Archer’s Elbow: How to Treat and Prevent Lateral Epicondylitis

What Is Lateral Epicondylitis and Why Do Archers Get It?

Lateral epicondylitis — commonly called tennis elbow, but just as accurately called archer’s elbow — is an overuse injury that affects the tendons attaching the forearm extensor muscles to the lateral epicondyle, the bony prominence on the outside of the elbow. When these tendons are repeatedly stressed beyond their capacity to recover, they develop micro-tears, inflammation, and eventually a degenerative condition that can sideline you for weeks or months if left unmanaged.

Archery loads the forearm extensors differently than most sports. Every draw pulls the forearm into slight flexion against muscular resistance, and every release sends a shock wave of energy through the grip hand and into the forearm. Multiply this by hundreds of arrows per week across multiple seasons and you have the recipe for a lateral epicondyle that eventually says enough.

Archery-Specific Causes: Grip Faults, Overdrawing, and Poundage Jumps

Not all archers develop lateral epicondylitis. Those who do usually have one or more identifiable risk factors.

Grip faults. A tight, clenched grip on the bow handle — what coaches call the “death grip” — keeps the forearm extensors in continuous high-tension engagement through the entire shot. A relaxed, open bow hand with pressure applied only through the thenar pad (the meaty base of the thumb) dramatically reduces extensor loading. If your bow falls to the ground after every shot because you let the grip go entirely, that is not bad technique — that is correct archery form. A wrist sling or bow sling lets the bow fall forward safely without requiring a death grip to catch it.

Overdrawing. Drawing to an anchor point that is longer than your natural draw length forces the musculature to work at a mechanical disadvantage. The tendons absorb more load per shot, and cumulative damage accumulates faster. This is especially common when archers switch to recurve from compound with different draw lengths, or when they start shooting at longer distances and unconsciously pull back further than their setup allows.

Poundage jumps. The single most common cause of overuse injuries in archery is moving to heavier draw weight faster than the tendons can adapt. Tendons adapt more slowly than muscles — you may feel strong enough to handle a 10-pound increase, but the tendons need weeks more to catch up. The general guideline is to add no more than 2 to 5 pounds per month, and only when your current weight feels effortless through a full session. Read our compound bow draw weight guide for more on matching draw weight to your current capability.

Recognizing the Symptoms

Lateral epicondylitis has a recognizable pattern of symptoms. The primary complaint is pain on the outside of the elbow, often described as aching during activity and sharp when pressure is applied directly to the epicondyle. The pain is typically worse during and after shooting sessions, and may persist as a dull ache for hours afterward. Gripping anything — including the bow, a coffee cup, or a doorknob — can provoke the pain, as can wrist extension against resistance.

In early stages, the pain appears only during or after archery. In moderate stages, it is present whenever you grip anything. In severe cases, the pain may wake you at night. Do not wait until the severe stage to address it — the condition is significantly harder to resolve once the tendons have entered a chronic degenerative state.

Immediate Management: RICE Protocol and Load Reduction

If you have acute lateral epicondylitis pain after a session, the RICE protocol is your first response: Rest, Ice, Compression, Elevation. Ice the lateral elbow for 15 to 20 minutes after shooting. Avoid activities that provoke pain — including prolonged gripping — for 48 to 72 hours after an aggravating session. An elbow compression sleeve can provide support and proprioceptive feedback during activity.

Ibuprofen or naproxen in the first 48 hours can help manage inflammation. However, NSAIDs mask pain rather than treat the underlying tendon pathology — do not use them to push through sessions you would otherwise rest from.

If symptoms persist beyond two to three weeks of self-management, see a sports medicine physician or physiotherapist. Corticosteroid injections can provide short-term relief, though research suggests they may slow long-term recovery if used repeatedly. Platelet-rich plasma (PRP) therapy has shown promise for chronic cases resistant to other treatments.

Eccentric Exercises for Tendon Rehab

The most evidence-backed rehabilitation exercise for lateral epicondylitis is the eccentric wrist extension. Sit in a chair with your forearm resting on your thigh, palm facing down and wrist hanging off your knee. Use your other hand to lift the wrist into extension, then release the helping hand and slowly lower the wrist under its own weight over three to five seconds. That slow lowering is the eccentric phase — the controlled lengthening of the extensor tendons under load — and it is what drives tendon remodeling and healing.

Start with no weight and progress to a very light dumbbell (0.5 to 1 kg) as pain allows. Three sets of 15 repetitions, twice daily, is a standard starting protocol. You should expect mild discomfort during the exercise — a level of three or four on a ten-point pain scale is acceptable. Sharp or severe pain is not. Give the tendons at least six to twelve weeks of consistent eccentric loading before concluding whether the exercise is working.

When to Rest vs. When to Push Through

The push-through-the-pain ethos that works for muscular fatigue is dangerous for tendon injuries. The key distinction: muscle soreness (DOMS) is safe to work through; tendon pain that worsens during activity or fails to settle within 24 hours of a session is a signal to reduce load, not increase it.

A useful rule of thumb for returning to archery during rehab: if your pain during shooting is below a four on a ten-point scale, and it returns to baseline within 24 hours after the session, you are managing the load appropriately. If pain exceeds a four during shooting, reduce arrow count. If it takes more than 24 hours to settle, you shot too many arrows or at too much poundage and need to step back.

Long-Term Prevention Through Poundage Progression

The most powerful long-term prevention strategy is conservative poundage progression combined with regular eccentric exercise as maintenance. Do not be in a rush to shoot heavy limbs. Elite recurve archers may spend a full year or more building from beginner poundage before settling into competition draw weights. Strength comes from cumulative loading over time, not from leaping to the heaviest bow you can barely draw.

Periodize your training volume as well as your poundage. If you shoot five days a week during peak season, schedule at least one or two full rest days and build in easier low-volume weeks every four to six weeks. Tendons need recovery time just as muscles do.

For accessory gear that supports grip comfort and forearm load management, browse our archery accessories — including shooting gloves and finger tabs that distribute string pressure more evenly and reduce the grip tension that aggravates lateral epicondyle tendons.