Best Strings and Tension for Tennis Elbow — What a 2016 Study Actually Found

You finish a weekend match and your elbow aches. A few days of rest helps, then you pick up a racket and the pain is back — tennis elbow is far from rare among recreational players. According to clinical data, approximately 10–50% of tennis players experience it at some point. (StatPearls, NCBI)

This article is not a substitute for medical advice. In a problem where swing mechanics, play frequency, equipment, and age all intertwine, we focus exclusively on the equipment piece — the one you can change today. A 2016 biomechanics study from the UK showed that, without changing your swing, simply adjusting string tension measurably reduced the peak elbow impact during a backhand. Here's what to change, why, and by how much.

There's No Single Culprit — Four Axes of Tennis Elbow

Tennis elbow (lateral epicondylitis) cannot be attributed to a single cause. Major clinical reviews consistently point to the complex interaction of four axes.

*Four-axis framework based on general clinical perspective. Individual contributions vary.

This article covers the equipment axis only. Swing mechanics and physical management are the domain of coaches and sports medicine physicians — but equipment can be changed with a single restring.

When Swing Is the Culprit — The Science of Wrist Angle

Before we talk equipment, let's address the swing axis. Skip this and no matter how many string changes you make, the pain will keep coming back.

In 1994, Blackwell and Cole compared wrist angles at impact between novice and expert tennis players in a biomechanics study of tennis elbow. (Via Bisset & Vicenzino 2008 review, PMC2465303)

• Experts: Wrist approximately 23° extended at impact
• Novices: Wrist approximately 13° flexed at impact

In simple terms: When you hit with your wrist slightly extended (dorsiflexed), your extensor muscles are at an optimal length to absorb the impact. When you hit with your wrist flexed forward, that same force concentrates at the tendon attachment on your elbow. The injury-relevant difference between skill levels comes down to load distribution — how wrist position determines the stress on the extensor tendons. It's also well established that two-handed backhand players have a lower incidence of tennis elbow.

If any of the following applies, a session with a coach may be a faster fix than a restring:

• You hit a one-handed backhand with contact occurring beside or behind your body
• Pain is notably worse after slice backhands
• Pain occurs after serves (a serve mechanics issue, unrelated to strings)

Why This Article Talks About Equipment

Fixing your swing takes time — typically months of working with a coach to retrain your wrist angle. If your arm hurts throughout that process, you'll eventually put the racket down. A restring takes an hour, and there's a study with measured results backing it up. Four reasons this article focuses on equipment:

1. Time: Months of swing correction vs. one hour to restring
2. Cost: Multiple lessons vs. one restring
3. Evidence: Equipment's independent contribution has been measured (Mohandhas study below)
4. Parallel action: Lessons and restringing can happen simultaneously

This isn't about skipping swing work. It's about hurting less while you do it.

How Tension Affects Elbow Impact — The Exact Findings of the 2016 Study

This is the core evidence behind this article. In 2016, a team at the University of Dundee (Mohandhas et al.) published results in the journal Shoulder & Elbow. (PMC4950282)

Twenty recreational tennis players performed a controlled laboratory one-handed backhand (under controlled conditions, not in a match scenario) at three tension levels, while researchers measured peak elbow acceleration.

*Reconstructed from Mohandhas et al. (2016), Shoulder & Elbow data.

Three things to read precisely from these numbers:

1. Lower tension does reduce elbow impact — that part is true. At 45 lbs, a statistically significant reduction in peak acceleration was measured compared to 50 and 55 lbs.
2. However, a narrow range like 50 vs. 55 lbs showed no significant difference. The popular advice to "just drop 2–3 lbs" is not justified by this study. To enter the range where evidence supports a meaningful effect, you need to drop at least 5 lbs, or down to the lower end of your racket's recommended range.
3. This experiment was conducted under controlled laboratory conditions — not actual match play. Whether the same ratio applies to dynamic swings, forehands, or serves requires further research. Even the authors phrase their conclusion carefully: "may be hypothesized to have beneficial effects in risk of development of LE."

In simple terms: You need to drop enough that it actually feels noticeably looser — not a token adjustment of a pound or two. That's where the evidence lives.

Material — Same Tension, Very Different Impact on Your Arm

Material matters as much as tension. At the same 55 lbs, polyester and natural gut speak entirely different languages.

*Relative comparison based on manufacturer specs and USRSA guidelines. Variation exists between brands and products within each category.

In simple terms: If natural gut is a trampoline, polyester is closer to concrete. The quality of shock returning to your arm is categorically different at the same tension.

This is why the modern recreational trend of "going full poly like the pros" warrants caution. Without a pro's swing speed, training volume, and physical conditioning, the stiffness of full polyester accumulates in your arm. And because polyester loses shock absorption before it breaks, missing a restring interval compounds the burden. For a detailed comparison of string materials, see The Complete Guide to Tennis String Types.

Three Common Myths — Before You Spend Money

❌ "A dampener protects your arm"

✅ A 2007 study by Dr. Francois-Xavier Li's team at the University of Birmingham found that string dampeners do not reduce the transmission of frame vibration to the forearm. Dampeners only attenuate high-frequency audible vibrations (the sound of impact) — they have no effect on the low-frequency frame vibrations that actually reach the arm. Use them for acoustics or peace of mind, but there is no scientific basis for dampeners as a tennis elbow prevention tool. (University of Birmingham)

❌ "Thicker gauge absorbs more shock"

✅ Gauge (string thickness) significantly affects durability and spin, but the primary variables for vibration absorption are material and tension. A 1.30mm polyester is not necessarily easier on your arm than a 1.25mm multifilament.

❌ "Higher tension reduces wobble at impact"

✅ The Mohandhas study points to exactly the opposite. Higher tension correlated with higher peak elbow acceleration at impact.

Four Steps You Can Take Today

Here's how to apply the above in practice.

1. Replace dead strings first. Polyester loses its elasticity and shock absorption after roughly 10–20 hours of play (varying by product and swing style) — long before it breaks. See how to tell when it's time to restring. This is the lowest-cost first step.
2. Drop tension by a meaningful amount. If you normally string at 52 lbs, go to 47. If 55, go to 50 or below. Not 2–3 lbs — 5 lbs or more, or down to the lower end of your racket's recommended range. See the tension guide for reference.
3. Transition materials gradually. Full poly → hybrid (cross strings to multifilament) → full multifilament or gut if needed. Change one variable at a time and track the results.
4. Racket and grip come next. A very stiff frame (RA 70+) or an undersized grip can also stress your arm. If steps 1–3 don't resolve the pain, investigate these next.

And keep in mind the signs that equipment isn't the answer:

• Pain persists for more than two weeks → consult a sports medicine physician
• Pain only after one-handed backhands → coach (swing issue)
• Pain only after serves → serve mechanics, unrelated to equipment
• Aching at night or pain when not holding a racket → inflammation stage, see a doctor first

Why Tracking Matters — Because There Are Four Variables

As we've seen, tennis elbow is a problem where swing, frequency, equipment, and age all move simultaneously. Without records of which settings felt good and which caused pain, you can't isolate the cause from data.

"When was the last time you restrung?" — the most common question at sports medicine clinics. Most players can't answer.

Track your string, tension, material, and restring date alongside a post-session Comfort score, and the timeline of when your arm improved aligns with your equipment history. You can finally see which combination actually works for your body.

String GOAT was built for exactly this. Record your string setup, restring date, and six-axis post-session feedback (Power · Control · Spin · Comfort · Feel · Durability) in 30 seconds, and the AI analyzes your patterns to suggest settings that are easier on your arm.

Start free on iOS or Android. For more on why tracking matters, read Why Tracking Your Strings Changes How You Play.

The pain isn't a reflection of your skill. Your equipment just hasn't been dialed in for your body yet.