Recovering From Lateral Epicondylitis, A.K.A. Tennis Elbow

The following blog post was the winning submission into our Sports Injury: What the Heck Happened to You Contest.

Elbow injuries caused by cycling

By Dr. Nicole Dorholt

It’s not traumatic, and it’s not glamorous, but lateral epicondylitis, a.k.a. tennis elbow, will keep you off your bike just as effectively as any other sports injury that I’ve endured.

So now you’re asking, how does a cyclist get tennis elbow, right?  Easy…hold your handlebars at a wonky angle and then ride your road or mountain bike every single day for a month without recovery.  Sounds fun, right?

Tennis Elbow Anatomy

Ok, let’s go a little more in-depth about the mechanism of injury.  This kind of tendonitis is generally caused by overuse of the wrist extensor muscles in a poor position.  The muscles that allow your wrist to bend back towards your forearm connect via their tendon connect right at the outside of your elbow, with the bellies of the muscle just below your elbow.


In my case, it happened because my shoulder musculature was weak, causing me to ride with my shoulders internally rotated and my elbows turned out.  Then add a crazy self-challenge in which I logged at least 20 miles a day, every single day, for a month.  By the end of April 2012, my right elbow hurt so much that I couldn’t ride, couldn’t grasp anything in my right hand, and could not even lift a gallon of milk out of my refrigerator!

So what did I do about it?

I’m lucky in that I’m a physical therapist, so I was loaded with knowledge and resources, and was ready to roll out my treatment plan.  First, I had to address my pain symptoms.  I started with ceasing activities that aggravated the condition.  That meant no bike riding for me unless it was on a trainer, with no pressure on my arms…bummer.  Then, I started working with a fellow physical therapist on the soft tissues; working on breaking down poorly aligned collagen and scar tissue in the tendons and muscle bellies of the wrist extensors with special tools and techniques for this process.  To aid the new collagen to lay down properly, I needed to gently stretch the muscles, gradually adding movement in the pain-free range of motion that I had, and adding more aggressive stretching as I could tolerate.  I’m a cyclist…I can tolerate an awful lot, so there were times when I would overdo it, and the only thing I found that reduced the pain and inflammation was ice and moderate compression.  Lots of it, all the time.  We didn’t have an elbow-specific ice pack in my clinic, so I had to rig up a ridiculous cold pack-pillow case-plastic wrap contraption that was not ideal, but worked as long as I didn’t have to do anything with that arm…have I mentioned that I’m a right handed physical therapist?  Finally the pain symptoms began to subside and I could do every-day functional things, but riding wasn’t quite on the menu yet…I had to fix the reason I was injured in the first place.

cycling formThat brings us to those pesky shoulder stabilizers.  A cyclist’s typical position on a bike leads to some serious muscle imbalances in the shoulder and rotator cuff:  your internal rotators (muscles on the front side) get shortened, tight, and over-strengthened while the external rotators are the red-headed step children of the bunch, becoming long, weak, and useless.

I had to divide and conquer if I were to win this battle and get back on my bike pain-free.  First, I used the direct attack on the external rotators, strengthening them with elastic bands, and various shoulder stabilization exercises (lower left and center photo).  Then, I ambushed the internal rotators, stretching them every single time I passed a doorway, and every morning and evening (lower right photo).  I knew that I had to flank the problem from both sides.  Once the initial inflammation was gone, I initiated an eccentric contraction-focused strengthening program for my wrist extensors, which works best for tendonitis conditions.  Eventually, I was able to progress to regular strengthening of the wrist extensors and regained full, pain-free function.


It took nearly 6 weeks to rehab myself to the point where I could ride my bike again without pain, but the 6 weeks were worth it.  Rushing a tendonitis injury will only cause a more chronic condition, long term pain, and osteophyte (bone spur) formation if stressed for too long.

The key to avoiding tendon injuries in any form is PREVENTION.

Start stretching now.  Correct muscle imbalances by strengthening the weak muscle groups and stretching their muscle antagonists.   If you’ve already moved into the injury zone, get help right away from a professional before a potentially short term annoyance becomes a long term problem.


Dr. Nicole DorholtNicole Dorholt, DPT is a physical therapist, owner of Athleta Sports Massage, and a Saint Francis Tulsa Tough Ambassador guest blogger, sharing her expertise on flexibility, injury prevention, muscle balance, and recovery.  She races road, mountain, triathlons, and trail runs and likes to have FUN!  Cycling and running is all about meeting new people, seeing new sights, and sharing knowledge with new athletes.