significant, and the trials were of low quality.^[7] A 2021 meta-analysis of 14 trials found low-level evidence that manual acupuncture, but not electroacupuncture, reduced pain and disability in the short term.^[8] A review of 19 trials found three moderate-quality trials in which acupuncture beat sham acupuncture, while comparisons with other treatments were limited by weak methods.^[9]

On the other side, an umbrella review of 40 meta-analyses concluded that acupuncture was ineffective for tennis elbow, and a network meta-analysis found no treatment clearly better than placebo for short-term pain.^{[10, 11]} In a sham-controlled trial of 45 people, real acupuncture was better than sham at two weeks, but the difference in pain was gone by two months.^[12] Dry needling, a related technique, improved short-term pain and grip strength in a 2024 meta-analysis of 17 trials.^[13]

How acupuncture may work

Researchers propose that acupuncture and electroacupuncture ease pain by activating the body's opioid and other signaling systems and by reducing inflammatory chemicals in tissue and the spinal cord.^{[5, 6]} In a small trial, 10 acupuncture sessions were followed by a thinner extensor tendon on ultrasound, but this is an early finding.^[14] These are proposed explanations, not settled facts.

What treatment involves

Treatment uses fine, sterile, single-use needles placed near the elbow and along the forearm and arm, usually left in place for about 20 to 40 minutes. A course is several visits, and we reassess progress. Some trials used 10 sessions.^{[12, 14]}

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[15] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Tennis Elbow

The Ayurvedic view

Ayurveda has no single condition that matches tennis elbow. Pain and stiffness in tendons and joints is traditionally linked to aggravated Vata, and heat and inflammation to Pitta. These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine that favor warm, regular meals and enough rest
• Warm herbal oil massage and local heat on the forearm
• Herbs traditionally used for pain and inflammation, such as turmeric and Boswellia
• Local herbal preparations applied to the skin, including transdermal medication therapy

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and heat or oil is not suitable on a freshly injured, swollen elbow until a clinician has assessed it.

What the research shows

No clinical trials of Ayurvedic treatment for tennis elbow were found, so the evidence is none. Research on turmeric and Boswellia in tendon problems is covered under herbal medicine.^[16] Product quality is a concern with some Ayurvedic medicines: about one fifth of those bought online contained detectable lead, mercury or arsenic.^[17] Any Ayurvedic herb should come from a tested source and be prescribed individually.

Herbal medicine for Tennis Elbow

Herbs and formulas that have been studied

No trials of herbal formulas for tennis elbow specifically were found. The nearest research covers supplements for tendon disorders in general. A scoping review of 16 studies included collagen peptides, omega-3 fatty acids and a turmeric and Boswellia combination, as well as several multi-ingredient blends.^[16] A systematic review of nutraceuticals for tendinopathy also considered curcumin and boswellic acid.^[18]

What the research shows

The evidence is limited and of low quality. The scoping review suggested some supplements may help alongside exercise but noted a lack of studies. The systematic review of 46 articles found encouraging laboratory results that clinical studies had not fully confirmed, and it could not support firm recommendations because of poor methods and products with several ingredients.^{[16, 18]}

Safety and herb-drug interactions

Herbs can interact with medicines. Case reports describe bleeding when warfarin was combined with herbs including dang gui, dan shen, ginger, ginseng and Boswellia.^{[19, 20]} Tell us about all medicines you take, including blood thinners and anti-inflammatory painkillers.

Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or have surgery planned.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine describes tennis elbow as stagnation of qi and blood in the channels of the arm, often after overuse or with cold or dampness. Researchers studying acupuncture look at things that loosely parallel this: local inflammatory signaling, pain pathways and the body's own opioids.^{[5, 6]}

Ayurveda's aggravated Vata describes stiffness and pain on movement. Modern research describes degenerative change in the tendon rather than only inflammation.^[2] No study has shown that a dosha or pattern of qi corresponds to a specific change in the tendon.

How this care fits with your medical care

Integrative care for tennis elbow is complementary. Keep your physician, physical therapist or sports medicine specialist, and do not stop or change prescribed medicines, injections or your rehabilitation program without their advice. Exercise is a core part of treatment, although the certainty of the evidence for it is low.^[3] We do not diagnose the cause of elbow pain, so new or worsening pain should be medically evaluated.

Please bring your diagnosis, imaging reports, your rehabilitation plan, a full list of medicines and supplements, and details of any recent injections or surgery.

When to seek urgent medical care

Some elbow symptoms point to a fracture, infection or another problem, not tennis elbow. Imaging is used when another cause is suspected.^[2]

• Severe pain, swelling or deformity after a fall or injury
• Inability to bend or straighten the elbow
• A hot, red, swollen elbow, especially with fever
• Numbness, tingling or weakness in the hand, or a cold or pale hand
• A sudden pop with loss of arm strength
• Pain at night or at rest that keeps getting worse

If any of these occur, call 911 or go to the nearest emergency department.