What is Tennis Elbow?
It has a few different names but the pain is the same—debilitating. Tennis elbow is a medical condition called lateral epicondylitis, or an inflammation of the tendons (bands of muscles) that connected to the bony area on the outside of the elbow. It is also referred to as repetitive strain injury (RSI).
You don’t have to be a tennis player to suffer from this injury, but approximately 50% of all tennis players experience tennis elbow at least once during their playing career. I have experienced tennis elbow; it is no picnic. Novak Djokovic is the latest casualty on the ATP tour to be debilitated by tennis elbow’s painful grip. Knowing how to prevent tennis elbow will save you from losing precious time on the court.
The Causes of Tennis Elbow
Tennis elbow is caused by overuse of the arm, forearm, and hand muscles that results in pain around the outside of the elbow. Another common term for this condition is golfer’s elbow, which is the same development occurring on the inside of the elbow (medial epicondylitis).
So why do non-tennis players suffer from this condition? The muscles on the outside of the elbow are overstretched by any repetitive action or stress that requires the use of the wrist and fingers, such as typing, painting, or hammering. If these muscles or tendons are weak or inflexible and incorrectly overused or stressed they break down and subsequently become swollen or inflamed. Less than 5% of all tennis elbow diagnoses are attributed directly to playing tennis.
This harmful overuse on the court can be attributed to:
- Improper technique – repetitive overstretching of the muscles on the outside of the elbow (an unnatural laying back of the wrist)
- Meeting the ball too late in your contact zone
- Using the wrong grips while executing your strokes
- Using the wrong size grip handle (too small or too large), causing you to squeeze the handle too tightly
- Using a racquet that is too light and/or too stiff
The Symptoms of Tennis Elbow
Tennis elbow pain doesn’t appear overnight. It develops gradually with pain and numbness in the bony knob (where the tendons connect to the bone) on the outside of your elbow. The pain associated with tennis elbow can radiate externally from your elbow into your forearm and wrist. The elbow becomes sore, weak and tender, making it difficult to:
- Lift even small objects
- Grip an object, such as your racquet
- Turn a doorknob, unscrew a jar top, or shake hands
- Straighten your elbow
Your doctor or therapist will need to perform a thorough examination to render a diagnosis of tennis elbow. He or she will ask you to flex your arm, wrist, and elbow to see where it hurts. Imaging tests such as an X-ray or MRI (magnetic resonance imaging) will be helpful to diagnose tennis elbow or detect other problems.
How to Treat Tennis Elbow
Tennis elbow doesn’t go away on its own. Initially, you will need to take some time away from tennis or whatever activity was found to cause the inflammation. My doctor fervently prescribed two weeks without hitting normal strokes—I could only feed balls to my students during lessons. My elbow healed in about a month, but it wasn’t without a lot of work. Armed with my doctor’s recommendations and some research on my own, I created a comprehensive regimen to combat my condition:
1. Ice, ice, baby… – if you want to reduce pain and give comfort to your swollen elbow, then put an ice bag on it. Do it every three to four hours for at least the first week, and particularly after any activity involving your arm.
2. Skip the elbow strap– go instead for a Cooper sleeve or KT (Kinesiology Tape), to protect your elbow from further injury, if you still have things to do.
3.Physical therapy– the range of motion exercises will help to strengthen and stretch your muscles. You can ask your medical provider for more ideas, but here are a few that I used, just to get you started:
` a. Finger stretch – Place a rubber band around your fingers and thumb, then slowly bring your fingers together with your thumb. Slowly open your fingers and thumb, then close them again. Perform 25 repetitions, three times daily. When this gets too easy, use two rubber bands or an extra thick rubber band.
b. Wrist stretching – Hold your affected arm straight out with your elbow as straight as possible, the palm of your hand facing up. Use your other hand to press the fingers of your extended hand back toward your body until you feel the stretch in your inner forearm. Hold for 10 to 15 seconds (work your way up to 30 seconds), repeat three to five times daily to start, then increase to five to 10 times. A variation to this exercise is to start with your palm facing down, then pull the fingers back toward you.
c. Wrist strengthening – take a 1 to 3-pound dumbbell, place your forearm on your thigh or the edge of a table so that your wrist hangs over the edge. You will perform these exercises with your palm facing up and facing down. Slowly raise your hand, then slowly lower it as your forearm remains in contact with your thigh or the table. Perform 10 repetitions, three times daily. Squeezing a dead tennis ball or balling up a piece of newspaper works well to strengthen the muscles as well.
4.Massage & Acupuncture – I found both massage and acupuncture vital to my quick recovery. Transverse friction massage for tendonitis has been the most widely used form of treatment. Frictions used by a therapist provides stimulation to move tissue fluids to induce connective tissue repair. Once some of the tenderness subsides, the massage therapist can apply more pressure (go deeper within the muscle tissue) to relieve the remaining tenderness. Transverse friction combined with therapeutic ultrasound also helped to speed repair of elbow condition.
Acupuncture is a technique that is included in the broader category of Traditional Chinese Medicine (TCM.). A typical Acupuncture treatment involves the insertion of very thin, filament needles into specific points in the body referred to as Meridians, which are located along 12 invisible pathways. Acupuncture works to “unblock” the flow of energy – also known as ‘Qi’ or ‘Chi’ in TCM – which is thought to flow along these Meridian pathways in the body. By restoring the normal flow of this energy, healing and reversal of the injury can occur.
5. Medications & Natural Supplements – your first defense against inflammation is a healthy diet, avoiding processed foods, particularly those with added sugar, high in sodium and fat content, and alcohol and processed grains. In addition to the anti-inflammatory diet, the following foods are highly recommended:
- Green leafy vegetables
- High-quality, clean proteins such as wild-caught salmon
- Fruits such as melons, pineapple, and berries
- High potassium and magnesium nutrients such as coconut water, avocados, sweet potatoes, or bananas
In addition to the ice for managing your inflamed elbow, essential oils have been proven effective in improving circulation (Cypress), repairing damaged nerve tissue (Helichrysum), reducing pain (Peppermint), and decreasing inflammation (Frankincense). Mix several drops of an oil with a carrier oil (like coconut oil) and apply the mixture to your elbow area topically 3 times a day.
Only if your pain is out of control would I recommend taking anti-inflammatory medications such as Advil or Tylenol, or taking an injection such as a Cortisone shot. If none of these approaches render any relief of your elbow condition in 6 to 12 months, your doctor may then recommend surgery. How will you know if your choice of treatment is working? Easy. You will be able to:
- Grip and lift objects pain-free
- You will feel the same strength in both your injured and non-injured elbow
- You will be able to straighten your elbow with ease.
In fact, you will be able to resume all previous activities that once caused you pain.
After sending tennis elbow on its way, there are preventative measures to ensure it doesn’t interfere with your game ever again:
- Warm up and stretch before sports and other activities where you repeat the same motions with your arm.
- Assess/change your racquet and strings—if your racquet is lighter than 10.0 ounces; has more weight in the head; is stiff (rigid) rather than flexible; is strung with more than 58 pounds of tension; is the wrong grip size; or your strings are too stiff; then you have all the contributing factors that lead to tennis elbow.
- Correct faulty stroke mechanics— get with your tennis pro and have your strokes evaluated. I discovered that maintaining a relaxed grip on the handle, particularly in between shots, and especially while executing your forehand and serve, allows the racquet to effortlessly move through your swing path.
- Holding the racquet handle with a death grip creates tension in the forearm and elbow areas, causing the racquet to decelerate during contact, leading to muscling the ball over the net. Bending your knees slightly during the service motion will reduce the load on the shoulders and elbows also.
- Develop a balanced training program for tennis to include stretching, strengthening, speed, core stability, agility, balance, and coordination.
One of the most frustrating aspects of dealing with tennis elbow is taking time off the court to heal. Platelet-rich plasma (PRP) is presently being studied for its success in speeding the healing of a mixture of tendon injuries. PRP is a powerful growth factor “cocktail” developed from a patient’s own blood. Normal blood contains 6% platelets, but there is a concentration of 94% platelets in PRP. It contains a high concentration of proteins called growth factors that are very important in the healing of injuries. This stimulates the cellular creation and tissue regeneration to significantly accelerate healing.
Recent studies on PRP and lateral epicondylitis are very encouraging. A handful of treatment centers throughout the country have begun to integrate PRP injections into their nonsurgical treatment regimen for lateral epicondylitis. Still, more time and research are needed to fully prove PRP’s effectiveness.
Tennis elbow is an excruciating pain and a debilitating condition; but, it is also treatable and preventable. Tennis elbow or lateral epicondylitis also affects more than just tennis players. Occupations such as plumbing, painting, gardening, and carpentry, can lead to tennis elbow due to repetitive movements with the same arm. Hence, education is the best line of defense to prevent elbow damage.
Most of us never think about educating ourselves about tennis elbow until we are suffering with it. Stretching before and after playing tennis or any repetitive movements, using the correct form and technique, and using the proper equipment can greatly decrease your chances of ever being affected by symptoms of tennis elbow. At the first twinge of pain, immediately apply ice and seek medical advice. Don’t put it off thinking it will get better on its own—it won’t. Treatment can take up to six months from the inception of symptoms.