How to Care for Tennis Elbow: Preventing It From Coming Back
Knowing how to care for tennis elbow once the acute pain has settled means shifting from treatment to prevention: the goal is stopping it from coming back. This guide focuses specifically on that ongoing side, grip size, string tension, racquet choice, and stroke technique adjustments, since equipment and mechanics are what most often bring tennis elbow back after someone has already recovered once.
Preventing tennis elbow from recurring mostly comes down to reducing repeated strain on the same tendon: check that your racquet grip size actually matches your hand, keep string tension toward the lower end of the manufacturer’s recommended range rather than stringing tight, consider a more flexible or larger-head racquet if you have had recurring issues, and work on generating power from the shoulder and trunk rather than snapping the wrist through contact. None of these guarantee it will never come back, but each measurably reduces the load on the tendon.
- →Grip size that is too small forces extra forearm muscle activity on every shot
- →Looser string tension within the recommended range reduces shock transmitted to the arm
- →A stiffer racquet frame and off-center hits both increase vibration reaching the elbow
- →Leading shots with the wrist rather than the shoulder and trunk is a common mechanical contributor
- →This is prevention guidance, not a substitute for treatment if pain has already returned
Table of Contents
Check your grip size first
An undersized grip is one of the more overlooked contributors to tennis elbow because it feels fine in the moment, most players do not notice a grip is too small just by holding the racquet. A grip that is too small forces the forearm muscles to work harder to keep the racquet stable through contact, since your fingers have to grip more actively to compensate for the lack of surface area, adding repeated strain to the same tendon that tennis elbow affects. A simple check: with a proper grip size, you should be able to fit the tip of your index finger from your other hand into the gap between your fingers and palm while holding the racquet naturally. If there is no gap at all, the grip is likely too small; if there is a large gap, it may be too large.
💡 Pro tip: Racquet grip size is usually adjustable within a small range using an overgrip (adds a small amount of size) or by having a shop adjust the base grip, so you do not necessarily need a whole new racquet if the size is only slightly off.
String tension: looser generally means less shock to the arm
String tension affects how much shock and vibration transfers from the ball to your arm on contact. Higher tension strings feel more controlled but transmit more of that shock energy into the frame and your arm; lower tension strings absorb more of the impact themselves, trading a small amount of control and feel for reduced strain on your elbow. If you have had recurring tennis elbow, stringing toward the lower end of your racquet’s recommended tension range, rather than the tighter end many players default to, is a low-effort adjustment worth trying at your next restring.
📊 Note: String material matters too: multifilament and natural gut strings generally dampen shock better than stiffer polyester strings, though polyester is popular for the spin and durability it offers. If elbow strain is a recurring issue, a softer string material at slightly lower tension is a reasonable combination to test.
Racquet choice: frame stiffness and head size
A stiffer racquet frame transfers more shock to your arm than a more flexible frame, since flex in the frame itself absorbs some of the impact energy before it reaches your hand and elbow. A larger head size also generally means a bigger sweet spot, which matters because off-center, mishit shots are a significant source of the jarring vibration that aggravates tennis elbow, more so than well-centered shots even at similar swing speed. If you have had recurring issues and currently play a stiff, smaller-head, player’s racquet, trying a more flexible, larger-head recreational or intermediate racquet is a reasonable equipment change to test, even if it means a small trade-off in precise control.
Technique: generating power from the shoulder and trunk, not the wrist
A stroke that relies heavily on snapping the wrist through contact, particularly common in self-taught players on backhand strokes, places repeated concentrated strain directly on the same tendon involved in tennis elbow. Technique that instead drives the racquet through contact using rotation of the shoulder and trunk, with the wrist staying comparatively stable through the hitting zone, spreads the load across larger muscle groups rather than concentrating it at the elbow. A few lessons with a coach specifically focused on this mechanical pattern, rather than general stroke improvement, is often worth the cost for someone with a recurring history of tennis elbow.
⚠️ Watch out: A one-handed backhand, in particular, is more commonly associated with tennis elbow than a two-handed backhand in a lot of anecdotal coaching experience, partly due to the added wrist and forearm load. Switching backhand style is a bigger technical change than most players want to make, but it is worth knowing as a contributing factor if your backhand is the specific stroke that triggers pain.
Overgrips and vibration dampeners: small, low-cost adjustments
Beyond the base grip size, an overgrip, a thin layer wrapped over the existing grip, is a cheap and easy way to fine-tune both size and tackiness without replacing the racquet’s built-in grip. A slightly tackier or more cushioned overgrip can also reduce how hard you need to squeeze the handle to maintain control, which indirectly reduces forearm strain over a long session. A vibration dampener, the small rubber piece some players weave into the strings, has a smaller and more debated effect on actual shock transmission to the arm compared to string tension and material, but it is inexpensive enough that trying one costs little if you are already experimenting with other equipment changes.
Pacing your return to play after time off
A significant number of tennis elbow recurrences happen not during steady, regular play but after a break, a vacation, an injury layoff, or an off-season, when someone returns to their previous volume and intensity immediately rather than easing back in. Tendons that have not been under regular load lose some of their conditioning during time off, similarly to how muscles do, and jumping straight back to a full match schedule or a long practice session asks the tendon to handle a load it is no longer conditioned for. Building back up over one to two weeks, shorter sessions at first, progressively longer as the arm adapts, is a simple habit that meaningfully reduces this specific recurrence pattern.
💡 Pro tip: If you know a break is coming, some coaches suggest keeping light forearm and grip exercises going even while away from the court, which can reduce how much conditioning is actually lost and make the return to play smoother.
Non-racquet triggers: work and repetitive tasks
Tennis elbow is not limited to tennis players; repetitive gripping and wrist-extension tasks at work, typing and mousing, manual labor, even repeated cooking or cleaning motions, can cause or contribute to the same tendon irritation. If a work task is a factor, look at ergonomic adjustments: a keyboard and mouse positioned so the wrist stays neutral rather than extended, a properly sized tool grip for manual tasks, and scheduled short breaks during repetitive activity to give the tendon periodic rest rather than continuous strain through an entire shift.
Tracking your own pattern over time
Keeping a loose mental or written note of when flare-ups happen, after a long match, after a specific work task, after returning from time off, after switching equipment, helps identify your own personal trigger pattern rather than applying generic advice blindly. Some people find their tennis elbow is almost entirely tied to one specific stroke or task; others find it is more about total volume regardless of the specific activity. Knowing which pattern applies to you makes it much easier to decide which of the adjustments above, grip, string tension, racquet, technique, or pacing, is worth prioritizing first.
Building a warm-up and cool-down habit
A brief warm-up before racquet sports or a repetitive work task, and a short stretch or ice session afterward if the elbow feels irritated, is a simple ongoing habit that reduces cumulative strain over time. This does not need to be elaborate: a few minutes of light wrist and forearm movement before activity, and the same wrist extensor stretch used in acute treatment, done as routine maintenance rather than only reactively once pain returns.
- ✓Check grip size with the fingertip-gap test rather than assuming it is fine
- ✓String toward the lower end of the recommended tension range if issues have recurred
- ✓Get a coach’s opinion on whether your stroke technique is wrist-driven
- ✓Adjust ergonomics for any repetitive work task that also strains the forearm
- ✕Assume equipment does not matter if technique feels fine to you personally
- ✕String tighter than necessary just because it feels more precise in isolation
- ✕Ignore a recurring pattern where pain returns every time you resume the same activity
- ✕Return to full intensity activity immediately after a flare-up without any adjustment
How do I know if my racquet grip is too small?
With a natural grip, you should be able to fit the tip of your index finger from your other hand into the gap between your fingers and palm. No gap at all usually means the grip is too small for your hand.
Does string tension really affect tennis elbow risk?
It affects how much shock transfers to your arm on contact. Lower tension within the recommended range absorbs more shock in the strings rather than passing it to your arm, which is why players with recurring issues are often advised to string looser.
Is a one-handed or two-handed backhand worse for tennis elbow?
A one-handed backhand is more commonly associated with tennis elbow in general coaching experience, likely due to greater wrist and forearm loading, though individual technique matters more than the category alone.
Can equipment changes alone prevent tennis elbow from coming back?
They meaningfully reduce risk factors but are not a guarantee. Combining equipment adjustments with sound technique and reasonable activity pacing gives the best realistic chance of avoiding a recurrence.
What if tennis elbow comes back despite these changes?
Go back through the acute treatment steps, activity modification, stretching, and eccentric strengthening, and consider seeing a doctor or physical therapist if it does not improve, since a recurrence may need a fresh evaluation rather than the same self-treatment repeated indefinitely.
