What Causes Tennis Elbow
Lateral epicondylitis (tennis elbow) is an overuse injury of the extensor carpi radialis brevis (ECRB) tendon at the lateral epicondyle. Despite the name, only 5-10% of cases occur in tennis players — it's an occupational/repetitive use injury in most cases. In tennis, it's typically caused by: poor backhand mechanics (leading with the elbow), improper racket fit (grip too small or large), high-tension poly strings, or sudden training load increase.
Counterforce Braces
Counterforce braces (the strap worn below the elbow) work by compressing the forearm muscle bulk, reducing the mechanical load on the injured insertion point at the epicondyle. Multiple RCTs show they reduce pain during activity and allow earlier return to play.
Best braces:
- Bauerfeind EpiTrain (~$50): Medical-grade, graduated compression, approved by sports medicine physicians
- ProCare Tennis Elbow Support (~$20): More affordable, effective for mild cases
- Futuro Sport Tennis Elbow Support (~$15): Best value, widely available
String Type & Tension
String stiffness directly affects arm comfort. The stiffer the string, the more vibration transmitted to the arm.
| String Type | Stiffness | Arm Impact |
|---|---|---|
| Polyester (poly) | Highest | Worst for tennis elbow |
| Multifilament | Low | Excellent — closest to natural gut feel |
| Natural gut | Lowest | Best — most arm-friendly string available |
| Synthetic gut | Moderate | Acceptable for mild cases |
If you have tennis elbow, immediately switch from polyester strings to natural gut or multifilament. Lower string tension (4-5 lbs below normal) further reduces shock transmission. The difference is dramatic — many players recover without any other changes after switching string type.
Best arm-friendly strings: Tecnifibre X-One Biphase (multifilament, ~$18/set), Babolat VS Touch (natural gut, ~$40/set).
Grip Size & Overgrip
An incorrectly sized grip forces forearm muscles to work harder to secure the racket at impact. Too small a grip = more muscle engagement = more ECRB stress. Too large = wrist movement restriction.
Build up your grip with overgrip if you suspect yours is too small — overgrip adds ~1/16" per layer. Most players grip too small, not too large. Try one overgrip layer if you're experiencing elbow discomfort.
Racket Modifications
Flexible rackets (lower RA stiffness) significantly reduce vibration transmission. The Wilson Clash (RA 55) and HEAD Boom (RA 58) are the most arm-friendly modern rackets. If you're playing with a stiff power racket (RA 65+), switching to a flexible frame can reduce elbow symptoms meaningfully.