Tennis Elbow

With your left arm bent slightly, find the pointy end of the elbow with your right hand. Then move your right index finger about an inch towards the outer side of your arm bone. This pointy outer part is called the “lateral epicondyle” and is a place where many muscles that cross through your forearm, wrist, and hand attach to. When you have pain here, you might be experiencing tennis elbow, also known as lateral epicondylitis or lateral elbow tendinosis.  ​

What is Tennis Elbow?

Tennis elbow happens when you repeatedly extend your wrist for activities like tennis strokes, working on the computer, and household chores like wringing towels. Since the muscles used to extend your wrist and fingers attach to the outside bony part of your elbow, overusing these muscles can cause strain here.

Ironically, only 10% of the overall number of people with tennis elbow are tennis players. However, the name came about because about 75% of people who play tennis, experience this condition. The backhand stroke can especially cause pain because of the tendency to extend the wrist more than necessary. Recreational tennis players are more at risk than professional players because of lack of training and racquets that are not suited for their grip size.                  

Tennis elbow is typically diagnosed with a few clinical tests by a professional. Painful points include:

• Pressing on the outer bony part of your elbow
• Extending your wrist with or without resistance
• Keeping your elbow straight with your palm facing down and using your other hand to flex your wrist
• Resisting movement at your middle finger by pressing down at your nail

All of these motions or pressures irritate the already strained wrist extensor muscles and would likely cause pain.

What can I do about it?

Posture
The first thing I look at with someone who has tennis elbow is their posture! When we are stacked up in a better way, with our shoulder set up in the right place, it’s much easier to use the muscles around the elbow effectively. Note that the shoulder muscles are much larger and more robust and can handle difficult motions better than the smaller muscles further down your arm.

Ergonomics
A lot of times a simple check of the workspace can eliminate much of my patients’ pain. Typing at a desk for 8+ hours requires our wrists to be slightly extended for long periods of time. Getting a full check up of your upper body alignment at your desk is highly recommended!

Manual Therapy
Imagine neatly combed straight hair. This is what healthy muscle fibers tend to look like. Now imagine a bowl of spaghetti. This cross hatched and haphazard pattern is what muscles that have gone severe chronic strain look like. Specific manual therapy techniques employed by a PT can help reorient muscle fibers. Mobilizing the joint can also alleviate pain.

Flexibility and Strength Training
Depending on the acute or chronic nature of your condition, your PT can prescribe you a personalized exercise program to restore proper flexibility and strength around your elbow joint. However, it is important to make sure these exercises are done in a pain free range of motion! Meaning do not go for the “no pain no gain” policy here, because this can cause more abnormal strain! One exercise I highly recommend is working on your grip strength (gently!). Using a stress ball or a squishy toy that fits in the palm of your hand, try to squeeze and release, with control, 2 sets of 15 reps. This not only helps keep your muscles strong, but helps pump blood around the forearm for some fresh circulation.

Proper Tennis Training
Learn specific ways of performing strokes and racquet choices from a professional to prevent injury. For example, a double handed backhand stroke alleviates the pressure off of the dominant hand. Instead of snapping your wrist forcefully to move the ball, it’s important to leverage your hips, torso, and shoulders.

Last Thoughts.

If you are a weekend warrior and still want to keep playing tennis, I’d recommend taking classes first with someone who really knows the craft. Learn the technique properly to avoid injury. Tennis is a great way to strengthen the body overall, so don’t let a bad elbow stop you altogether!

References:

1. De Smedt T, de Jong A, Van Leemput W, Lieven D, Van Glabbeek F. Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment. Br J Sports Med. 2007; 41(11):816–819.
2. Dines JS, Bedi A, Williams P, Dodson CC, Ellenbecker TD, Altcheck DW, Windler G, Dines DM. Tennis Injuries: Epidemiology, Pathophysiology, and Treatment. J Am Acad Orthop Surg. 2015; 23(3):181-189.

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