If you have tennis elbow, there’s a reasonable chance someone has handed you a stress ball or told you to do wrist curls and extensions to strengthen the forearm. It sounds logical. The pain is at the elbow. Strengthen the forearm, fix the elbow. The problem is that this approach focuses on the site of pain, not the source of the problem.
Why the forearm is overloaded in the first place
The lateral elbow is where the wrist extensor muscles all attach. These muscles are designed to support the load of gripping, not generate all of it. When the muscles upstream, the mid and lower trapezius, the rotator cuff, the serratus anterior, aren’t doing their job, the forearm muscles pick up the slack. They weren’t built for that level of demand.
The mid-back connection
Research on lateral elbow pain has consistently found a relationship between weakness in the mid and lower trapezius and chronic elbow tendinopathy. In clinical practice, you can test grip strength and provoke pain. Then activate the mid-back and shoulder stabilizers with a set of band pull-aparts. Retest grip. The pain is measurably less. Same elbow, same forearm muscles, but now the upstream system is providing the support it should have been providing all along.
Progressive functional loading
Farmer carries. Suitcase carries. Heavy single arm deadlift holds. These exercises load the forearm in a functional context while requiring the entire upper body system to contribute. The elbow gets a stimulus for adaptation while not being the only thing working.
Grip strengthening has some value, particularly in the later stages of rehab. The issue is treating it as the whole solution. At Land and Sea PT in Oceanside, we assess the full chain and build a program that addresses the actual driver.
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Dr. Jonny Blue is a Doctor of Physical Therapy and founder of Land and Sea Physical Therapy in Oceanside, CA. He specializes in orthopedic PT, root cause methodology, and helping active adults in North County San Diego get back to the activities they love without surgery or pain medication.