Tennis Elbow: Understanding the Connection Between the Elbow, Tendons, and Neck

Pain on the outside of the elbow that occurs when picking something up, squeezing or wringing out a towel, writing, or working at a computer is commonly known as tennis elbow, or lateral epicondylitis.

Tennis elbow is a very common condition. In some cases, it improves on its own. However, when the condition becomes chronic, it can be more difficult to treat and may tend to return even after treatment. In more severe cases, the pain can interfere with everyday activities and become a constant part of daily life.

Steroid injections may temporarily reduce pain and inflammation in some patients. However, they do not necessarily address the underlying mechanical or functional factors contributing to the problem. Repeated or excessive steroid injections may also have potential risks, particularly to tendon tissue. For these reasons, identifying the factors contributing to the condition is important rather than relying only on temporary pain relief.

Could Tennis Elbow Be Related to the Neck?

An interesting study published in the Canadian Medical Association Journal (CMAJ) in 1976 examined 50 patients with tennis elbow who had not improved with conventional treatment and were unable to return to their previous occupations.

The patients received neck exercises and physical therapy. According to the report, 47 of the 50 patients improved, and 29 were able to successfully return to their previous work.

The authors also reported that abnormalities involving the neck and cervical nerve structures were present in these patients. This raised an important question: Could some cases of tennis elbow involve more than a problem with the tendon itself?

Traditionally, tennis elbow has been viewed primarily as a condition involving the tendons attached to the outside of the elbow. However, research and clinical observations have suggested that the cervical spine and nervous system may also play a role in some patients with arm or elbow pain.

This does not mean that every case of tennis elbow originates in the neck. Rather, it emphasizes the importance of looking at the entire pathway from the neck to the arm instead of focusing exclusively on the painful elbow.

The Role of Nerves in Tennis Elbow

The human nervous system is more complicated than a simple electrical wire.

When a nerve becomes irritated or mechanically stressed, it can become more sensitive. Changes in the way a nerve moves, stretches, or interacts with surrounding tissues may contribute to pain and sensitivity.

This is one reason why some patients continue to experience pain even when there is no obvious severe injury to the tendon.

For example, a person may have pain around the outside of the elbow even though imaging does not show a significant structural abnormality. In these situations, the source of pain may involve several different tissues, including the muscles, tendons, fascia, joints, and nerves.

A Disc Problem Does Not Always Mean Pain

Another important point is that the presence or absence of a disc problem on an MRI does not necessarily explain a person’s symptoms.

Some people have disc bulges or degenerative changes without experiencing any pain. Even when a disc herniation is significant, it may not necessarily cause symptoms if the affected nerve is not sufficiently irritated.

On the other hand, a person can experience arm or elbow pain without having an obvious disc herniation.

Nerves traveling from the neck into the arm can become mechanically irritated or sensitized along their pathway. Depending on the severity, these changes may not always be clearly identified through standard objective tests such as electromyography (EMG), nerve conduction studies, or ultrasound.

Therefore, a comprehensive evaluation may include not only imaging and neurological testing, but also examination of the skin, muscles, tendons, fascia, joints, and nerve mobility.

Nerve and Tendon Movement Matters

Healthy nerves and tendons need to move properly relative to the surrounding tissues.

When tissues become restricted or irritated, normal movement may be affected. Improving mobility and reducing mechanical stress may help decrease sensitivity and improve function.

This is why appropriate movement and exercise can be an important part of recovery.

Many people assume that the best treatment for elbow pain is simply to stop using the arm completely. Rest can be helpful during an acute flare-up, but prolonged inactivity is not always the best solution.

Under appropriate guidance, gentle exercises and movements that improve the mobility of the nerves, tendons, and surrounding tissues may help restore normal movement and reduce sensitivity.

NoVA Gonstead Chiropractic Clinic
9514 Lee Hwy (Route 29), Suite B
Fairfax, VA 22031
(703) 359-6262