The pole dancer’s guide to tennis elbow

That nagging pain on the outside of your elbow when you grip the pole, open a jar or pick up the kettle? It’s one of the most common conditions we see in pole dancers and one of the most manageable if you address it properly.

Tennis elbow affects pole dancers because pole training places sustained, repetitive load on the forearm muscles that accumulate over time. Understanding what’s happening and what helps is more effective than waiting for it to resolve on its own.

What tennis elbow is

Despite the name, tennis elbow has nothing to do with tennis. The clinical term is lateral epicondylalgia referring to pain at the lateral epicondyle (the bony prominence on the outside of the elbow) where the forearm extensor muscles attach via the common extensor tendon.

It’s important noting the mechanism, because it affects how you treat it. Tennis elbow is not primarily an inflammatory condition, despite the older term lateral epicondylitis suggesting otherwise. It’s a tendinopathy, which means a failure of the tendon to repair adequately in response to repetitive loading. NSAIDs and anti-inflammatory approaches have limited effectiveness for this reason. What does work is progressive tendon loading, which we’ll cover in the treatment section.

The condition develops when the load placed on the tendon through gripping, wrist extension (bending the wrist backwards) and forearm supination (turning the palm upwards) repeatedly exceeds the tendon’s current capacity. Microtrauma accumulates faster than the tissue can repair and the result is the characteristic pattern of pain, weakness and stiffness.

How tennis elbow happens on the pole

Pole loads the forearm extensors in multiple ways at once. Split or true grip in particular places the wrist extensors under significant load. Any grip-dependent hold requires continuous forearm activation. Practising the same movement repeatedly means the same structures are loaded in the same pattern, session after session.

Common contributing factors are:

• Sudden increase in training volume
• New grips or moves
• Poor technique or compensations
• Weakness in the kinetic chain
• Training through fatigue or pain
• Insufficient recovery between sessions
• Returning too quickly after time off or injury
• Imbalance between forearm flexors and extensors
• Cumulative load from non-pole activities, such as desk work, manual work or any hobbies requiring repetitive wrist and forearm activity
• Individual factors, such as age (30-50 more prevalent), previous history of tennis elbow, smoking, high alcohol consumption, certain medical conditions (such as diabetes or obesity), poor sleep and nutrition or high stress levels

On their own, these might not be an issue, but these can all individually contribute and be a piece of the puzzle.

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Signs and symptoms of tennis elbow

The presentation is fairly consistent. Pain is located on the outside of the elbow and may radiate into the forearm or upper arm. There is pain with gripping, carrying or twisting. Grip strength is typically reduced. Gripping or carrying, particularly with a straight elbow (picking up a full kettle, carrying a bag, holding the pole at arm’s length) are often the most provocative.

Night pain and stiffness is common in more severe cases. Tennis elbow tends to favour the dominant arm, though pole dancers frequently develop it on either side.

Tennis elbow and shoulders are connected

This is one of the most important and least commonly understood aspects of tennis elbow, so it’s worth explaining properly.

When the shoulder muscles, particularly the rotator cuff and scapular stabilisers are weak or fatigued, the elbows have to work harder. Normally the kinetic chain transfers force through the whole body and each segment play their role. However, if the shoulder is a weak link in the chain, the distal segments (ie elbow and forearm) have to work harder, increasing the demand on the elbow.

This means in practice if you only focus on the elbow, results are often temporary and can lead to recurrence. Assessment and rehabilitation that includes the shoulder and scapular complex tends to produce better outcomes, which is why our approach at Polisthenics addresses the whole chain rather than just the symptomatic site. You can read more about shoulder rehab here.

Treatment of tennis elbow

The management of tennis elbow requires 3 key areas. Progressive loading, load management and activity modifications. Treatment should include addressing contributing factors. Whilst tennis elbow usually gets better by itself within 12 months, applying these approaches you can get better, quicker and long-lasting results.

Physiotherapy and progressive loading

This is the primary evidence-based treatment for tennis elbow and should be the first approach. The goal is to progressively reload the tendon to rebuild capacity in a controlled way that stimulates repair and adaptation, while managing symptoms throughout. Avoid stretching the wrist and forearm muscles as they can aggravate your symptoms.

The progression typically moves through three phases.

Isometric loading first. This is where you contract your muscles without movement at the joint This loads the tendon without the mechanical stress of full range movement and has good evidence for pain reduction in the early stage.

This is followed by eccentric loading consisting of slow, controlled lengthening contractions that apply the specific mechanical stimulus tendons respond well to.

Finally, progressive full range strengthening builds the capacity needed for return to full training.

For pole dancers, this includes wrist extensor loading, such as weighted wrist extensions, grip strengthening (towel wringing, gripper squeezes, dead hangs) and shoulder and scapular work (rotator cuff exercises, YTWs, push up plus, scapular stability drills). Core conditioning is also relevant. If load isn’t transferred efficiently through the trunk, other body parts will have to take up the slack, which in pole dancing tends to end up being the shoulders, elbows and wrists.

Relative rest and load management

Complete rest is rarely the right answer and often delays recovery by further weakening the tendon. Relative rest, which means reducing load to a level that doesn’t aggravate symptoms is more appropriate. In practice this means identifying which movements provoke pain and either modifying or temporarily avoiding those specifically, rather than stopping all training.

Gradually progress your exercises and training. Monitor your pain levels the following day. If your symptoms are worse the next day, you’ve done too much. Have a day or two off and reduce intensity in your next session. If your symptoms are the same or better, you’re on the right track.

Activity modification

Small changes can significantly reduce load on the elbow. Avoiding elbow extension under load where possible (lifting with the elbow bent, using two hands for heavy objects) reduces tendon stress. This applies to both on and off the pole.

In pole specifically, temporarily avoid true grip and Russian grip and any grip-heavy moves. If easier moves don’t aggravate your symptoms, carry on with those, however if something bothers you, don’t push through it, you will just end up flaring it up.

Meanwhile continue with lower body and core work and gradually reintroduce upper body loading as symptoms settle.

Work with a physiotherapist or coach to address poor technique, correct compensations and muscle imbalances contributing to your condition.

A counterforce brace or kinesiology tape (KT tape) worn during activity can provide symptomatic relief by redistributing some of the tendon load, though it’s a management tool rather than a treatment.

Other interventions

Ice and topical NSAIDs may provide short term symptomatic relief but have limited effect on the underlying tendinopathy. Manual therapy, taping and acupuncture have some evidence for short term pain reduction but aren’t a solution. Corticosteroid injections show good short term results but are associated with worse outcomes at 12 months compared to physiotherapy and the current evidence does not support their use. Surgery exists as a last resort for cases that haven’t responded to extensive conservative management.

Returning to pole stronger after tennis elbow

Return to full pole training should be gradual and structured. Don’t pick up where you left off. Absence of pain at rest is a starting point, not a clearance to return to full load. The tendon needs to rebuild sufficient capacity to handle pole-specific demands, which are significantly higher than daily activities.

A phased return typically involves starting with basic moves with multiple contact points, progressing to 3 point grips (butterfly, poissaint, etc), then reintroducing true grip, Russian grip and dynamic moves at a lower intensity as strength and symptoms allow. Review your technique. Returning to the same training pattern that caused the problem without addressing any modifiable factors tends to result in recurrence.

Preventing tennis elbow in the first place

The most modifiable risk factors are load management and shoulder and forearm strength. Increase training volume or introduce new grips gradually, ensure adequate recovery between sessions and maintain shoulder and scapular strength are simple ways to prevent tennis elbow.

Include a thorough warm up that includes wrist, forearm and shoulder preparation before each session. Regular grip variation (cup grip alongside true grip and both sides trained) distributes load across different structures rather than accumulating it in one place. Specific grip strengthening and prehab for your wrist extensors, rotator cuff, scapular and core stability muscles should be part of every pole dancers training routine.

If you notice the early signs, such as elbow discomfort after training that resolves within a day, slight grip weakness or occasional niggle with wrist extension, make sure you address load and technique. It’s much easier to manage at that stage than a fully developed tendinopathy.

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Are you dealing with elbow pain or have you been through tennis elbow and come out the other side? Share your experience in the community forum – it’s one of the questions that comes up most often and a thread with real experiences alongside the clinical information is genuinely useful for people in the early stages. And if you know someone who’d find this useful, spread the word!

If your elbow is giving you consistent trouble or you want to understand whether what you’re experiencing is tennis elbow or something else, a virtual physio assessment with someone who understands pole-specific loading is the most efficient route to a clear answer and a plan.

We offer virtual physiotherapy, strength coaching and personalised training programs tailored to pole dancers whether you’re injured, want to avoid getting injured or want to get stronger and achieve your pole goals.

💻 Book your appointment or message us here or on Instagram @polisthenics!

Disclaimer: This post is for educational purposes and should not replace professional medical advice. Always consult with a healthcare provider for diagnosis and treatment tailored to your needs.

References

Coombes, BK, Bisset, L and Vicenzino, B. (2015). ‘Management of lateral elbow tendinopathy: one size does not fit all’, Journal of Orthopaedic & Sports Physical Therapy, 45(11), pp. 938-949. Available at: https://www.jospt.org/doi/pdfplus/10.2519/jospt.2015.5841 [Accessed 15 August 2024].

Day, JM. et al. (2015). ‘Scapular muscle performance in individuals with lateral epicondylalgia’, Journal of Orthopaedic & Sports Physical Therapy, 45(5), pp. 414-424. Available at: https://www.jospt.org/doi/full/10.2519/jospt.2015.5290 [Accessed 15 August 2024].

Karabinov, V and Georgiev, G. (2022). ‘Lateral epicondylitis: new trends and challenges in treatment’, World Journal of Orthopaedics, 13(4), pp. 354-364. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048498/ [Accessed 15 August 2024].

Lin, KM, Ellenbecker, TS and Safran, MR. (2022). Rehabilitation and return to sport following elbow injuries’, Arthroscopy, Sports Medicine, and Rehabilitation, 4(3), pp. 1245-1251. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210377/ [Accessed 15 August 2024].

Zhang, C. et al. (2024). ‘Impact of lifestyle and clinical factors on the prognosis of tennis elbow’, Scientific Reports, 14, 3063. Available at: https://www.nature.com/articles/s41598-024-53669-x [Accessed 15 August 2024].