What tennis elbow
actually is
Tennis elbow is not an inflammation, which is why ice, anti-inflammatories and a strap have not fixed it. What Jonathan can work on is the muscle around it.
Tennis elbow is not an inflammation, which is why ice, anti-inflammatories and a strap have not fixed it. What Jonathan can work on is the muscle around it.
Plenty of clinics offer to fix your tennis elbow, and you have probably been round the houses already: a strap, ibuprofen, six weeks off. It helps to know what researchers found when they looked at the tissue itself.
Researchers have looked at more than 600 cases under a microscope. They did not find inflammation. They found disorganised, immature collagen and no inflammatory cells at all, so the -itis in the medical name has been wrong for decades. That is why the strap, the tablets and the rest only take the edge off until your first hard set brings it back.
What the adverts leave out is how the steroid injection did when it was tested. In a year-long trial of 165 people, it did worse than a salt-water injection: 83 per cent recovered, against 96 per cent, and the pain came back in 54 per cent, against 12 per cent. The same research is just as clear that hands-on work has not been shown to make a difference by 12 months either. So there is no quick fix here.
What Jonathan can do is work on the muscles around the elbow: the ones on the outside that pull your wrist back, and the ones on the inside that bend it forward. That matters, because you are likely to be playing through this for months.
Histopathology from Nirschl's series, reported in Journal of Orthopaedic & Sports Physical Therapy, 2005; the one-year injection figures from Coombes et al., JAMA, 2013; the twelve-month comparison from the watchful-waiting trials of Smidt et al. and Bisset et al.
And the boundary is the same here as everywhere else on this site: if it turns out to need a diagnosis, a scan or a prescription, Jonathan will say so and point you to the person who can, rather than work around it.
Each of these four shots puts strain on a different part of your arm or shoulder. Pick the one that hurts afterwards. This is not a diagnosis, just what each shot does to your body.
The muscles that pull your wrist back start at the outside of your elbow. On a backhand, their job is to hold your wrist firm so the ball does not bend it back. You do that under load a few hundred times an afternoon, and that is where tennis elbow comes from.
Close to half of club and social players over 30 get pain on the outside of the elbow at some point. Over a playing life, 40 to 50 per cent of racquet players are told they have tennis elbow.
Figures from the review literature on racquet sport; see the evidence note.
"My backhand hurts afterwards" tells Jonathan more than "I play tennis".
Say it is the backhand →Only 5 to 10 per cent of people with tennis elbow play tennis. Most are plumbers, decorators and others who grip things all day. But if you do play, your chance of getting it over a playing life is close to 50/50. Both are true, and anyone who only tells you the second is selling you something.
Both figures from the review literature; see the evidence note.
That is the problem: playing all season is what causes the strain. Regular sessions keep on top of it while you play, so you are not waiting for the match where it gets too bad to play through.
You always turn the same way, so your shoulder, elbow and opposite hip take uneven strain every session, and it builds up without you noticing.
Like most seasonal sports: weekly while you are playing competitively, less often between seasons. The Rhythm: racquet sportSee how regular sessions work
Take the backhand, the shot tennis elbow is named after. The muscles that pull your wrist back start at the outside of your elbow. On a backhand, their job is to hold your wrist firm so the ball does not bend it back. You do that under load a few hundred times an afternoon, and that is where tennis elbow comes from.
Close to half of club and social players over 30 get pain on the outside of the elbow at some point. Over a playing life, 40 to 50 per cent of racquet players are told they have tennis elbow.
Figures from the review literature on racquet sport; see the evidence note.
Only 5 to 10 per cent of people with tennis elbow play tennis. Most are plumbers, decorators and others who grip things all day. But if you do play, your chance of getting it over a playing life is close to 50/50. Both are true, and anyone who only tells you the second is selling you something.
That is the problem: playing all season is what causes the strain. Regular sessions keep on top of it while you play, so you are not waiting for the match where it gets too bad to play through.
Like most seasonal sports: weekly while you are playing competitively, less often between seasons. The Rhythm: racquet sportSee how regular sessions work
He knew every single muscle - knew the issues immediately. 60 minutes on just my right shoulder and arm.. Unbelievable THE best.
Review 01 of 03
That is a question for your GP or pharmacist, not Jonathan, and nothing on this page is a reason to stop taking anything. The research only shows there is no inflammation there to reduce. The tablets may still be helping with the pain. If weeks of them have not fixed it, that tells you something useful. It does not mean you were doing anything wrong.
It might be. Grip size, string tension and how stiff the racquet is all play a part, and there is ongoing research on frame stiffness in particular. Jonathan does not fit or string racquets. If it is your kit, see a stringer or a coach. What Jonathan works on is the muscle your kit has been straining.
Most of it, and some of it even more so. It is the same movement: one arm held firm as you hit, several hundred times a session. The name "tennis elbow" is just history, and most people who get it do not play tennis at all. Padel also has far more overheads, because the ball stays in play off the walls, so you hit many more of them than you would serves in tennis.
Usually it will not need much, and that is the point. Your other arm shows what normal looks like for you. 87 per cent of professional players have less rotation in their racquet shoulder than in the other one, so comparing the two sides shows how much playing has changed things.
Longer than most people will tell you. The research says months, not weeks, and sometimes a lot longer. It also comes back often enough that a flare-up is seen as normal, not a failure. Nothing Jonathan does changes that timeline. Regular sessions are for the months in between, while you keep playing.
Possibly, and Jonathan is the one who will say so. He is not a physiotherapist, and this is soft tissue work, one-to-one. If what you have turns out to need a diagnosis, a scan or a prescription, he will tell you and point you at the right person rather than keep you on the table.
It is your elbow, your shoulder or your kit. If it is the kit, you need a stringer, not another appointment. A first session tells you which.
Book a sessionOr start from where you are: something already hurts, or nothing hurts yet.
