Tennis elbow is a deceiving name for lateral epicondylitis. While giving the impression of only occurring while playing racket sports, it is extremely common in repetitive office, tactical, and industrial work.  

For firefighters, tennis elbow is one of the most common overuse injury. The “why” behind this makes us look at the entire arm: The entire upper extremity and thoracic spine play a crucial role in the amount of force and tension applied at the elbow. 

What’s Really Happening at the Elbow 

Tennis elbow often starts at the wrist: The tendons/muscle groups are responsible for extending the wrist, fingers, and supinating the forearm. 

The extensor tendons that connect the wrist to the rest of the arm anatomy act as stabilizers of the elbow and prime movers of the wrist; They also play a role in elbow flexion and extension, supination, while working to extend the wrist and fingers. When they’re repeatedly asked to do this job under heavy load, awkward positions, or fatigue, the tissues’ tolerance fades away.  

Since firefighters are required to have grip-heavy work- like pulling and advancing hoselines, carrying ladders, and dragging loads- sustained grip combined with arm movement can cause upstream elbow pain. 

The shoulder can also cause tennis elbow: The shoulder can be a contributing factor if there is a mobility restriction or if there is a reduction in stability thus creating more force/mobility requirements of joints above and below. 

Between heavy gear, awkward positions, and fatigue, a firefighter’s shoulder goes through a lot. When shoulder stability and control is compromised, sometimes the force needed to complete a task is transferred to the elbow and forearm- and they end up doing work in excess of their abilities.  

This is especially evident during: 

  • Gripping 
  • Tool swinging where power comes from the elbow instead of the hips and torso 
  • Overhead or forward-reaching tasks with poor scapular support 
  • Prolonged carries where the shoulder collapses into internal rotation 

Performing tasks in positions of elbow extension are also a major, and often overlooked, contributor to tennis elbow. 

When the elbow is fully extended, the tendons at the wrist are placed under a great deal of tension and that can decrease their mechanical advantage. Gripping any object while the elbow is fully extended increases the strain on your elbow simply because the muscle groups are acting as stabilizers of the elbow while contracting the muscle groups responsible for gripping. 

Advancing hoselines, pulling debris or victims, and extended carries are all examples of tasks that can increase stress on the extensor tendons. 

Fatigue compounds the problem. As grip strength declines, firefighters often subconsciously lock out the elbow to create stability. While this may feel stronger in the moment, it further increases tensile stress on the lateral elbow structures. 

The issue isn’t that full extension is inherently bad—it’s that repeated, forceful work at end-range without variability or proximal support overwhelms tissue tolerance. When this becomes the default strategy under load, lateral epicondylitis is almost inevitable. 

Why Rest Alone Doesn’t Fix It 

Rest is certainly an essential component of managing symptoms.  One reason tennis elbow can be difficult to resolve is the fact that, once irritated, it does not take much to aggravate symptoms.  While other areas of the body may be easier to rest, we tend to use our arms for various tasks throughout the day. This can range from vigorous work tasks to grabbing a gallon of milk out of the fridge.   

Rest may improve symptoms in the short term but usually does not result in full recovery in the long term. It is common for individuals experiencing Tennis Elbow, or Lateral Epicondylitis to often try and “work through” discomfort or briefly rest the arm, only to see symptoms return. 

That’s because the underlying issue isn’t just tendon irritation—it’s faulty force distribution. 

Unless grip strategies, shoulder mechanics, and movement patterns are addressed, the wrist extensors will continue once returning to normal activity. 

Addressing tennis elbow effectively means looking beyond the elbow itself. And Solveglobal partners with firefighters to help them identify and address which specific issues are contributing to and causing the symptoms. 

This isn’t just pain relief. It’s long-term resilience in one of the most physically demanding professions.