Tennis elbow (lateral epicondylitis) is an overuse injury affecting the tendons on the outside of the elbow joint. The condition involves the common extensor tendon, particularly the extensor carpi radialis brevis (ECRB), which attaches the forearm muscle to the bony prominence on the outer elbow. Repetitive strain or eccentric overload causes microtears and degeneration at the tendon’s origin. A counterforce brace or strap functions by applying direct pressure to the muscle belly, which changes the angle of pull on the tendon. This mechanism temporarily shifts the strain away from the damaged insertion point, providing immediate pain relief during activity.
When to Wear the Brace
You should not wear a tennis elbow brace all the time. The primary role of the brace is to reduce the load on the injured tendon during activities that cause pain. This makes it a tool for acute symptom management when performing repetitive tasks, such as lifting, gripping, or working with tools. Wearing the brace during these high-load periods allows the tendon to rest and begin the healing process while you remain functional.
Continuous wear is discouraged because it may lead to muscle dependency and potential weakening of the forearm muscles over time. The muscles need to be actively strengthened as part of the overall recovery, and relying on the brace prevents this necessary loading. You must remove the brace before going to sleep at night, as continued compression is unnecessary and potentially harmful. Wearing a tight brace overnight can impede circulation or cause nerve irritation.
Types of Elbow Supports and Their Roles
Elbow supports for this condition fall into two main categories, each with a distinct function. The most common is the counterforce strap or band, a narrow strap designed to be worn on the forearm. This device works by compressing the muscle just below the elbow, altering the angle at which the tendon pulls on its attachment site.
This focused pressure effectively dampens the force transmitted to the painful area, making the counterforce strap ideal for use exclusively during high-load activities. The other option is a compression sleeve, which covers the entire elbow joint and provides generalized, mild support. A sleeve offers warmth and proprioception (a sense of joint position), which can be beneficial for overall comfort during less intense, longer periods of wear.
Compression sleeves are often helpful for generalized aching or for providing mild support after an activity. Some sleeves incorporate a separate strap to combine the general compression with the targeted counterforce mechanism. While a sleeve may be comfortable for extended wear, the focused counterforce strap provides the mechanical advantage needed to reduce strain during forceful movements.
Ensuring Proper Brace Placement
For a counterforce strap to be effective, its placement must be precise, as misuse can reduce its benefit or cause secondary complications. The strap should be positioned on the forearm one to two finger-widths below the point of maximum tenderness, near the outside bony bump of the elbow. This placement ensures the brace is directly over the bulk of the extensor muscle group, known as the extensor wad.
A common technique for proper application involves flexing the wrist upward while tightening the strap. This action elevates the muscle belly, allowing the strap to be secured snugly over the activated muscle. The tightness must be firm enough to provide a counterforce but should not be restrictive or cause tingling, numbness, or discoloration in the hand or fingers.
Wearing the brace too tightly risks compressing the radial nerve, which can lead to increased pain or nerve symptoms in the forearm. A properly fitted strap will feel secure and relieve pain during gripping, but it should not leave deep marks on the skin upon removal. Adjusting the placement and tension is necessary to find the optimal position for pain relief.
Beyond Bracing: Other Recovery Steps
While a brace provides immediate relief, it is only one component of a comprehensive recovery plan. The most impactful intervention involves active rest and modification of activities that aggravate the condition. Avoiding or altering the repetitive actions that caused the strain is necessary to prevent further microtrauma to the tendon.
A long-term solution requires specific strengthening and stretching exercises, focusing particularly on eccentric loading. Eccentric exercises involve slowly lengthening the muscle while it is under tension, which encourages healing and improves the strength of the affected extensor tendons. These exercises are performed using light resistance, such as a small dumbbell or specialized bar, to extend the wrist slowly against gravity.
Other conservative measures include applying ice to the painful area for 15 to 20 minutes several times daily to manage acute pain or inflammation. If pain persists after several weeks of bracing, rest, and home exercises, seeking professional medical advice is warranted. A physical therapist can provide a tailored rehabilitation program and ensure proper progression of strengthening exercises for a full recovery.