Choosing a Tennis Elbow Brace

Tennis Elbow supports:  Do straps work?

Tennis elbow is also known as lateral epicondylitis or lateral elbow tendinosis. Overuse or repetitive strain on the forearm muscles and tendons can cause this condition. 

Whether you’re an athlete, work in a labouring job role or someone who does a lot of repetitive arm movements, the discomfort of tennis elbow can be overwhelming.

Fortunately, there are many supports and options available. At SA Hand Therapy we routinely recommend tennis elbow braces that can offer much needed relief and aid in recovery. In this article, we’ll explore two different styles of braces available, how to choose the right one, and how to use them effectively.

What is Tennis Elbow?

Tennis elbow, or lateral elbow tendinopathy, is a term used to describe pain elicited on the lateral side (outside) of the elbow during movement, resistance or general use. Tennis elbow is a condition that usually develops overtime through repetitive motions such as gripping tasks (e.g. using a tennis racquet or jobs that require repetitive tasks such as a manual labour or playing an instrument) (Vaquero-Picado, Barco, & Antuña, 2016). For further information on tennis elbow, read about it here.

Is wearing an elbow support a good idea?

Tennis elbow supports act to provide compression to the muscle, tendon or soft tissues around the elbow. There are 2 main supports;

1) A counterforce strap like this:

The goal of the counterforce strap is to dampen and disperse the force from the attachment origin of the extensor tendons and decrease pain with gripping. This can assist with reducing discomfort of acute or chronic pain. One way to check if a counterforce tennis elbow brace might be effective is to firmly press into the forearm muscles with 2-3  fingers as shown below and then have your arm extended away from the body whilst simultaneously squeezing an object or ball. If pain is slightly or significantly less, then a counterforce strap is probably a good option to consider.

There are hundreds of options available in the market with most being lightweight and flexible, allowing for easy application and customisation. They can be worn during the day when you are completing daily tasks, in the garden and sport.  We prefer the semi-rigid style with a broad surface area like in example 1 above that we endorse. This design tends to disperse pressure more evenly on the forearm muscles. Others that have an internal gel or foam support can, and often do cause more issues including pressure on the radial nerve which sits in the central part of the forearm. If the radial nerve is compressed, then forearm pain could worsen or you may end up with a diffuse type ache in the forearm muscles and the problem may take much longer to go away.

Use of a counterforce strap should be reserved for activity only. It’s not generally recommended for sleeping or resting.

It’s also essential it is not too tight and a heavy indentation in the skin is a sign that it might be and this could cause pressure onto a nerve structure. Seeing a hand therapist or experienced physiotherapist should help you to guide the correct positioning and fit.

2) An elbow sleeve like this:

Elbow sleeves come in a variety of options with many choices available on the market. They provide more of a diffuse support to the elbow. They are particularly useful in cold environments or for generalised aching at the elbow that is present most of the time during activity. The arm sleeve / elbow sleeve option should provide more constant relief of elbow pain. They might be appropriate if there is more elbow pain that is un-related to tennis elbow such as a combined golfers and tennis elbow and / or bursitis or elbow arthritis.

This type of elbow sleeve can also be worn for sleep as long as circulation in the hand and forearm are not compromised.

Choosing the correct material is important to ensure it breathes but also conforms to the bony prominences of the elbow. A thinner neoprene like this counterforce elbow brace is one  that we also endorse and is generally better than a cotton style fabric option. Neoprene will provide much greater warmth and support.

Other factors to consider should include:

• Is it conforming?
• Does it slide down during activity?
• What material is it made from and what environments is it likely to be used in?

Is there any evidence to back up use of a tennis elbow support  or counterforce brace?

Research is still currently limited, however emerging evidence such as a study completed by Kroslak, Pirapakaran & Murrell, (2019) on counterforce bracing for tennis elbow found associated improvements with pain reduction and increased levels of function.

Furthermore, evidence involving the effects of kinesiology tape to manage tennis elbow symptoms has also shown promising effectiveness in both reducing pain symptoms, restoring grip strength and improving overall functional capacity (Zhong et al, 2020). Whilst taping is not described here, the effect of a brace may have similar proprioceptive (the subconscious awareness of your brain telling your body part where it is in space) support to kinesiology tape which we also often recommend and utilise for this condition.

Barati et al, (2019) discuss that a sleeve may improve sensorimotor control and joint position sense (individual’s ability to perceive the position of a joint with his/her vision occluded and minimal cues) as this is something commonly disrupted whilst suffering symptoms of tennis elbow.

Choosing the right brace for you

To find the right brace for your condition, consider all of the above factors such as fit, size, adjustability, and personal preferences. Ensure that you measure the circumference of your forearm or elbow accurately and follow the manufacturers guidelines.

We recommend for sharp pain during gripping and activity, a counterforce brace / strap is a worthwhile consideration.

We recommend for aching pain or night pain, a compressive elbow sleeve could be a good choice.

When choosing a brace or sleeve for your tennis elbow, look for options that will suit your lifestyle and functional demands. A neoprene sleeve may not be suitable if performing work in hot environments.

Importantly, tennis elbow straps and elbow sleeves don’t work for everyone and are generally recommended during activity. No strap replaces the need for a targeted tennis elbow strengthening program. An overly tight tennis elbow brace might compress a nerve in the forearm.