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Core Knowledge

Injury/Pain

How to Avoid and Treat Tennis Elbow

Overview

Tennis elbow (lateral epicondylitis) is the inflamed tendon attached to the bony, outside part of the elbow. The tendon’s tissues may be not only inflamed, but partially torn. It is a condition that affects hundreds of thousands of tennis players, as well as people who have never played a set of tennis, but who manage to sustain the same injury because of movements they perform at work or in other sports.

Swiv on flickr

Another form of tennis elbow is called golfer’s elbow (medial epicondylitis). It is the same problem, has the same symptoms, and is treated the same way, but the inflammation and pain are on the inside part of the elbow instead of the outside.

How It Happens

Repetitive stress is the most common explanation for tennis elbow, but the exact cause is not clear and may vary from person to person. The most likely cause is overuse combined with other factors, such as age (over 35), frequency of play (three or more times a week), lack of flexibility or strength, poor technique on ground strokes, off-center hits and holding the racquet too tightly. The impact between the racquet and the ball causes vibrations that are transferred to the arm and elbow. Add repeated contraction of forearm muscles with every hit and the end result is an inflammation—and in some cases, degeneration—of tissue on the outside part of the elbow. 

“Long-standing tendinitis will eventually turn into tendonosis,” says Sue Falsone, director of performance physical therapy at Athletes' Performance. “In this stage, there are no inflammatory cells present at the site of pain anymore, which is why anti-inflammatory medication does not work. Tendonosis is a breakdown of the tendon tissue at the area, and it can take longer to heal. Surgery is sometimes necessary in these cases.”

Mark Verstegen on Tennis Elbow

“The majority of tennis elbow results from chronic overloading and under-recovery due to poor biomechanics caused by grip style and size, and related movement pattern dysfunction” says Mark Verstegen, president and founder of Athletes’ Performance. “Sixty-five percent of tennis injuries like tennis elbow are classified as overuse/overload injuries and are traditionally overcome with the proper training, preparation, progression and movement pattern correction like those found in the Core Performance program.”

By the Numbers

3+
Number of times per week a person who gets tennis elbow typically plays tennis

35+
Age group most often affected by tennis elbow

50
Percentage of recreational tennis players who get tennis elbow

Who’s at Risk for Tennis Elbow?

Tennis players get most of the attention regarding tennis elbow, but it affects other racquet sport athletes and throwing/hitting athletes, such as quarterbacks in football and golfers. Tennis elbow is not confined to athletes. Anyone who regularly lifts, reaches, pushes, or pulls can sustain the injury.

Symptoms

Tennis elbow is marked by a gradual onset of the following symptoms:

  • Sharp pain on the outside of the elbow
  • Pain that radiates down the forearm (but not in all cases)
  • Pain when you extend your wrist (bend it upward), shake hands or lift objects (including a comb or toothbrush in severe cases)
  • Pain to the touch
  • Loss of grip strength

Initial Treatment

If you believe you suffer from tennis elbow:

  • Rest from tennis for at least one week.
  • Apply ice applications 15-20 minutes, 3-4 times a day.
  • Take aspirin, acetaminophen, ibuprofen or naproxen for pain and inflammation.
  • Use an elbow brace or wrap to redirect pressure away from the inflamed elbow.
  • See a doctor if pain persists

Comeback Strategy

Prehab

Perform these prehab exercises to improve flexibility and enhance arm strength:

1. Wrist Flexion Stretch

  • Hold your injured arm out straight, palm down.
  • Use your other hand to hold the back of your injured arm's hand.
  • Press down so your fingers point to the ground.
  • You should feel a light stretch on the top of your forearm. Do not stretch to the point of pain.

2. Wrist Extension Stretch

  • Hold you injured arm out straight, palm up.
  • Use your other hand to hold the palm of your hand and press down.
  • You should feel a light stretch on the top of your forearm. Do not stretch to the point of pain.

3. Massage Stick

  • Use the massage stick to gently work the muscles on the top of your forearm.
  • Concentrate on working any tender areas.

Don’t try to come back from the injury too soon. Many players aggravate the injury because they can’t stay off the courts.

Cross-train by playing sports or exercising in ways that don’t place undue stress on the elbow (jogging, running, cycling, walking, stretching, lower body resistance training).

How to Avoid Tennis Elbow

  • Work with a certified tennis professional to learn the correct hitting technique, which will place less stress on the elbow.
  • Consider using a two-handed backhand if you are having pain with a one-handed grip.
  • Play with a racquet that has a flexible shaft and strings strung with a lower tension (55 pounds or less).
  • Don’t hold the racquet too tightly while hitting and relax your grip between points.
  • Use a racquet grip that is soft enough to provide a cushioning effect.

Movement Prep

Perform these exercises before you practice or play:

1. Squeeze and Release

  • Grip a tennis ball in the hand of your injured arm.
  • Squeeze and release the tennis ball for 2-3 minutes, 3-4 times a day.

2. Wrist Flexion Stretch

  • Hold your injured arm out straight, palm down.
  • Use your other hand to hold the back of your injured arm's hand.
  • Press down so your fingers point to the ground.
  • You should feel a light stretch on the top of your forearm. Do not stretch to the point of pain.

3. Wrist Rolls

  • Make a fist with your elbow bent at your side
  • Make circles with your wrist, 5 in each direction.
  • Straighten your elbow and do 5 more circles in this position.

 Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.


Tags: Soreness, Injury, Tennis, Rehabilitation, Elbow Pain, Hand, Pain, Elbow

References

  1. Sue Falsone PT, MS, SCS, ATC, CSCS, Director of Performance Physical Therapy at Athletes' Performance
  2. National Institute of Health (MedlinePlus.com)
  3. Sports Injuries: Prevention, Treatment and the Healing Process (Cleveland Clinic)
  4. Tennis: Steps to Success

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