Tennis elbow, also known as lateral elbow tendinopathy, is a common condition involving
irritation of the tendons that attach to the outside of the elbow. Despite its name, it affects many people
who have never played tennis. Repetitive gripping, lifting, typing, and tool use can all contribute to the
condition. Traditionally, treatment has focused on the elbow, forearm, and wrist. However, growing
evidence suggests the shoulder may also play an important role.
One reason involves the concept of the kinetic chain. When reaching, lifting, throwing, gripping,
or performing other arm movements, force is transferred through a connected system that includes the
shoulder blade (scapula), shoulder, elbow, wrist, and hand. If the muscles around the shoulder and
shoulder blade are weak, the body may compensate by placing greater demands on the forearm muscles
that attach to the elbow. As a result, the wrist extensor tendons may work harder, increasing stress on
already irritated tissues and reducing opportunities for recovery.
The shoulder blade serves as the foundation for arm movement. Several muscles help stabilize
and control its position, including the lower and middle trapezius, serratus anterior, and rhomboids.
Weakness in these muscles can contribute to poor shoulder positioning and less efficient movement
patterns throughout the arm. When the scapula is more stable, the arm can move more efficiently and less
force may be transferred to the elbow.
The rotator cuff muscles are also important because they help stabilize the shoulder joint during
movement. If these muscles are weak, larger muscles may compensate, making movement less efficient
and potentially increasing stress farther down the arm. Improving rotator cuff strength may help distribute
forces more effectively, reduce excessive gripping, and decrease repetitive loading of the wrist extensor
tendons.
Many people with tennis elbow have reduced grip strength because gripping increases tension on
the irritated tendons. Interestingly, grip strength often improves when shoulder and scapular exercises are
included in rehabilitation programs. Better shoulder function can make the entire arm more mechanically
efficient, reduce protective muscle guarding, and decrease irritation of the painful tendon. Better shoulder
mechanics can reduce tendon stress, improved muscle endurance can distribute workload across the entire
arm, and exercise can enhance motor control and influence how the nervous system processes pain
signals.
Rather than viewing tennis elbow as an isolated elbow condition, many researchers now
recognize the important role that shoulder and scapular function can play in both the development and
persistence of symptoms. A chiropractic evaluation may help identify contributing factors involving the
shoulder, elbow, and surrounding structures. Chiropractors are trained to evaluate musculoskeletal
conditions, recognize findings that may require referral, and provide conservative care when appropriate.
Depending on the individual, treatment may include exercise recommendations, manual therapies, activity
modification, and other conservative approaches designed to improve function and support recovery.
Brent Binder, D.C.
4909 Louise Dr. Suite 102
Mechanicsburg, PA 17055
Pain Relief Chiropractic 
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