When tennis elbow has nothing to do with tennis..

How the Neck and Shoulder Girdle Can Contribute to Tennis Elbow Pain

Tennis elbow—formally known as lateral epicondylitis—is often thought of as a local issue in the elbow, caused by overuse of the wrist and forearm muscles. But did you know that problems in the neck and shoulder girdle can actually play a major role in both the development and persistence of tennis elbow pain?

The Kinetic Chain Connection

Our bodies work as an integrated system. Movements of the hand and elbow are influenced by what’s happening upstream—in the shoulder, scapula (shoulder blade), and even the cervical spine (neck). Due to the structure of the nervous system and other body systems, changes in the soft tissues and/or posture of the neck and shoulder girdle can have dramatic effects in the arm and elbow.

Poor postural habits like forward head posture or rounded shoulders can lead to muscle imbalances in the upper back and neck. This reduces scapula stability and shoulder strength, which forces the forearm muscles to work harder than they should during repetitive arm movements. Over time, this extra strain can trigger or exacerbate symptoms of tennis elbow.

Nerve Irritation and Referred Pain

In some cases, tennis elbow symptoms may actually be driven by irritation of nerves that originate in the neck. Since the nerves supplying the arm originate in the neck and upper back, restrictions such as muscle or connective tissue tightness, or joint stiffness in this region can cause referred pain or alter the function of muscles in the arm. This can lead to abnormal loading patterns at the elbow, or affect the forearm muscles’ ability to withstand normal loads.

Muscle Tension and Movement Dysfunction

Tight or underactive muscles in the neck and shoulder girdle can also disrupt arm mechanics. If the shoulder doesn’t move well, the elbow often takes the brunt of it, increasing load on the lateral epicondyle, where the forearm muscles insert onto the bone.

What Can Be Done?

A holistic approach to tennis elbow should include assessment of neck mobility, scapular control, and posture. Strengthening the shoulder girdle, improving thoracic spine mobility, and correcting postural imbalances can offload the elbow and support long-term recovery.

So next time you’re dealing with stubborn elbow pain, don’t forget to look upstream. The problem might not be where it hurts—but where it starts.