Here’s Why Your Tennis Elbow May Not Be an Elbow Problem

Here's Why Your Tennis Elbow May Not Be an Elbow Problem

Do you have elbow pain and think you have tennis elbow? As a doctor of physical therapy, I am here to tell you that your elbow might not be the true source of your pain.

In the video below, Dr. Jacob Templar discusses why your tennis elbow might not be an elbow problem.

If you don’t like the video or want more information, continue reading.

What is tennis elbow?

First, let’s me begin by giving some background information about the elbow. The elbow is at the joining of the upper arm and forearm. This joint moves in several ways, bending and straightening as well as twisting.

The elbow has several points of bone where muscles attach called epicondyles. To help you understand where these are, put your right arm out and look at it with your palm facing up. The part of your elbow to the left side is the medial epicondyle, the opposite side is the lateral epicondyle. Tennis elbow is pain on the lateral epicondyle, while pain on the medial epicondyle is termed golfers elbow.

Pain around the outer part of the elbow, known as tennis elbow, is often linked to playing sports with a racket such as tennis, hence the name. Tennis elbow is estimated to impact 2.4 people in every 1000. Most rehab professionals agree that we often see these conditions do not improve with tradition treatments. Why is that? What can be contributing to this? Are we missing something?

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Diagnosing tennis elbow from pain

So here is the thing, many clinicians only look at the area of pain, failing to screen other areas. Why is this important? Many diagnoses that can also cause elbow pain includes pain that actually starts in the neck. Personally, I see 4-5 patients per year who have symptoms into their arms and legs who either have had no change with previous treatment or after a surgery. But, when I move their spine, the symptoms change! We don’t want this to be you, so let me explain why and how your neck can be impacting your tennis elbow.

Science continues to support the idea that many extremity conditions have spine origin and we are moving the wrong joints. Signs and symptoms of this include a history of spine pain, stiffness in the middle back or neck, pain present in other areas of the arm, as well as, tingling, pins and needles or numbness. Surprisingly, you may notice pain in positions of rest with little stress on your elbow. You also may notice you actually feel better when you move around more, even using your arm. So, why does something that is typically associated with overuse feel better when you move? Maybe it’s not the elbow.

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Differential diagnosis

Is your tennis elbow an elbow problem?

In medicine, we have what are called differential diagnosis, or ideas about what your problem could also be. These are things that need to be ruled out before starting treatment. According to research, tennis elbow like symptoms often have origins in the lower neck. Therefore, if you present with elbow pain, we need to do a detailed screening of your neck too. This is even truer when your elbow has little to no changes in motion or no signs of strength loss. And even when those findings are present, we need to look at the neck and middle back after checking the motion and strength of your elbow.

Now, you may be saying to yourself, “but I don’t have any neck stiffness or pain, surely it’s not my neck.” Well, that’s a good reason why we should start there. Many times neck pain isn’t so obvious to you or your clinician. As a rule of thumb, we cannot say it is not your neck until your neck tells us it isn’t. This often takes only a few minutes in clinic and is completely worth your time.

Garden hose analogy

Think of the nerve as a garden hose that is always supposed to have some flow of water. If you squeeze the hose, what happens? Flow is restricted and you don’t get as much water coming out. This is just like the nerve that sends signals down our arms! If any pressure is applied to the nerve, it disrupts flow of information to our brain, leading to pain, tingling, numbness or weakness. Unfortunately, this may not be so obvious at the beginning.

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Garden hose

Think back to the garden hose analogy. The hose is pinched closest to the source of water, not at the spot where you are expecting to see the water. Just like the hose, in our bodies sometimes where the problem is seen is not the source of the problem. We have to look further up the stream. The spine joints are often the least screened when symptoms do not appear textbook.


This article is meant to raise more awareness and open the Pandora’s box that is often left closed by many healthcare providers. If we can educate patients on what good care involves, and give good information about conditions, we can significantly improve our healthcare system. Help us improve medical care by making sure you get properly screened.

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I am a Doctor of Physical therapy practicing in Upstate NY. I graduated from Utica College with a Bachelors of Science in Health Studies and a Doctorate in Physical Therapy. I currently work in a private outpatient setting, treating mainly patients with spine-related injuries. In addition to working with the general public, I have worked with professional athletes, powerlifters, and recreational lifters. However, the majority of the patients I see have persistent symptoms often lasting decades. Over the last 12 months, I was ranked in the top 5% in orthopedic outcomes internationally in FOTO, a standardized outcome tool used in rehab. I also have advanced training in McKenzie (Mechanical Diagnosis and Therapy) and as a Primary Spine Provider with Blue Cross Blue Shield. I very much believe in being an educator first and therapist second. Many conditions involve teaching someone information about their body in an easy to digest manner. If I am doing my job, not only am I helping to guide someone through their current musculoskeletal issue, but teaching them how to prevent future issues.