Elbow pain is common in people who play sports, work with their hands, lift weights, or repeat the same arm movements every day. One of the most common reasons for elbow pain is overuse. When the muscles and tendons around the elbow are asked to do more work than they can handle, pain can develop over time.
But what causes elbow pain? In many cases, it is not one single cause. Elbow pain can come from repeated stress, weak muscles, poor strength balance, or returning to activity too quickly after an injury.
For many people, the key to long-term recovery is not simply getting the pain to go away. It is rebuilding the strength and ability of the entire arm.
What Causes Elbow Pain?
There are many possible causes of elbow pain. These can include:
- Repeated or overuse movements
- Tennis elbow or golfer's elbow
- Weakness in the forearm, wrist, or shoulder
- A sudden injury or fall
- Nerve irritation
- Joint problems or arthritis
This article focuses on overuse elbow injuries, including tennis elbow and golfer's elbow, and why building strength can be an important part of recovery.
1. Repeated Use Can Lead to Elbow Pain
One of the most common causes of elbow pain is doing the same movement again and again. Think about a tennis player hitting hundreds of serves, a golfer taking repeated swings, a baseball player throwing, or someone using a hammer at work all day. Each movement puts stress on the muscles and tendons around the elbow.
Your body can handle stress. In fact, stress is needed to make muscles and tendons stronger. The problem starts when the amount of stress is greater than your body's ability to recover.
This can happen when you:
- Increase your activity too quickly
- Train harder without enough recovery
- Repeat the same movement for long periods with poor form
- Suddenly start a new sport or exercise
- Return to activity before your arm is ready
Over time, this can contribute to an overuse injury such as lateral elbow tendinopathy, often called tennis elbow, or medial elbow tendinopathy, often called golfer's elbow.
The goal is not always to stop using the arm. Instead, the goal is to slowly build the arm's ability to handle the work again.
2. Weakness in the Shoulder, Forearm and Wrist Can Add Stress to the Elbow
Your elbow does not work alone. Your shoulder, upper arm, forearm, wrist and hand all work together to control your arm. If some of these muscles are weak, other muscles may have to work harder.
Research supports this idea.
A 2021 systematic review looked at 14 studies involving people with lateral elbow
tendinopathy. The researchers found strength problems in several areas, including the
shoulder, wrist and forearm. They found weakness in muscles that help control the shoulder blade, shoulder rotation, wrist movement and grip strength. The authors said these areas should be considered when building a strengthening program for people with tennis elbow. (PubMed)
This is important because treating the painful spot alone may not be enough. A strong recovery program should look at the whole arm. That may include strengthening the:
- Shoulder
- Shoulder blade muscles
- Forearm
- Wrist
- Grip
- Muscles that rotate the forearm
3. Returning to Activity Too Soon Can Bring Elbow Pain Back
Another common cause of ongoing elbow pain is returning to normal activity before the arm has rebuilt enough strength. Pain may improve before your arm is ready for full activity. For example, a baseball player may feel better and start throwing again. A golfer may return to a full round. A tennis player may start hitting hard again. If the muscles and tendons have not regained enough strength and endurance, the elbow may once again be asked to do more work than it can handle.
This is why recovery should be a progressive process.
Start with movements you can handle. Then slowly increase the resistance, repetitions and speed as your strength improves. Research supports the use of exercise and strengthening in the treatment of lateral elbow tendinopathy. A systematic review and meta-analysis found that exercise programs can improve pain and function compared with passive treatments. (PubMed)
The goal is simple: Build your arm back stronger than it was before.
Why Rotational Strength Matters for Elbow Pain
One part of elbow recovery that can be overlooked is forearm rotation.
Your forearm can rotate in two main directions:
- Pronation — turning your palm down
- Supination — turning your palm up
These movements are used during throwing, swinging, lifting, gripping, working and many daily activities.
Research published in 2025 found that people with lateral elbow pain had lower pronation and supination torque in the painful arm compared with the other arm. The researchers noted that these findings may help guide rehabilitation and progressive return to activity. (PubMed)
This gives us another reason to look beyond simple grip exercises when working on elbow strength.
The goal is to build strength through the movements your arm actually needs.
How The Pronator Can Help With Elbow Recovery
This is where The Pronator can become an important part of a strengthening program for elbow pain caused by overuse injuries. The Pronator was designed by a Doctor of Physical Therapy to help build shoulder, forearm and wrist strength. Its design allows a dumbbell or resistance band to be placed away from the hand. This creates a longer lever and adds rotational resistance to the exercise. (The Pronator)
The Pronator can be used to train movements such as:
- Forearm pronation
- Forearm supination
- Wrist rotation
- Grip strength
- Shoulder rotation
- Shoulder and scapular control
This makes it different from many basic elbow exercises that only use straight up-and-down resistance. The Pronator's rehabilitation approach is based on controlled rotational loading. It is designed for use with conditions such as lateral and medial epicondylitis and for building forearm and shoulder rotational strength.
Building Strength Takes Time
If you have elbow pain, it can be tempting to look for a quick fix. But overuse injuries often take time. The goal should be to gradually improve your ability to handle stress. This means finding the right amount of exercise, allowing enough recovery and slowly increasing the workload.
For someone recovering from an overuse elbow injury, a good program may include:
1. Reducing activities that make symptoms worse
2. Restoring comfortable movement
3. Building forearm and wrist strength
4. Building shoulder and shoulder blade strength
5. Training pronation and supination
6. Slowly increasing resistance
7. Gradually returning to sports, work or normal activities
Don't Just Get Rid of Elbow Pain. Build a Stronger Arm.
So, what causes elbow pain?
For many active people, repeated stress and overuse are major contributors. Weakness in the shoulder, forearm and wrist can also play a role. And returning to full activity before rebuilding strength can increase the chance of continued problems.
The good news is that your arm can become stronger. A complete strengthening program should not only focus on where you feel the pain. It should look at the muscles and movements that help your entire arm work together. Rotational strength is an important part of that process. The Pronator was built to make rotational strengthening easier by combining a lever arm with the weight or resistance you already have.
Whether your goal is to return to baseball, tennis, golf, work or everyday activities, the goal is the same:
Build strength. Build capacity. Challenge your potential.
References
1. Heales LJ, Bout N, Dines B, et al. An Investigation of Maximal Strength of the Upper Limb Bilaterally in Individuals With Lateral Elbow Tendinopathy: A Systematic Review With Meta-Analysis. Physical Therapy. 2021;101(12):pzab230. (PubMed)
2. Herrera-Ligero C, Sánchez-Zuriaga D, Martínez-Iranzo Ú, De Rosario H. Impact of Lateral Elbow Pain on Pronation and Supination Torques and Influence of Forearm Rotation Angle. American Journal of Occupational Therapy. 2025;79(5). (PubMed)
3. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials. PubMed. (PubMed) Medical disclaimer: This article is for educational purposes only and is not medical advice. Elbow pain can have many causes. If pain is severe, persistent, follows an injury, or limits normal activity, consult a qualified healthcare professional.
