20 Lateral Epicondylitis (Tennis Elbow)
This module teaches the release of muscles associated with lateral epicondylitis, commonly called tennis elbow. Spasm in this region can produce pain along the lateral elbow and dorsal forearm.
Step 1
Understanding the Problem
Lateral epicondylitis (Tennis Elbow) is commonly treated as a tendon problem at the elbow.
But the primary driver is often:
👉 the brachioradialis in spasm
This muscle:
• runs from the lateral supracondylar ridge of the humerus• to the distal radius
When it spasms:👉 it creates constant tension at the lateral elbow
Step 2
The Clinical Problem
Lateral epicondylitis is commonly treated as a random inflammation of the lateral epicondyle of the humerus bone - the bump on the outer elbow. The cause of this has a name - it is caused by the brachioradialis muscle. It originates at the lateral epicondyle and its attac hment to the epicondyle is what becomes inflammed when it is chronically involumtary contracting.
This muscle:
• runs from the lateral supracondylar ridge of the humerus
• to the distal radius
When it spasms:
👉 it creates constant tension at the lateral epicondyle of the elbow, very close to where it crosses over the radial nerve.
The brachoradialis is part of a true chain of muscles. It will itself spasm when the coracobrachialis is in spasm because its nerve supply (the musculocutaneous nerve) becomes pinched when the coracobrtachialis (a small muscle in the armpit) is in spasm.
The brachioradialis, in turn, pinches the radial nerve, where it passes over slightly above the elbow, just beyond the lateral epicondyle of the humerus bone. The radial nerve is the supply for the extensor muscles of the forearm, wrist and hand. When the brachioradialis in spasm, these muscles will also spasm as a result of the radial nerve impingement.
When the brachioradialis is in spasm, it pinches the radial nerve which supplies several muscles:
-
extensor digitorum
-
extensor pollicus
-
dorsal interossei of hand
These muscles will all automatically spasm when the brachioradialis is in spasm. Why? Because, the brachioradialis pinches the radial nerve - the nerve supply for these muscles. Understanding how these myofacial chains are triggered, obviously helps you navigate which of them to do first and which order to go in.
Step 3
Why This Happens
The brachioradialis is innervated by the radial nerve and functions strongly in elbow flexion, especially when the forearm is in neutral or transitioning between pronation and supination.
When the brachioradialis becomes fatigued and enters spasm:
• it provides elbow flexion normally, but doesn't let go when in spasm, so the elbow loses the ability to extend
• it traps and compresses the radial nerve
• it pulls the radius bone too far into the anterior plane of the wrist, and pulls wrist ligaments and carpal bones along with it
• it causes chronic inflammation of the radial insertion
• it causes chronic inflammation of the lateral epicondyle (aka tennis elbow)
This produces constant stress at its attachment near the lateral elbow.
That is why the elbow hurts.
The pain is not random. It is the natural result of a muscle in sustained contraction pulling continuously on its attachment.
In clinical practice, this is why local treatment to the lateral elbow often fails. The practitioner may work directly over the painful region, but unless the brachioradialis itself is released, the pull remains and the symptoms return.
The logic is simple:
👉 spasm in the muscle
👉 constant traction at the attachment
👉 constant radial nerve entrapment
👉 chronic lateral elbow pain
When the brachioradialis releases, inflammation in the lateral elbow has no more cause. It generally disappears within 48 hours - which should be alloted for any releasology pain syndrome to clear completely. Immediately after release the nerve pain should be released and normal range of motion should be re-established, but the soreness take a couple days sometimes to go away - this should also be applied to virtually all of the releasology topics.
Step 4
Anatomy
Anterior (Palmar) View
The brachioradialis originates from the lateral supracondylar ridge of the humerus and travels down the forearm to insert near the distal radius.
It lies superficially enough to be clearly palpated, especially when in spasm.
Its pathway can be understood as:
• beginning just above the lateral elbow
• crossing along the anterior-lateral forearm
• ending near the distal radius on the thumb side
This is important because many people think of it only as an elbow muscle. It is not. It is a long forearm muscle whose tension is merely felt strongly at the elbow.
In releasology, a very useful assessment is to trace the muscle from the elbow along the anterior forearm all the way to its distal attachment. If it feels like a continuous tight cord, the pattern is clear.
Step 5
Palpation & Tissue Assessment
Palpate along the lateral forearm.
Cross-fiber:
• feel side-to-side across the fibers of the brachioradialis
• travel from origin (outside of the elbow) to the insertion (front of the distal end of the radius bone) and back again. Do this over and over again as the treatment progresses to assess your progress with releasing it.
• as you palpate, determine wether you can feel its fibers or not.
• if it is in spasm, and someone has tennis elbow, you will be able to feel its fibers with cross-fiber palpation
• as you palpate, also determine which part of its fibers are the tightest and most resistent to stretching.
Spasm feels like:
👉 tight fibers or cables under the skin
Step 6
Neurological Consequences
Because the brachioradialis is innervated by the musculocutaneous nerve, and causes impingement of the radial nerve, it is a key intersection. This is also known as the Kurpara Marma. And, that's due of this myofacial-neurological hub. Spasm here is not only mechanical. It also affects neural conduction and circulation through the lateral forearm.
This will cause:
• lateral epicondylitis
• chronic posterior forearm (extensor) spasm and pain.
• pain extending the elbow
• weakness flexing the elbow or holding weight in flexion
From a Releasology perspective, the scenarios associated with radial nerve pain and tennis elbow are good examples of where therapists could spend a lot of wasted time trying to release the muscles that just are not going to let go. Why because they need to know which key muscles to release first. Once a key muscle is released, the muscles that we call secondary spasms may also need to be released, but they will relatively easy to release by releasing the key muscles first. If this is done in the wrong order, the secondary muscles are likely to never release. For this reason, stay with me here, if a muscle is being really stubborn, there is probably a key muscle to release upstream.
When the brachioradialis releases:
• the radial nerve will be released
• tennis elbow (lateral epicondylitis) and the associated inflammation will immediately begin to subside
• full strength, movement are restored
Step 7
Technique Demonstration
Watch the technique demonstration carefully.
Pay attention to:
• how the practitioner locates the brachioradialis near the lateral elbow
• how the forearm is positioned in supination
• how the practitioner traces the muscle down the anterior forearm
• the direction of pressure across the fibers
• how the pressure is sustained rather than jabbed or rubbed
• the Yang–Yin release cycle
Observe how the practitioner does not chase the pain only at the elbow.
Instead, they work the entire muscular cause.
Notice:
👉 where the tissue feels dense
👉 how the hand follows the line of the muscle
👉 when the tissue changes from tight and resistant to soft and responsive
Step 8
Worksheet Exercise
Download the skeletal worksheet on this page and open it on your phone or tablet.
Using a red pen or pencil tool, draw the brachioradialis from:
• the lateral supracondylar ridge of the humerus
• down to the distal radius
Fill at least 80% of the anatomical space the muscle occupies.
Then add flank lines for:
• Origin
• Insertion
• Action
• Innervation
Also indicate the area where tennis elbow pain is usually felt, and show how that pain is secondary to the pull of the muscle above and below it.
Save your completed worksheet and upload it in this section.
Step 9
Practice Assignment
Clinical Skill Development
Practice this modality on a client who can comfortably rest their forearm in supination.
Your goal is to:
• locate the brachioradialis precisely
• trace its full line of tension
• identify the densest part of the spasm pattern
• release the muscle rather than merely rubbing the painful elbow
Focus on:
• steady pressure
• correct forearm positioning
• cross-fiber palpation
• patient body mechanics
Do not rush to the elbow only.
Instead:
👉 find the line
👉 trace the line
👉 release the line
This is the difference between symptom treatment and cause treatment.
Step 10
Treatment Recording
Record your session using a tripod.Your video should clearly show:
• the client’s forearm in supination
• your hand placement near the lateral elbow
• how you trace the brachioradialis down the forearm
• the direction and steadiness of your pressure
• your body mechanics throughout the technique
The purpose of this recording is to show that you understand both the anatomy and the method.
Step 11
Client Testimonial
Ask your practice subject to rate their symptoms before and after the treatment using a 0–10 scale.
Record a brief testimonial video including::
☑ symptom description
☑ before score
☑ after score
☑ changes they experienced
Upload the testimonial video.
Documenting real clinical outcomes is an essential part of Releasology training.
Step 12
Knowledge Check & Module Completion
Complete the quiz for this module.
You must understand:
• the anatomy of the brachioradialis
• why tennis elbow is caused by spasm of the brachioradialis
• how to draw the brachioradialis
• that the brachioradialis pinches the radial nerve when it is in spasm
• both tennis elbow and radial nerve pain will not go away without releasing the brachioradialis
• the musculocutaneous nerve is the nerve for the brachioradialis, and it is commonly pinched by the coracobrachialis - which for this reasonwould need to be released prior to attempting to release the brachioradialis.
• the radial nerve will absolutely be pinched and the extensor muscles of the forearm will contract when the brachioradialis is in spasm, but under the scalenus anterior, the radial noose and triceps are also likely candidates and will need to be released first, and in that order, before releasing the brachioradialis will release the radial nerve
Go ahead and take the quiz when you are ready. Don't forget to click the submit quiz button when you are done.
A score of 80% or higher is required to pass.
Once your worksheet, technique video, testimonial, and quiz are complete, this module is finished.
1. Which muscle is the key root cause in this modality?
A. Triceps
B. Brachioradialis
C. Biceps
D. Deltoid
2. What is the primary symptom of brachioradialis spasm?
A. Shoulder pain
B. Neck stiffness
C. Knee pain
D. Lateral elbow pain and forearm tension
3. What is another symptom of brachioradialis spasm?
A. Shoulder pain
B. Gluteal pain
C. Elbow extension stiffness and/or pain
D. Neck stiffness
3. Why is brachioradialis often overlooked?
A. It is small
B. It lies deep and is not commonly targeted directly
C. It has no function
D. It is not connected to the elbow
5. What happens when this muscle is released?
A. Pain increases
B. Lateral elbow pain resolves rapidly and function improves
C. Muscle weakens
D. Skin tightens