Tennis Elbow: Common Causes, Prevention, and Treatment
Though tennis has many health benefits, sometimes the conditioning nature of it causes wear on select parts of our body—especially our elbows. There is a common tennis injury called tennis elbow where pain radiates from the elbow. There are 2 types of tennis elbow: traditional tennis elbow where pain is on the outside of the forearm/elbow area, and golfer’s elbow where pain is on the inside of the elbow.
Traditional tennis elbow is typically from making contact late and/or too close to the body. Contact points of that nature force the arm to bend at contact. With a bent arm all of the energy from the ball stops at the elbow creating a jarring shock. To stop this pain at the source it is important to work on forehand technique and there are several ways to do that: seeking a private tennis lesson with a certified tennis professional, working on it alone with a ball machine, or hitting against a wall. It is very important to have the speed and interval for the feeds to be slow. In this scenario it is important to make contact with the ball in front of your body and to swing confidently. A tentative swing will cause more pain. Please remember that changing your contact point also changes your timing of the swing; there will be a slight drop in consistency and control in the beginning, but it will pick back up as you get accustomed to the new contact point. The best and most inexpensive way to cure a contact point issue is to hit against the wall. It would be best to use a foam ball for softer contact on your racket and a softer bounce off the wall. Any solution you choose will take a great amount of focus and persistence.
Golfer’s elbow is usually an injury that occurs from overuse of the extensor carpi radialis brevis (ECRB) muscle in our forearm that helps to stabilize the wrist when the elbow is straight. Each time we use the ECRB muscle, the muscle rubs against small bumps on the bone. Usually, this is fine, but with vigorous and constant use, the muscle starts to weaken and form microscopic tears in the tendon, causing inflammation and pain—a bit like getting blisters from constant rubbing in new shoes. This is a more common injury for tour players and highly competitive tennis players that are on the court 15 or more hours a week. The best cure for this pain is ibuprofen (or similar medication), patience, and stretching.
It is important to note that this kind of injury isn’t exclusive to tennis and golf players. It also occurs for painters, plumbers, carpenters, autoworkers, cooks, butchers, and other professions and hobbies that often utilize the wrist; due to the gradual temperament of this injury, most people don’t realize they’ve been hurting their elbow until they’ve reached 30-50 years in age. You may not feel any pain in your elbow now, but if you don’t take care to ensure you’re using proper technique and equipment, you may be in for a trip to the doctor in your 30s.
For those of you who are concerned, the symptoms of tennis elbow are a burning pain sensation on the outer part of your elbow, and weak grip strength. If you have these symptoms, it would be wise to go to a doctor to get checked. If you go to the doctors, they are likely to do x-ray tests, MRI scans, and an Electromyography (EMG). If the tests and scans come out positive for tennis elbow, then they doctor should give you the option for surgical and nonsurgical treatment. The good news is that 80-90% of patients have success with nonsurgical treatment.
The nonsurgical treatment includes resting the arm from sports or heavy work activities for several weeks, and taking non-steroidal anti-inflammatory medicines that reduce pain and swelling. It may be good to have your equipment checked for proper fitting too. If you’ve gotten the injury from tennis, it may also be good to get a more flexible racket with softer strings, like Gamma Professional, Gamma Solace, Dunlop Silk, or Gamma TNT to reduce stress on your forearm; if you have an oversized racquet, changing to a smaller head may also help to prevent symptoms from reoccurring. In addition to these treatments, there are also physical therapy and brace options. There are also a few exercises you could do at home to relieve your tennis elbow symptoms:
- First straighten your dominant arm, pull your hand down so your palm is perpendicular to your forearm, and hold for 20 – 30 seconds.
- Keeping your arm straight, pull your hand up so your palm is perpendicular to your forearm and hold for 20 – 30 seconds.
- Keeping your arm straight pull your hand down again, this time bend your fingers so they are parallel to your forearm and hold for 20 – 30 seconds.
- After stretching, use a 2-pound weight (or something similar that is easy to hold) with one hand, and while sitting down, have your dominant arm bent at 90 degrees at the elbow.
- With the weight in your hand slowly raise your hand as far as it can go, ideally perpendicular to your forearm, and slowly release back to neutral. Do this for 10 reps.
- With the weight still in your hand, start your hand at a neutral position, and release your hand down as far as possible before moving back to neutral for 10 reps.
- Again, start at a neutral position, and turn your wrist to the right
- Finally, starts one last time at the neutral position, and turn your wrist left.
While you’re doing the exercises, keep in mind that the key is to slowly release your hand from each position— it’s the releasing that is rehabilitating the injury, so the slower, the better. After the exercises ice your arm for 20 minutes. Make sure to let your arm rest and warm up naturally for 20 minutes after taking the ice off your arm.
Another more simple, but useful exercise is using a foam roll before icing. While standing, put a foam roll up against the wall, parallel to the ground. Then lean against the foam roll, pinning your injured arm between your body and the foam roll. Once comfortable, slowly start moving your body up and down to roll out your forearm area. There’s an extra hidden benefit to this is doing particular exercise— you’re also doing lunges for leg strength!
If the symptoms aren’t relieved after 6-12 months despite your efforts, then your doctor may recommend surgery. Most of the procedures involve removing the diseased muscle, and reattaching healthy muscle back to the bone. Should you come to this point, please consult with your doctor about the best option for you.
If you would like more information on this topic, please feel free to look into these references:
Josh Basha. Interview. 2016