Should you wear a brace as a treatment for your Tennis Elbow?
If so, what's the best kind of brace? – And when should you wear it?
Although there are a few exceptions, which we'll discuss, here's why wearing a brace or support the way they're typically recommended (all day long – and sometimes even at night) is actually NOT a good idea when it comes to treating Tennis and Golfer's Elbow!
Yes, it’s true that most of the “authorities,” such as Doctors, consumer medical websites and Physical Therapists do recommend that you wear some kind of support pretty much all the time for a few weeks to help "rest, protect and heal" your Tennis Elbow.
And, intuitively, it just sounds like the right thing to do – but on closer inspection there are several reasons why those supports are not the way to help you heal, (in most cases) and why they can actually end up slowing your recovery instead.
Table Of Contents:
(Links jump down the page to various sections of this article.)
This podcast is an older version, one of my very first. (You can download it for later listening by clicking the "download" link under the player below:)
Tennis and Golfer's Elbow, (along with most other Tendinopathies, which is a fancy name for chronic tendon injuries) are simply not the kinds of injuries that benefit from being bound up with some kind of restrictive "support" all day long.
These "supports" don't actually support the healing of this kind of tendon injury!
In other words, the "cure" doesn’t fit the "disease!"
So, if you’ve already been wearing a brace and have noticed it's been feeling a little better – make sure you ask yourself this question:
Does that mean it’s actually healing?
(Unfortunately, NO – It doesn't.)
Yes, there are a host of things you can do to make your Tennis Elbow feel better, (like icing, resting, using topical creams and lotions, taking anti-inflammatories and, worst of all, getting Cortisone shots.)
But, the problem is, all these so-called treatments do is trick you by suppressing and postponing your pain (and, in some cases, your healing process, along with it.)
And that's what braces tend to do, too.
- Now, if you broke your arm, then you’d have to put it in a rigid cast while the bone heals – No question about it!
- Or if you sprained your ankle badly, then you’d probably need to wrap it for a while – No argument there either...
But Tennis Elbow has nothing in common with these kinds of injuries!
Tennis Elbow is certainly not a fracture and it's not a sprain or a strain (usually) – By that I mean there is usually no major tear (strain) in the muscle or tendon that needs to be protected from movement!
(In the case of a significant tear, a brace or support probably would be needed at first – but you'd need to get an MRI in order for a tear to be diagnosed.)
But What About The Possibility of a Smaller Tear?
A lot of Golfer's and Tennis Elbow sufferers really worry that they might have a tear – often because the pain is so sharp or relentless.
Well, that’s always a possibility, but the truth is the severity of the pain and its persistence often has little to do with it.
Pain does not necessarily = TEAR!
In other words, just because it hurts like hell for weeks or months – or even years doesn’t mean there’s a tear – large or small – Often there isn’t.
Only a very small percentage of Tennis Elbow sufferers end up having surgery (something like 3-4%) and that's often due to tears, so they're not that common.
However, for arguments sake, even if there is a small tear, from my understanding and what the leading-edge sports medicine approach seems to favor, is to either keep it free and mobile – or brace it for a very short time after the injury, and then start moving it again as soon as possible
We’re talking about mere days of bracing (in the case of a small tear) followed as soon as possible by gentle movement rather than weeks of bracing and immobilization.
But let’s get right back to the typical case of Tennis Elbow now.
Tennis Elbow is a tendon injury, and most of the time the injured tendons are NOT badly torn in one big, traumatic event – They’re damaged gradually.
The Key Issue And Biggest Risk To Injured Tendons
The key problem is that tendons heal slowly, and the biggest risk is that they don’t heal fully – Or heal at all!
Tendon healing all too often stalls and the tendon gradually breaks down instead.
THAT'S what’s really going on more often than not in the typical case of Tennis Elbow!
Stagnation and degeneration – NOT runaway inflammation, swelling and big tears!
It’s an insidious, weakening or "decay" of the collagen protein that the tendon is made of, where the normal, expected healing response fails to keep up with the breakdown.
Technically, it’s called 'Tendinosis' and there’s no longer any scientific basis for continuing to use the tired, old term of TendonITIS or referring to inflammation (not the problem) any longer.
So it’s a mistake to treat Tennis Elbow as if it were an Acute injury that’s swollen and inflamed, like a sprained ankle or a broken bone.
Especially by immobilizing it!
The key thing to always remember is the fact that Tendons heal slowly – and often don't heal completely.
And the last thing you want to do is to reduce that circulation and blood supply to your tendons even more as they’re trying to heal.
What tendons need is the opposite; more circulation.
Unfortunately, reducing circulation is exactly what wearing a brace, splint, strap or any other kind of so-called support tends to do where you’re wearing it – Two ways:
- First, indirectly, by restricting the movement of your muscles, tendons and elbow joint. Less movement = Less circulation, because muscle movement is essential for good blood flow (and lymph flow, which is completely dependent on movement.)
- And second, by directly compressing the tissues and blood vessels in that area. And, yes, even if it’s not that tight. Naturally, the tighter and more restrictive it is, and the longer you wear it the worse it is.
Supports Can Also Lead To More Scar Tissue
The other big downside with supports is that the compression and reduced mobility tends to encourage sticky 'adhesions' or scar tissue, which further binds and restricts your muscles and tendons.
I’m sure you will agree losing your flexibility to a bunch of nasty scar tissue and having your healing process stall are the last things you want!
Muscles and tendons actually need gentle movement and mobility to heal – (except right after a major tear, which I’ve already mentioned is rarely the case with Tennis Elbow).
Gentle movement during most if not all of the healing process helps the repair process and helps to prevent excessive Scar Tissue build up.
What about the claim that a brace or support helps you rest the area, which helps your tendons heal?
Don't you need rest?
Yes, but only in the sense that you should try to avoid the kind of stressful, repetitive motions and activities that caused your injury in the first place and which would likely aggravate it.
And in the sense of avoiding heavy, physical activity, in general (if you can and it's not what you do for a living.)
Not in the sense that you shouldn’t move the area at all, AKA: “Total Rest.”
Too little movement means less circulation, which can contribute to more stagnation and degeneration in the tendon – which is your #1 enemy.
(See the following article and video for more about the question of rest.)
Should you wear your Tennis Elbow brace all the time?
Absolutely not! As we've already covered, that may be detrimental to your tendon healing process.
However, there are some times and places when it may make sense to wear a brace or support to help prevent further injury:
- In the case of a tear – As mentioned above, if you’re sure you’ve suffered a significant tear (you had an MRI or sonogram and a tear was diagnosed)...
- When playing tennis / golf – While you’re playing tennis, golf, Pickleball, Pingpong, etc. if you choose to play while you're still recovering (See below)...
- Heavy exertion – OR possibly while you're engaging in some kind of short-term forceful activity, like hammering nails, moving furniture or digging in your garden.
In these cases, your goal is to protect your injury (somewhat) from the risk of further damage – while you're doing something strenuous involving sudden, dynamic, forceful motions.
But only for short periods while exerting yourself, and never the rest of the time, while you're walking around, sitting at home or while you’re working.
That is, if your work involves doing something repetitive and lower intensity, like working on a computer. Never wear a brace (or wrist splint) then.
If you're a contractor doing heavy, physical work, then it may be a good idea to wear a brace, and to wear it for longer periods while you're doing that work.
Hopefully, if your job does not entail heavy, physical work, you can avoid it entirely while you're recovering. Hire someone else to whack those weeds!
There are classic, rigid, “around the whole elbow” supports, Counterforce Braces, (elbow straps) wrist splints, various kinds of tapes and taping techniques AND compression sleeves...
Which is the best kind – IF you're going to wear one?
When it comes to playing tennis, golf, Racquetball, Pickleball or Pingpong, the Counterforce Brace / elbow strap seems to be the clear winner.
This type of brace is more of a strap that encircles the upper forearm an inch or two below the Lateral Epicondyle / “Tennis Elbow spot.”
It also seems like the best brace to use while performing heavy, physical tasks, whether you're gardening, doing construction or perhaps while lifting weights at the gym.
It should be obvious this is a temporary, interim measure, though; a crutch, if you will, which should be abandoned as soon as possible.
One of the downsides to playing a racket or paddle sport while wearing a strap / brace is that alters your ‘biomechanics’ – (The normal mechanical function of the muscles and tendons.)
This can lead to the emergence of compensation patterns, and it can stress other joints above or below your elbow; your wrist or shoulder, especially.
Of course, you have to choose a particular brand of strap, but I'll refer you to these resources to help answer that question:
What About Compression Sleeves?
Another possible exception is the 'neoprene compression sleeve' type of support.
It's different from a classic Tennis Elbow brace in that it's completely flexible and elastic. There is no rigidity.
I'm skeptical about the “compression” aspect of the sleeve-type support – once again, tendons don't need compression to heal...
However, these sleeves can provide one key benefit:
Keeping the area warm!
Some people swear they have issues keeping their elbows warm – especially at night, and the compression sleeve helps.
Keeping the area warm is certainly beneficial for circulation, and good blood flow is essential to healing.
I would still recommend caution, though. The compression itself could limit circulation, particularly lymph flow.
And let's include the kinesiology / Kinesio Tape and taping techniques, since they're somewhat related, even though they're not technically braces.
There are many brands, including Rock Tape and KT Tape.
I don't see how these athletic taping techniques are going to either help or hurt, so have at it if it speaks to you.
The Worst Types Of Supports
“Around the whole elbow” supports, seen in the picture above, are probably the worst type, since they're so bulky and restrictive.
Unless you're doing heavy construction or something like that - They're certainly not for tennis or golf or even doing work around the house!
Wrist splints are the next worst, since they rigidly immobilize your wrist, preventing flexion and/or extension.
Wrist splints are not elbow braces, per se, however they target and immobilize the wrist, which is controlled by the same muscle groups that are involved in Golfer's Elbow and Tennis Elbow; the Wrist Flexors and Extensors.
Here are a couple of resources to guide you in placing and adjusting your elbow strap, starting with a video by a Physiotherapist / Physical Therapist:
Compression sleeves are self-explanatory, but if you choose to buy and use a Tennis or Golfer's Elbow strap or Counterforce Brace, they have to be placed and adjusted correctly.
Here's another guide on WikiHow on How to Wear a Tennis Elbow Brace
Placing these braces incorrectly or adjusting them too tight will do you more harm than good.
If you’re tired of chasing your Tennis Elbow pain with things like braces, ice and pills – without ever managing to break the cycle – Then take a look at my program and learn how to help yourself make a full recovery and finally heal...
Learn To Treat And Heal Your Own Tennis Elbow Or Golfer's Elbow At Home With This Video Program
I'll be your personal tutor guiding you through step-by-step video lessons, where you'll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home. (Without any special equipment.)
Tennis Elbow sufferers: Learn more about the home program here
Golfer's Elbow sufferers: Learn more about the home program here