What is it and what tennis elbow exercises are available?

(Keywords: tennis elbow, thoracic outlet syndrome, inter scalene triangle, cervical facet syndrome )

In tennis elbow , the muscles of the outer part of the elbow have been presumed to be the primary site of the problem.

However, it is well known that this condition can be extremely resistant to conventional treatment, the primary cause of the condition often not being just repetitive use of the arm but a chiropractic subluxation in the lower neck, or inter scalene triangle.

Strike out "itis" in lateral epicondylitis and write "osis". Read more about why further down the page.


Thus it comes as no surprise that researchers report in the Journal of Hand Surgery (2008;33) that:

"Corticosteroid injection did not affect the apparently self-limited course of lateral elbow pain."

Given the known potential dangers of corticosteroid injections on tendon strength it makes no sense to follow a course of treatment that may at best be described as non-scientific, and at worst as potentially dangerous.

If a subluxation of the first rib or lower neck joints (such as the cervical facet syndrome) is the cause of the pain in your arm, then no amount of cortisone injections, or physical treatment of the elbow will cure the condition.

Chiropractic tennis elbow can only be properly addressed by first treating of the subluxations in the spine that are irritating the spinal nerves that serve the elbow muscles.

Inflammatory changes have been noted in the acute stages but are absent after a few months which is why steroid injections have no benefit, and in fact have a significant chance of causing infection and tendon rupture.

Hence this condition is no longer caused lateral epicondylitis, but epicondylosis. There is no itis or inflammation.

Is this all just exaggerated chiropractic rhetoric?

Read what Dr Jennifer Chu, M.D. emeritus professor of physical medicine and rehabilitation, school of medicine, university of Pennsylvania has to say about neck pain, elbow pain and extensor carpi radialis longus:

Commonly neck pain is due to C5, C6 cervical nerve root irritation. This can produce pain and spasm in the extensor carpi radialis longus muscle which crosses the elbow and therefore pain in the elbow can also be felt by the patient.

Extensor carpi radialis longus receives C5 and C6 nerve root fibers through the radial nerve. Together with the brachioradialis and the extensor carpi radialis brevis, it is one of the three muscles that is known as the wad of three.

  1. Brachioradialis
  2. Extensor carpi radialis longus
  3. Extensor carpi radialis brevis

These three muscles can give significant pain in the elbow commonly known as tennis elbow.

It originates from the outer aspect (lateral) of the lower one third of the arm bone (humerus), and inserts into the base of the second knuckle (metacarpal bone) on the back of the hand. Its action is to bring the wrist up as in making a fist. It can also deviate the hand away from the midline of the body.

Neck pain > elbow pain > extensor carpi radialis brevis

Neck pain secondary to C5, C6 nerve cervical root irritation, or a first rib subluxation setting up a thoracic outlet syndrome can cause pain and spasm in the extensor carpi radialis brevis muscle causing elbow pain.

This is one of the three muscles known as the wad of three and together with the triceps, causes the common condition known as tennis elbow.

It arises from the arm bone just above the elbow joint in the region called the outer (lateral) epicondyle and inserts into the base of the third knuckle (metacarpal) bone. It lifts the wrist and also deviates the hand away from the trunk.

The inter scalene triangle and Thoracic Oulet syndrome

After leaving the spine, the nerve roots combine in a complex of nerves known as the "brachial (meaning "arm") plexus. These nerves, together with the main artery that supplies the arm pass through a narrow passage known as the inter scalene triangle  where the nerves and artery can be irritated by scalene muscle spasm, a first rib subluxation,  cervical ribs ... and other more serious causes. Smoker?


The diagnosis is made by clinical symptoms (pain in the elbow, and often pain or stiffness in the neck and shoulder), four frequently used orthopaedic tests, and often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, on the outside of the elbow.

These elbow tests are based on

  • contraction of the muscles (as in shaking hands, and extending the wrist and the third finger upwards against resistance), and
  • stretching of these tendons.

Simple home test: With the elbow straight, place the tip of your middle finger against your thumb. Now, does flicking the middle finger, as though firing off a paper pellet cause pain in the elbow?

These are the symptoms of tennis elbow.

  • Pain and tenderness of the muscles the outer part of elbow.
  • Possible pain and stiffness in the neck, upper back and shoulder.
  • Gripping and movements of the wrist hurt, especially wrist extension as in lifting a heavy kettle, and twisting movements as in using a screwdriver and even simple activities such as lifting up a glass of beer or throwing a ball.
  • Extreme tenderness to touch.

Without proper treatment tennis elbow is likely to become chronic and very difficult to eradicate. Nip it in the bud! There are few conditions I love more to treat. Mostly, so easy. Occasionally, a bugger!

Chiropractic Help

  1. The first goal is to free up any subluxations in the neck, if any are present. This is what makes chiropractors the pre-eminent therapists of this debilitating condition. Nerve tension tests may be positive in the acute phase.
  2. A second goal of treatment is to relieve pain and swelling, if present. Treatment of choice is alternating ice and heat. An ice block directly on the painful muscles in a hot shower is an ideal way. First cold, then warmth. More cold.
  3. Cross friction of the muscles may be useful, but should be limited to a few strokes. Personally I prefer to do it along the length of the muscle. It may be extremely painful and increase the inflammation if done too enthusiastically. Dry needling also may be helpful.
  4. Regular stretching of the tendonsĀ§; TENNIS ELBOW EXERCISES ...

  5. Progressive strengthening exercises to rehabilitate the muscles are essential part of the regimen of treating chiropractic tennis elbow. If you love baking, kneading bread is excellent exercise for the forearm muscles. For more, click here. HONEY BREAD ...

  6. Rest is also necessary in the acute phase. No tennis, shaking hands with the left hand, and no lifting of beer mugs!
  7. Strapping may help.

The search this site function in the navigation bar on the left enables you to find stuff on this site.

Google has gone through an enormous shakeup in the last year, giving webmasters much grief.

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Steroids, anti-inflammatories and heat treatment should be avoided. Surgery is rarely necessary. There is no conclusive evidence that ultrasound assists in the treatment of tennis elbow.

Love to read?

Chiropractor Bernard Preston tells of a an unnerving experience after curing a glider pilot of Tennis Elbow. Double or quits? The Enemy Within ...

Stones in my Clog ... only $2.99

Without proper treatment tennis elbow is likely to become chronic and very difficult to eradicate. Nip it in the bud! Click here to learn how a degree in healthcare will help you diagnose and develop treatments for ailments such as tennis elbow.

(April, 2013/ 82/454/29days)


How bad is your pain? Since we all have different pain threshholds it's often difficult tell if you have a serious debilitating problem or are just whinging.


Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

Interesting challenges of the day

1. Mr B  came initially for a painful and stiff neck and then asked whether chiropractic could help the cold numb feeling running down the side of his thigh for six months. Meralgia paresthetica is a double crush syndrome with the nerve affected in the back and groin. He's 80% improved after five treatments.

2. Mrs C has a long history of severe, disabling migraine headaches since having her wisdom teeth removed. She clenches her teeth at night. After six treatments she has no migraines but some jaw joint discomfort remains; a bite plate is in the offing.

3. Mrs U has the trophy for the worst back this year. After major surgery with plates and screws two years later she still had paresis in the lower leg and severe disabling back pain. She's doing far better than expected, in no little part due to a lift in her shoe for a very short leg.

4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.

5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.

6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of her foot. It started after a long drive in the car. After six treatments she is 60 percent better, but it's slow and is going to take the full 6 weeks to heal.

And now a setback, after lifting her child she now has leg pain. It's going to the be difficult.

7. This lady is a 70 year old woman, is on maintenance care for a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection after a total shoulder replacement. After four operations he is incapacitated.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. This man is a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. I reassured him it's not hip arthritis.

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mr C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.

Brachial plexus

Arm pain

1. Shoulder

Frozen Shoulder

Rotator cuff

"My thumb, forefinger and middle finger went weak after cuff surgery."

"Hello John, I take it you've been back to the surgeon.

It's probably temporary inflammation of the median nerve, but of course could be worse... I'm afraid I don't think chiropractic has anything to offer at this stage.

Once everything has healed up, if you don't get the strength back, or your fingers remain numb and tingly, then I'd consult a local chiro to see if there is also a problem in your neck or the first rib.

Dr B"

Letter from reader looking for advice.

2. Elbow

Elbow pain

3. Wrist

How bad is your arm shoulder hand pain?