Outer Elbow Pain? These Muscles Could Be To Blame

Sarah, a 42-year-old graphic designer, had never played a game of tennis in her life, yet she found herself dealing with persistent pain on the outside of her elbow. At first, it was just a dull ache after long hours at her computer, but over time, it became a sharp, nagging pain that flared up whenever she used her mouse, typed for extended periods, or even carried groceries. Frustrated, she started wearing a brace, assuming it was tennis elbow, but the discomfort never fully went away.

Determined to find a lasting solution, Sarah visited a massage therapist, who identified the root of the problem—not her elbow, but her overworked forearm muscles. Years of gripping a mouse, typing, and using a stylus had overused certain muscles in her forearm, causing them to tighten and pull on the tendons connected to her elbow. With targeted massage and strengthening exercises, Sarah began to feel relief within weeks. She also made ergonomic adjustments to her workspace, helping to prevent the pain from returning.

What muscles were behind Sarah’s symptoms, and how can overuse lead to this kind of pain? In this article, we’ll explore the forearm muscles that contribute to outer arm pain, more technically known as tennis elbow or lateral epicondylalgia, and what you can do to find relief.

How Overused Muscles Can Cause Outer Elbow Pain

When a muscle is overused—kept in a tight or constricted state for too long—it becomes fatigued and tense, much like you might feel after a stressful, overbooked week. Over time, the muscle can lock into this tight position, forming painful knots known as trigger points. These knots don’t just cause localized pain; they can pull on surrounding muscles, restrict movement, and even contribute to joint dysfunction.

In cases of lateral epicondylalgia, commonly known as "tennis elbow," overstrained forearm muscles become tight and develop trigger points. This tension pulls on surrounding muscles and places excessive strain on the elbow joint, leading to pain and discomfort. Like Sarah, you may have never played tennis—despite the name, this condition isn’t exclusive to athletes. Perhaps you play the violin, an instrument that places significant strain on the forearm muscles, or you spend hours each day typing or performing repetitive tasks that exceed your muscles' current capacity.

My exploration into how overused and triggered muscles impact daily life has been deeply influenced by Myofascial Pain and Dysfunction: The Trigger Point Therapy Manual by Dr. Janet G. Travell and Dr. David G. Simons. This comprehensive two-volume set transformed my approach to massage, allowing me to provide lasting relief to my clients. For a more accessible, hands-on resource, I highly recommend The Trigger Point Therapy Workbook by Clair Davies, NCTMB, which breaks down these concepts into a practical, easy-to-follow guide for self-treatment.

Muscles That Can Create Outer Elbow Pain

Now that we've explored how muscles can contribute to or even cause outer elbow pain, let's take a closer look at the specific muscles that may be responsible. While there's much more to say about each one, I've highlighted the key points that you should know. If any of these symptoms sound familiar, be sure to check out the section below on what you can do to find relief.

1. Extensor Carpi Radialis Longus

This muscle lies on the back of the forearm on the thumb side of the arm and extends from the elbow to the base of the metatarsal of the second finger. Its main function is to bend the wrist outwards and keep it in position for activities like typing or playing the piano.

Symptoms It Can Cause:

• Tennis elbow-type pain

• Burning pain in the outside of the forearm

How It Can Be Overused:

• Playing tennis

• Playing the violin or piano

• Typing on a keyboard

2. Brachialis

This muscle lies under the biceps and covers the front of the lower half of the humerus. It functions to bend the elbow, doing much of the work typically credited to the biceps.

Symptoms It Can Cause:

• Difficulty in straightening the elbow

• Oppressive tightness at the outer arm near the elbow

• Pain at the base of the thumb

How It Can Be Overused:

• Carrying heavy bags

• Holding heavy tools

• Typing for long periods of time

• Playing the oboe, clarinet, or saxophone

3. Anconeus

This small muscle is located right at the elbow joint itself, extending from the ulna to the lateral base of the humerus. Its function is to support the triceps muscle in straightening the elbow.

Symptoms It Can Cause:

• Tennis-Elbow-type pain

How It Can Be Overused:

• Extensive pronation of the hand (turning it palm side down)

4. Extensor Digitorum

This muscle is located on the outside of the forearm and extends from the base of the humerus to the fingers. Its function is to straighten and extend the third, fourth, and fifth fingers.

Symptoms It Can Cause:

• Pain in the outer elbow

• Stiff fingers

• Pain in the knuckles of the hands

How It Can Be Overused:

• Typing at a keyboard for long periods of time

• Any activity that requires lots of repetitive or explosive movement or gripping of the fingers

How Do We Fix Triggered Muscles?

The good news is that triggered muscles can often be relatively quick and easy to "un-trigger." However, if you continue the activity that caused the issue in the first place, the muscle will likely become triggered again. Consider how you can modify or mediate these triggers—for example, using an ergonomic keyboard. For activities that cannot be adjusted, consistently applying the following two steps can help keep your pain significantly reduced.

Step 1: Relax the Muscle

The first step in releasing a triggered muscle is to relax it. Whether through using self-massage of your forearms with a tennis ball or your hands, or seeking the help of a professional massage therapist, massage is the most effective way to ease muscle tension and restore movement. If you're interested in learning more about self-massage, I highly recommend The Trigger Point Therapy Workbook by Clair Davies, NCTMB.

Step 2: Strengthen and Stabilize

Relaxing the muscle alone is not enough. The reason it became overworked in the first place is often due to weakness—either in the muscle itself or in surrounding muscles that failed to provide adequate support. Developing a targeted corrective exercise routine to strengthen and stabilize your upper body and arms is essential for long-term relief. These exercises normally don’t require a gym and usually take just a few minutes each day, but the benefits will be well worth the effort!

If you are currently dealing with outer elbow pain, schedule a consultation with me today to see how we can work together to help you feel and move better!

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