Tennis Elbow Treatment
Chiropractic care, loading exercise, and shockwave therapy when appropriate for lateral epicondylitis.
Tennis elbow, clinically known as lateral epicondylitis or lateral epicondyle tendinopathy, is a painful overuse injury of the tendons on the outside of the elbow, caused by repetitive gripping, twisting, and lifting that creates micro-tears in the forearm extensor tendons where they attach to the bone.
Understanding Tennis Elbow
The primary tendon involved is the extensor carpi radialis brevis, which helps stabilize the wrist during gripping activities. When this tendon is subjected to repeated stress without adequate recovery, micro-tears form in the tissue, triggering an inflammatory response that causes pain and tenderness at the outer elbow.
At Advanced Wellness Chiropractic in Bridgeton, MO, Dr. JC takes a whole-picture approach to diagnosing and treating tennis elbow. Rather than relying solely on rest and anti-inflammatory medications, we identify the specific biomechanical factors contributing to your condition and develop a targeted treatment plan. Care may combine hands-on soft tissue techniques, exercise, and shockwave therapy when appropriate.
Despite its name, tennis elbow is not exclusive to racquet sports. The majority of cases stem from occupational or recreational activities that involve repetitive gripping, twisting, or lifting. Office workers who spend hours using a computer mouse, tradespeople who operate hand tools, and weekend warriors who overdo it in the yard are all common patients we see at our Bridgeton, MO practice.
The elbow is where three bones meet and multiple tendons and ligaments provide stability. When the lateral epicondyle, the bony bump on the outside of the elbow, becomes irritated from tendon strain, even simple tasks like turning a doorknob, shaking hands, or holding a coffee cup can become painful. Understanding the anatomy and mechanics behind your tennis elbow is the first step toward a successful recovery.
When to Seek Immediate Medical Care
Most tennis elbow responds well to conservative chiropractic treatment, but certain warning signs mean you should see your primary care doctor or an emergency provider right away rather than waiting for a chiropractic evaluation:
- •Sudden severe elbow pain after a fall or direct impact. A fracture, dislocation, or ligament rupture may be involved.
- •Numbness or tingling in the hand or fingers, which suggests nerve involvement rather than true tennis elbow.
- •Inability to extend the elbow fully or grip with the hand. A meaningful mechanical block needs imaging before manual treatment.
- •Fever with elbow swelling, redness, or warmth, which can signal a joint infection or inflammatory disease.
- •Pain at rest that is not relieved by anything, especially night pain, which can point to something beyond a tendinopathy.
Common Symptoms of Tennis Elbow
Tennis elbow symptoms typically develop gradually and may start as mild discomfort that worsens over weeks or months. Recognizing these symptoms early and seeking treatment can help prevent the condition from becoming chronic. If you experience any of the following, contact Advanced Wellness Chiropractic for an evaluation.
- Pain or burning sensation on the outer elbow
- Weak grip strength when holding objects
- Pain that worsens when shaking hands
- Difficulty turning doorknobs or opening jars
- Tenderness when pressing the lateral epicondyle
- Pain that radiates down the forearm to the wrist
- Stiffness in the elbow, especially in the morning
- Increased pain when lifting or carrying items
- Discomfort when using a computer mouse or typing
- Pain during racquet sports or gripping activities
Three Self-Tests You Can Try at Home
These are the same provocation tests Dr. JC uses in the office. None of them replace a proper exam, but if one or more reproduces your symptoms, it is a strong hint that the common extensor tendon is involved and worth evaluating. Stop any test that causes sharp pain or sudden weakness.
Cozen's Test (Resisted Wrist Extension)
How to do it
Make a fist with your affected arm, palm facing down. Straighten your elbow. Use your other hand to press down on the back of the fist while you resist by pulling your wrist up toward the ceiling.
What to watch for
A sharp or familiar ache right at the bony bump on the outside of your elbow, often radiating a few inches down into the forearm.
What a positive test suggests
Irritation of the common extensor tendon at the lateral epicondyle. Cozen's is one of the most reliable screens for tennis elbow.
Mill's Test (Passive Stretch)
How to do it
Straighten your affected arm in front of you with your palm facing down. With the opposite hand, slowly flex your wrist down so your fingers point toward the floor and pull gently toward your body.
What to watch for
Pain at the outside of the elbow as the forearm extensors are pulled long. The sensation is usually a deep pull rather than a muscular stretch.
What a positive test suggests
Lateral epicondylitis. Mill's confirms that lengthening the extensor tendon reproduces the pain, not just loading it.
Lateral Epicondyle Palpation
How to do it
Find the bony bump on the outside of your elbow. Press firmly with your thumb directly on that bump and on the strip of tendon just in front of it.
What to watch for
A sharp, focal point of tenderness that reproduces the same pain you feel with gripping, lifting, or racquet work.
What a positive test suggests
Focal tendinopathy at the lateral epicondyle. Combined with a positive Cozen's or Mill's, this confirms the diagnosis of tennis elbow.
If any of these tests reproduces your symptoms, the next step is a full evaluation. Dr. JC will examine the entire arm from the neck and shoulder through the elbow and wrist to identify every factor contributing to your elbow pain.
How Chiropractic Care Helps Tennis Elbow
Chiropractic care for tennis elbow goes beyond the elbow itself. Dr. JC at Advanced Wellness Chiropractic evaluates the entire kinetic chain, from your neck and shoulder down through your wrist and hand, to identify all the factors contributing to your pain. Misalignments in the cervical spine and restrictions in the shoulder or wrist joints can alter the biomechanics of your arm and place additional stress on the lateral elbow tendons.
Joint mobilization techniques restore proper movement to the elbow, wrist, and surrounding joints. When these joints move freely and in correct alignment, the muscles and tendons can function as they were designed to, reducing the overload that caused the tendinopathy. Soft tissue therapies such as Active Muscle Release break up adhesions and scar tissue within the damaged tendon and surrounding muscles, improving blood flow and promoting tissue regeneration.
For patients in Bridgeton, MO dealing with stubborn or chronic tennis elbow, shockwave therapy is one option we may discuss after an exam. It delivers acoustic energy to the affected tendon and has been studied mainly in cases that have not responded to other conservative approaches.
The plan combines chiropractic adjustments, soft tissue work, and rehabilitative exercises based on your exam. Care is drug-free and non-surgical, and response varies from person to person.
Shockwave Therapy for Tennis Elbow
A 2020 systematic review and meta-analysis by Yao et al. published in BioMed Research International analyzed 13 studies with 1,035 patients and found that ESWT significantly improved both pain scores and grip strength compared to other treatments. Low-energy ESWT protocols have also been reported to provide lasting pain relief and functional improvement in a small retrospective study (Santilli et al., 2024).
At Advanced Wellness Chiropractic, shockwave therapy is considered for chronic tennis elbow that has not responded to rest and bracing alone, alongside manual therapy and eccentric strengthening exercises. Results vary from person to person. Shockwave therapy is self-pay at our office. Most major insurance policies classify it as investigational or unproven for musculoskeletal conditions, so coverage is rare.
Learn more about Shockwave TherapyOur Treatment Approach
Every patient at Advanced Wellness Chiropractic receives a personalized treatment plan built around a thorough examination and diagnosis. Dr. JC uses a combination of orthopedic testing, range of motion assessment, and palpation to determine the severity and specific location of your tendon injury. Your treatment plan may include:
Shockwave Therapy
Acoustic wave therapy considered for chronic tennis elbow that has not responded to other conservative care. Self-pay at our office.
Active Muscle Release
Targeted soft tissue treatment that breaks up adhesions in the forearm muscles and tendons, restoring normal texture, tension, and movement to the tissues.
Graston Technique
Instrument-assisted soft tissue mobilization that effectively treats the fascial restrictions and chronic tendon degeneration common in lateral epicondylitis.
Joint Mobilization
Gentle mobilization of the elbow, wrist, and cervical spine to restore proper joint mechanics and reduce compensatory strain on the lateral elbow.
Therapeutic Exercises
Progressive eccentric strengthening and stretching protocols specifically designed to rehabilitate the extensor tendons and prevent re-injury.
Ergonomic Guidance
Practical recommendations for workstation setup, tool use, and sports technique modifications to eliminate the repetitive stress causing your condition.
Four Home Exercises for Tennis Elbow Relief
These are the exercises Dr. JC sends home with most tennis elbow patients. Eccentric loading is the most important piece of the puzzle, backed by decades of research on tendinopathy. The full routine takes about ten minutes and works best once a day. Stop any exercise that causes sharp pain or weakness that persists more than an hour after finishing.
Eccentric Wrist Extension (Tyler Twist Concept)
The single most important tennis elbow exercise. Slow, loaded lowering rebuilds tendon quality rather than just calming the pain. A rolled-up hand towel works as a simple home version.
- Grip a rolled towel with both hands, elbows bent at 90 degrees.
- With the unaffected hand, twist the towel so the affected wrist is cocked up into extension.
- Straighten both arms out in front of you and slowly let the affected wrist lower under control over 3 to 4 seconds.
- Use the unaffected hand to reset the starting position and repeat.
Dosage: 3 sets of 15 slow lowers, once daily. Mild discomfort during the exercise is acceptable, sharp pain is not.
Forearm Extensor Stretch
Opens the tight extensor muscles on top of the forearm that are pulling on the irritated tendon. A great warm-up before eccentric loading and a good mid-day break for desk and trade workers.
- Extend the affected arm straight out in front of you at shoulder height, elbow locked, palm facing down.
- With your other hand, gently pull the fingers and back of the hand down and toward your body.
- You should feel a stretch along the top of the forearm, not at the elbow joint itself.
- Hold, release, and repeat.
Dosage: Hold 30 seconds, 3 reps, twice daily.
Isometric Grip Squeeze
Builds grip endurance without aggravating the tendon. A soft stress ball or rolled pair of socks is plenty of resistance early on.
- Hold a soft stress ball or rolled pair of socks in your affected hand.
- Squeeze at roughly 50 percent of your maximum effort.
- Hold the squeeze for 5 seconds, breathing normally.
- Release slowly and rest for 5 seconds before the next rep.
Dosage: 10 reps, 2 sets, twice daily. Stop if squeezing reproduces sharp elbow pain rather than forearm fatigue.
Thoracic Extension Over a Foam Roller
Most tennis elbow patients have a stiff upper back and rounded shoulders that change how the arm loads the elbow. Mobilizing the thoracic spine reduces strain throughout the chain.
- Place a foam roller on the floor perpendicular to your spine and lie back with the roller at your mid-back.
- Support your head with your hands, elbows pointed at the ceiling.
- Gently lean back over the roller to extend your upper back, then return.
- Move the roller up or down an inch and repeat on a new spot.
Dosage: 8 to 10 slow extensions at 3 different levels of the mid-back, once daily.
A note from Dr. JC
Home exercises are powerful, but they are one piece of a larger plan. Most patients with stubborn tennis elbow also have restrictions at the neck, shoulder, or wrist that these drills alone will not resolve. If your symptoms are not clearly improving after two to three weeks of consistent home exercise, come in for an evaluation so we can address the other factors in your kinetic chain.
Who We See with Tennis Elbow in Bridgeton & St. Louis
Certain jobs and hobbies drive the majority of tennis elbow cases we treat at Advanced Wellness Chiropractic. If you recognize yourself in one of these, you are not alone, and conservative care is often the first step.
Plumbers & electricians
Days spent gripping wrenches, pliers, and impact drivers overload the forearm extensors. Vibrating tools speed up the tendon breakdown.
Carpenters & trades
Framing, nailing, sanding, and hammer work are textbook setups for lateral epicondylitis. The dominant arm usually flares first.
Office workers on a mouse
Hours a day of clicking and scrolling keeps the wrist extensors in a shortened, contracted position. A classic cause of mild but persistent elbow pain.
Pickleball & tennis players
The North County pickleball scene has exploded. Combined with recreational tennis players, this is one of the fastest-growing groups we see.
Weightlifters & climbers
Heavy pulling, hook grips, pull-ups, and climbing routes hammer the extensors and common tendon. We can usually adjust programming so you keep training.
Musicians
Guitarists, violinists, and other string players from the St. Louis music scene. Fine motor repetition at awkward wrist angles creates chronic tendon irritation.
Warehouse workers
Scanner use, box handling, and repetitive lifting at the Amazon, Walmart, and distribution hubs around North County. Grip and wrist extension both get hammered.
Chefs & kitchen staff
Chopping, whisking, and pan handling for hours a day. Restaurant and catering workers across St. Louis are a quiet but consistent group of tennis elbow patients.
Parents of toddlers
Hours of lifting car seats, toddlers, and diaper bags with an outstretched arm. Often pairs with wrist and thumb pain in new and recent parents.
If your tennis elbow is work-related, Dr. JC can help document the injury and coordinate with your employer or workers' compensation carrier. We see patients from Bridgeton, Maryland Heights, Hazelwood, Florissant, St. Ann, Creve Coeur, and across North County St. Louis.
Why Choose Advanced Wellness Chiropractic
At our Bridgeton, MO office, we understand how frustrating tennis elbow can be, especially when it interferes with your ability to work, play sports, or perform simple daily tasks. Our office offers shockwave therapy for selected chronic tendon conditions.
We take pride in offering a multi-modal approach that combines the best of chiropractic care with proven rehabilitation techniques. Rather than prescribing a one-size-fits-all treatment, every plan at Advanced Wellness Chiropractic is built around the individual patient. We consider your occupation, activity level, goals, and the specific characteristics of your injury when designing your care plan.
Our patients in the greater Bridgeton, MO area appreciate that we focus on getting results efficiently. We set clear expectations about your recovery timeline, track your progress at each visit, and adjust your treatment as needed. Whether your tennis elbow is a new injury or a chronic condition that has resisted other treatments, Advanced Wellness Chiropractic has the tools and expertise to help you recover.
Frequently Asked Questions
Tennis elbow, or lateral epicondylitis, is caused by overuse and repetitive strain of the forearm muscles and tendons that attach to the lateral epicondyle on the outside of the elbow. Despite its name, tennis elbow is not limited to athletes. It commonly affects people who perform repetitive gripping, twisting, or lifting motions at work or during everyday activities. Painters, plumbers, carpenters, office workers who use a mouse frequently, and musicians are all susceptible. Micro-tears develop in the extensor carpi radialis brevis tendon over time, leading to pain and inflammation at the outer elbow.
Often, yes. Chiropractic care for tennis elbow uses non-invasive techniques based on your exam. Treatment may include joint mobilization of the elbow and wrist, soft tissue techniques like Active Muscle Release and Graston Technique, corrective exercises to strengthen the forearm and improve mechanics, and shockwave therapy when appropriate. Response varies from person to person.
Shockwave therapy has been studied for tennis elbow, mainly in chronic cases that have not responded to other conservative care, and some trials report less pain and better grip strength. Results vary, and it is not appropriate for everyone. At Advanced Wellness Chiropractic it is considered after an exam and is usually combined with exercise and manual techniques. Shockwave therapy is self-pay at our office. Most major insurance policies classify it as investigational or unproven for musculoskeletal conditions, so coverage is rare.
Recovery time depends on the severity and duration of your condition. Acute cases caught early may resolve within four to six weeks of consistent chiropractic treatment. Chronic tennis elbow that has persisted for several months typically requires a longer treatment timeline of eight to twelve weeks or more. Factors affecting recovery include the extent of tendon damage, your activity level, whether you can modify the movements that caused the injury, and your adherence to prescribed home exercises and ergonomic changes. Most patients begin noticing improvement within the first two to three weeks of care.
Preventing tennis elbow involves addressing the biomechanical and lifestyle factors that contributed to the condition in the first place. Strengthening your forearm extensor and flexor muscles through targeted exercises builds resilience in the tendons. Using proper technique during sports, especially with your racquet grip and swing mechanics, reduces strain. Ergonomic modifications at your workstation, such as using a vertical mouse and keeping your wrist in a neutral position, help prevent recurrence for desk workers. Stretching regularly before and after activities, taking breaks during repetitive tasks, and using a counterforce brace during high-demand activities are all effective strategies your chiropractor can help you implement.
Patients on Their Experience Here
From the first phone call to exception customer service, I would recommend this place 100%.
If you want a Chiropractor that is thorough and on point, he's the one.
Excerpts about the office experience, not evidence of a particular treatment result.
Related Conditions We Treat
These conditions can overlap or share contributing factors. Explore how we approach each one.
Related Services & Articles
Shockwave Therapy
An option for chronic tennis elbow that has not responded to other conservative care. Self-pay at our office.
Learn MoreActive Muscle Release
Hands-on soft tissue treatment that breaks up adhesions and restores healthy function to forearm muscles and tendons.
Learn MoreGraston Technique
Instrument-assisted therapy that targets fascial restrictions and chronic tendon damage common in tennis elbow.
Learn MoreWhat Is Shockwave Therapy and Who Is It For?
An introduction to shockwave therapy and who may be a candidate.
Learn MoreAdvanced Wellness Chiropractic
Schedule Your Appointment at Advanced Wellness Chiropractic
Same-day appointments are often available. Tell us what is limiting you, and we will evaluate the concern and explain reasonable care options and referrals when needed.
No pressure and no pushy sales pitch, just an honest evaluation and a clear plan. No long-term contract.