Tennis elbow is a common disorder of the tendons attached to the outside of the elbow. The condition begins with micro tears followed by scar tissue developing under the tendons. Inflammation may also be one of the causes of pain. Pain is caused by repeated stress or overuse, either in racquet sports or simple daily activities.
- Usually occurring between age 30 and 50, tennis elbow is not exclusive to racquet sports. Other known contributory factors can include use of hand tools and vibrating equipment. Weak muscles and/or muscle imbalances
- Overuse- playing excessively, repeated twisting of the wrist or violent extensions
- Improper equipment- incorrect grip size, strings too tight, imbalance of string tension
- Poor playing technique- too much wrist action, jerky strokes, poor ball contact
The main symptom is pain in the outer region of the elbow. The affected area may be tender to the touch or become significantly painful during gripping, twisting, or lifting motions. Pain can range from mild to severe, and can radiate up to the forearm. There is usually no outward sign of redness or swelling.
Tennis elbow is diagnosed with a physical exam and x-rays that will occasionally show a bone spur or soft tissue cyst. We may use imaging tests to diagnose a potential bone problem.
Typically, we begin treatment with conservative techniques, such as application of ice compresses, use of a tennis elbow strap or neoprene sleeve, and non-steroidal anti-inflammatories. Occasional steroid injections can relieve pain as the tendon heals. Since most tennis elbow occurs in the 5th and 6th decades of life, the natural healing process can be slow, taking 6-9 months before the pain really resolves completely. Surgical treatment is rarely indicated. The procedure involves releasing the tendon, removing the scarred tissue, and a slow rehabilitation process as the tendon reattaches itself gradually.
Rest: You may have to stop playing golf, tennis, or other racquet sports temporarily, but this period of rest is important. Do not aggravate the condition by continuing activity, especially if you experience pain. Your doctor may recommend you not use your arm for anything- opening doors, handshaking, lifting, etc. Only rarely will a sling relieve the discomfort.
Ice. Use an ice bag (a bag of frozen peas works well, too) on your elbow three times a day for 30-60 minutes in the early painful stage and for 15 minutes after active use of your arm. Protect your skin by placing a towel between your elbow and the ice pack.
Stretching: Stretching helps prevent stiffness by breaking down scar tissue that may have resulted from inflammation (see Exercises).
Physical Therapy: Physical therapists will work to reduce the inflammation in your arm. They, or your doctor, can teach you the technique of ice massage. Later, they will teach you how to strengthen your muscles to protect the inflamed area and prevent injury from happening again.
Medication: Your doctor may prescribe analgesic or non-steroidal anti-inflammatory medication. If necessary, a steroid injection to the elbow may be used to relieve the local pain and joint tenderness. This can make physical therapy more effective. After a steroid shot, you should not participate in sports for 1-2 weeks. Check with your doctor for the exact timing to return to your activities.
Brace. Your doctor may recommend one of several braces, splints, or supports designed for this problem. A brace supports local structures, thus reducing the pressure on the inflamed tendon. At first the brace should be worn all the time except when doing gentle exercises to avoid elbow stiffness. Later, it will be needed only for protection during activities using the injured arm.
Surgery: In rare cases, surgery may be required.
Returning To Sports
- The Warm Up- Always warm up carefully before you play! Put all your major joints through their complete range of motion several times. Very slowly “shadow” all of the motions you use in your sport. In tennis, do ground strokes against a wall and gentle serving. Rallying does not substitute for warming up. Stretching and strengthening exercises help prevent injury.
- The Racquet- Use a lighter weight racquet and move your hand up a bit on the grip. Reduce your string tension. Change to a racquet that has greater spring. Grip size can also be an important factor. The new oversize and composite racquets are much easier on your arm than standard racquets. If possible, discuss equipment options with your local pro.
- The Stroke- In tennis, the backhand, the service, or the overhead smash may be equally damaging to your elbow if they are not done well. The two-handed backhand tends to be easier on your elbow. Avoid the shots that aggravate the problem. Keep wrist motion to a minimum. Lessons may be necessary to alter your strokes.
- The Game- When you go back to your sport, take it easy! In tennis, rally at first only for short periods of time, avoiding problem shots. Play less time each day or play doubles. Avoid playing competitive games until your elbow is completely healed. In golf, start with putting and pitch shots. Slowly work up from a few holes to a complete game.
Exercises: Weak muscles are a major contributor to the problem of tennis and golfer’s elbow. Exercises will strengthen the muscles associate with the damaged tendons. However, stretches and exercises should be avoided in every painful stage
Elbow Stretch Repeat_5_ Times_3_ times/day
Hold your racquet arm at shoulder level in front of your body with the elbow straight. With your hand clenched, flex the wrist as far as possible. Return the wrist to neutral position, and alternately turn the arm inward with a flexed wrist, then outward with an extended wrist.