Tennis Elbow in Tennis
KEY TAKEAWAYS
Load + impact mechanics drive symptoms: off-center hits, higher impact shock, stiffer setups, and high extensor demand increase elbow load. Technique and training volume matter more than any single gear spec.
Racquet properties can alter shock/vibration (thus perceived arm-friendliness), but effects are nuanced and sometimes small in live play. Mass/inertia, stiffness, and impact location matter more than cosmetic add-ons.
String dampeners (the little buttons) don’t reduce frame shock to the hand/arm; they mostly kill string “ping” (high frequency) and don’t show meaningful reduction in discomfort.
Grip size within ±¼″ of “recommended” does not change forearm EMG during backhands; i.e., small deviations are unlikely to be a primary cause/solution.
String tension affects feel/ball control and racket deformation more than elbow forces; evidence that tension materially changes elbow shock is mixed/limited.
What the science says
1) Epidemiology & general risk
Overuse dominates injury patterns in tennis; the lateral elbow is a common site. Load, repetition, and technique are key drivers.
Beyond tennis-specific factors, population risk modifiers include smoking and female sex; alcohol may worsen outcomes once symptomatic. (Useful when counseling lifestyle factors.)
2) Biomechanics: why the elbow gets hammered
Impulse forces to the hand/arm arise from rotation, translation, and vibration during impact. Off-center hits (tip/lat) amplify forces. Targeting the sweet spots (center of percussion; vibration node) reduces transmitted force. Coaching ball-strike quality really matters.
3) Racquet choice (mass/inertia, stiffness, impact location)
Impact location: Strikes away from the node/COP spike handle forces and vibration → more “shock” to forearm extensors. Mass/inertia & stiffness: Reviews note racket properties influence arm load and perceived shock; beginners (who hit lower on the stringbed) experience higher loads. Practical inference: slightly heavier / higher swing-weight frames can lower peak vibration amplitude (more momentum, less kickback), while very stiff frames may feel harsher. Evidence is mixed and context-dependent.
Measured comparisons: Frame and stroke speed alter shock transmission; different rackets produce different shock/vibration profiles under matched swings.
4) Strings & tension
String tension: In controlled studies, tension clearly changes ball speed/control and racket deformation, but has minimal or inconsistent effect on dynamic impact force to the arm; lower tension can subjectively feel softer but may not drastically change elbow load.
Practical: prioritize feel/strike quality (larger sweet spot, impact consistency) over chasing a “magic” tension number for pain relief.
5) Vibration dampeners
String dampeners reduce high-frequency string vibration (sound/feel) but do not attenuate lower-frequency frame vibration that drives arm shock; they did not reduce hand/arm discomfort in controlled testing.
Newer frame-integrated damping tech can reduce measured vibration transfer and muscle fatigue in lab testing, but real-world symptomatic benefit data are limited.
6) Grip size
Classic lore (Nirschl method) persists, but EMG studies show no significant differences in forearm muscle activity when grip is ±¼″ from recommended during a backhand. Conclusion: don’t over-index on micro grip changes; comfort/technique matter more.
Historical trend: many modern players use smaller grips than in past decades, without clear evidence of higher LE risk solely from that change.
Practical, evidence-informed setup (what I tell players)
Frame
Favor a moderately flexible (not ultra-stiff) frame with moderate-to-higher swing-weight you can control for clean center impacts. This reduces off-center shock and vibrational energy reaching the forearm.
If symptomatic, test frames with built-in damping—lab work shows less vibration transfer (clinical benefit still needs more human outcomes data).
Strings & tension
Use softer string beds (multifilament or hybrid; avoid full stiff poly when symptomatic). Lower-to-mid tensions can improve feel and sweet-spot size; don’t expect big changes in elbow forces from tension alone.
Dampener
Use it for sound/feel only—do not expect meaningful shock reduction or pain improvement from a button dampener.
Grip size
Set near your customary size; ±¼″ won’t change forearm EMG. Prioritize comfort, secure grip, and reduced over-gripping.
Technique & workload (biggest levers)
Minimize off-center hits (contact training, larger head/sweet-spot frame if needed).
Reduce sudden volume spikes (match/rally minutes, backhand reps).
Strengthen wrist extensors/supinators and kinetic chain; many cases resolve non-operatively with progressive loading. (General overuse and LE literature.)
Sources (peer-reviewed & technical)
De Smedt T, et al. Lateral epicondylitis in tennis: update on aetiology… (review). Br J Sports Med. Notes on equipment & grip trends.
Hatch GF III, et al. Effect of tennis racket grip size on forearm muscle firing patterns. Am J Sports Med. ±¼″ grip not significant for EMG.
Stroede CL, et al. String vibration dampers…hand/arm discomfort. J Sports Sci. Dampeners kill string ping; don’t reduce frame shock or discomfort.
Mohandhas BR, et al. Racket string tension affects force at the elbow during backhand. (Elbow force modulation; methodologically controlled.)
Zhao G, et al. Effects of different string tension on forehand performance & dynamics. PLoS ONE 2025. Tension changed control/deformation; minimal effect on dynamic impact force.
Yeh IL, et al. Vibration transfer, fatigue, and perceived exertion with a damping-tech racquet. (Lab reductions in vibration transfer.)
Hennig EM. Influence of racket properties on injuries & performance. (Review on stiffness, grip force, impact location & arm loads.)
Cross R. The sweet spots of a tennis racquet. (Physics of COP & vibration node; minimizing forces to hand/forearm with center contact.)
Rogowski I, et al. Racket vibrations & shock transmission to wrist during forehand. (Different rackets, different shock/vibration profiles.)
Kekelekis A, et al. Risk factors for upper limb injury in tennis players. (Overuse dominance; context for workload/technique.)
Meta-analyses on general LE risk: smoking/female sex; worse outcomes with alcohol—useful when counseling total risk.