Sports Injury Treatment - Spokane, WA
Reviewed By: Stephen Byers, DC CSCS
TENNIS ELBOW IN ATHLETES AND ACTIVE INDIVIDUALS--AND WHAT ACTUALLY FIXES IT
Tennis elbow is one of the most common elbow injuries we treat at the Movement Clinic. Most of the time it isn't from playing tennis — and it doesn't have to keep coming back.
Does This Sound Familiar?
Pain that follows you on and off the court
"My elbow hurts every time I shake hands."
"My elbow throbs the day after every pickleball match."
"It started in the gym during my pull workouts."
"The pain shoots up my forearm during my backhand."
"I can't open a jar or hold my coffee cup without pain."
"I've tried braces, ice, and rest — nothing sticks."
Why It Happens
Two patterns we see in almost every athlete with tennis elbow
EXTENSORS WORKING EXTRA
Many tennis and pickleball players recruit the muscles that attach to the outside of their elbow (the extensor group) while rotating the forearm down — often to shape shots. The extensor muscles are designed for the opposite job: supinating the forearm and extending the wrist. Asking them to help with pronation thousands of times per match overloads the tissue where they attach to the lateral epicondyle. On exam, you can see it — resisted pronation makes the wrist drift into extension and the outside of the elbow hurts.
WRIST EXTENSION UNDER LOAD
When the wrist drifts backward into extension during ball contact — or during a heavy grip in the gym — the load doesn't travel through the bones of the forearm well and instead the extensor group has to work hard to stabilize the load. Over time this causes injury where the muscles attach to the bone of the elbow. That's how a low-level irritation turns into a chronic, weeks-long elbow that won't quit.
What's Driving It
The physical reasons these patterns develop
Movement faults don't happen in isolation. They're usually the body's way of working around a physical limitation. When we evaluate athletes and active individuals with tennis elbow, we commonly find one or more of these:
WEAK/INHIBITED PRONATORS
When the true pronator muscles aren't doing their job, the extensors get recruited to compensate. This substitution pattern is the upstream cause of most tennis elbow cases.
LIMITED FOREARM ROTATION
If your forearm can't rotate freely into full supination, the body finds the motion somewhere else — usually by extending the wrist. That puts more demand on the extensor group than they were designed to handle.
LIMITED WRIST FLEXION
When the wrist can't bend freely toward the palm, it sits in a more extended position during gripping and impact. Every shot, every rep, every typing session adds load to the extensor tendons.
POOR GRIP STRENGTH
Weak grip strength or endurance forces the larger forearm muscles to work harder for longer. The extensor group ends up doing both grip stabilization and motion, which it can't sustain.
POOR ERGONOMICS
Sleeping with the elbow underneath the chest or head is an overlooked cause of elbow pain. When pressure is applied to the elbow, it restricts blood flow to the tissues and causes tightening of the muscles.
POOR RECOVERY BETWEEN MATCHES
Small irritations accumulate. Without consistent recovery work between play, stiff joints and tight muscles compound — turning a minor twinge into persistent pain that won't go away no matter how much you stretch or brace it.
Our Approach
How we evaluate tennis elbow at the Movement Clinic
Most tennis elbow treatment starts with the symptom — a brace, ice, rest, anti-inflammatories. We start with the movement, because that's where the answer usually is.
01
FULL MOVEMENT ASSESSMENT
We assess basic mobility, stability, and movement patterns across your whole body — not just your elbow. This reveals any physical limitations that may be contributing to the problem, not just where it hurts.
02
ACTIVITY-SPECIFIC BIOMECHANICAL TESTING
We assess your strength, power, and movement mechanics to see how your physical limitations connect to your sport or training pattern — lifting, cycling, racquet sports, throwing, or whatever you do. Understanding whether the pain is coming from physical restrictions, movement mechanics, or both shapes everything that comes next.
03
SPORTS CHIROPRACTIC CARE
Targeted adjustments restore motion to stiff joints in the wrist, elbow, and forearm so the extensor group isn't forced to compensate. Soft-tissue treatments help calm down the irritated tissues at the lateral epicondyle and free up the tight forearm musculature contributing to the problem.
04
ACTIVITY-SPECIFIC REHABILITATION
We use exercises to wake up the pronators, restore proper forearm rotation, and build the grip strength and endurance the elbow needs to handle the load. The goal isn't just to feel better — it's to fix the movement pattern that caused it in the first place.
05
RETURN TO ACTIVITY PLANNING
We work with you on lifestyle modifications, grip and equipment considerations, warm-up routines, and how you're managing load between sessions. The goal is to keep you in the game — not just recover from it. Sleeping position is one of the most common drivers of elbow pain we see, and we have a back-sleeping transition class that walks you through changing it.
Every plan starts with a Movement Assessment.
Common Question
Should you stop playing if your elbow hurts?
In most cases, no — and that isn't usually what we recommend. Pain is a signal that something needs to change, not necessarily that play needs to stop. With the right plan, most patients are able to continue playing while they recover.
What we want to understand is why it's happening. Once that's clear, we can usually modify your technique, your grip, your equipment, your warm-up, and how you're managing load between matches — and the pain starts to improve without giving up the sport.
Pain lasting more than 1–2 weeks, recurring flare-ups, elbow pain that's now causing weakness in your grip, or pain that wakes you up at night are all signs that it's worth getting assessed sooner rather than later. Tennis elbow tends to respond well when it's caught early and gets harder to resolve the longer you push through it.
What to Expect
Realistic recovery timelines
Every athlete is different, but here's what we typically see based on the nature of the issue.
6-8 VISITS
Acute Flare-up
Recent onset, first-time issue. Fast response with the right treatment and activity modification
4-8 WEEKS
Persistent or Recurring Pain
Pain that has been present for weeks or months, or keeps coming back. Requires addressing the underlying movement dysfunctions.
8-16 WEEKS
Performance Rebuild
Full recovery requires building the necessary mobility, strength and movement mechanics needed to stay pain-free for the long term.
Frequently Asked Questions
Questions athletes and active individuals ask us about tennis elbow
Q: Can a chiropractor actually help with tennis elbow?
A: Yes — particularly when the care is movement-based rather than just adjustment-focused. Chiropractic care that combines adjustments with targeted mobility and strength work addresses both the pain and the underlying pattern driving it. Most patients see meaningful improvement within a few weeks.
Q: Do I need imaging before coming in?
A: No. In most cases of tennis elbow, imaging isn't the first step. Our movement assessment gives us the information we need to get started. If imaging becomes relevant, we'll let you know and we can help refer you for it.
Q: Is this just age — should I expect tennis elbow as I get older?
A: This is one of the most common things we hear, and it's rarely true. Tennis elbow is almost always the result of a movement pattern, not age. We regularly work with patients in their 50s, 60s, and 70s who resolve persistent elbow pain once the underlying cause is identified.
Q: I play pickleball, not tennis. Is this the same condition?
A: Yes, and it's increasingly common. "Tennis elbow" is the everyday name for lateral epicondylitis — irritation of the tendons on the outside of the elbow. It shows up in pickleball, racquetball, weight training, golf, and even repetitive desk or trade work. The mechanism is the same regardless of the sport, and so is the treatment approach.
Q: Will a brace fix it?
A: Maybe in the short term. A counterforce brace can off-load the tendon during play and reduce pain in the moment, which is useful as a bridge. But a brace doesn't change the movement pattern that caused the problem — once you take it off, the underlying issue is still there. We use braces tactically during recovery while we address the real driver: the substitution pattern between your pronators and extensors.
Q: How is this different from seeing a regular chiropractor or physical therapist?
A: Our team specializes in working with athletes and active individuals. We assess movement patterns, understand the demands of racquet sports and weight training, and build treatment plans that include targeted exercise and adjustments. We're focused on solving the underlying problem and getting you back to doing what you love.