Sports Injuries: prevention and treatment of tennis elbow

Tennis Elbow (Lateral Epicondylitis) prevention and treatment

Follow these rules if you want to avoid – and treat – the dreaded tennis elbow.

If you play tennis, squash or racketball, chances are good that you will develop a problem called ‘tennis elbow’. This inflammatory condition, often accompanied by stiffness, soreness, and outright pain, affects up to 45% of regular racket sport participants.

Basically, tennis elbow is an overuse injury caused by repeated contractions of muscles connected to the elbow joint of the arm used to hit the ball. Stress on the elbow is inevitable, because some of the force created when the ball hits the racket automatically passes from the racket into the forearm and then to the elbow. This repeated impact produces trauma to the tissues surrounding the elbow, leading to inflammation and soreness. Unfortunately, continued play usually worsens the condition, heightens pain, and makes the elbow ‘stiff’, the result of a thickening of the synovium, the lubricating membrane, which surrounds the elbow joint. Routine activities such as turning a door knob, holding an umbrella, or shaking hands can become insufferable nightmares.

Elbow problems can be classified as either ‘backhand tennis elbow’ or ‘forehand tennis elbow’. Backhand elbow is usually caused by lack of strength in the extensor muscles of the forearm (the muscles which attach on the outer side of the elbow) and/or by poor technique. For example, if a player hits backhand shots by leading with the elbow, the head of the racket lags behind the elbow during the initial part of the stroke. Just before impact with the ball, the racket must accelerate dramatically, travelling much faster than the elbow. When the racket actually hits the ball, the impact forces the racket to slow down immediately, and the heavy force of impact is transmitted directly to the elbow. One remedy for this is to hit the backstroke with the entire arm – instead of ‘snapping’ the forearm ahead at the elbow joint. Forehand tennis elbow is less common among novice players, primarily because the average tennis participant’s inside-elbow muscles are stronger than the outside-elbow ones. However, professional players are at high risk for the malady, because their attempts to put spin on the ball (for topspin forehands and spin serves) lead to excessive action at the wrist, which in turn strains the elbow on the inside. Unfortunately, experience doesn’t lead to a lessened risk. In fact, studies show that the frequency of tennis elbow increases with age and the number of years of play. Sadly, tennis elbow takes longer to correct in older players, too. To limit your risk of tennis elbow, the following steps should be very helpful:

  1. Work with a knowledgeable coach to improve your technique.
  2. Make sure that the grip on your racket is the right size for you (a grip that is too large or too small increases wrist-muscle fatigue, making the wrist unstable and leads to too-large forces at the elbow).
  3. Play on clay or grass courts (cement and other hard courts raise ball velocity, producing greater impacts and higher elbow forces).
  4. Use less-stiff rackets (the stiffer the racket, the larger the force transmitted to the arm).
  5. String your racket less tightly (the tighter the strings, the higher the force).
  6. Strength train your wrist muscles, as well as the muscles on the inside and outside of the elbow. For the wrists, good exercises include squeezing a tennis ball and doing wrist curls and extensions with a dumbbell.
  7. Carry out stretching exercises for the wrist muscles and muscles on the outside and inside of the elbow after you play, or after a warm-up which includes light hitting of the ball.
  8. Avoid playing more than four times a week, and if soreness appears after a game, don’t play again until the pain disappears.

What if, despite these useful preventive steps, tennis elbow serves up a painful challenge to your game? The following measures should help you:

  1. Ice down your sore elbow, keeping the ice on for 10- to 12-minute intervals, with 20-minute rests between applications.
  2. Use oral anti-inflammatory medications as directed by your doctor.
  3. Apply anti-inflammatory creams to the elbow joint.
  4. As directed by your doctor, use Transcutaneous Electrical Nerve Stimulation (TENS) treatments, which have been shown to reduce pain and inflammation in scientific studies.
  5. Once the pain subsides, try using a ‘counter brace band’ when you play. This band, which fastens around your forearm no closer than one inch below the elbow joint, slightly changes the angle of pull on elbow tendons, helps distribute impact forces at the elbow, and is believed to absorb some of the shock.

The final word? Tennis elbow doesn’t have to ‘ace you out’ of your favourite sport. By building elbow and wrist strength and making some slight changes in your game, you should be able to eliminate tennis elbow in straight sets.

(‘Treatment and Prevention of Tennis Elbow,’ Sports Science Exchange, vol. 1 (8), 1988)

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