Cure your Nagging Tennis Elbow Before Spring


If you have ever spent time on the tennis court, you have likely heard a friend complaining about tennis elbow. It is typically categorized by a dull aching pain on the side of the elbow that is exacerbated when forcefully gripping objects (like tennis rackets). The pain is usually low level (easy to ignore), which leads people to wait for long periods of time before seeking medical attention. But waiting can actually make the disorder harder to fix. So what causes “tennis elbow” and how can you eliminate it before hitting the outdoor courts next Spring?!?

Lateral Epicondylitis is the medical term for tennis elbow. It occurs when the force running through the wrist extensors is greater than the strength the muscle can produce and control itself. This can happen when forcefully hitting a tennis ball with a tennis racket. The high levels of force over time can cause the muscle to pull forcefully at its attachment to the bone (the lateral epidcondyle). This forceful tugging of the tendon can cause an inflammatory reaction to develop where the muscle inserts on the bone on the side of the elbow.

Lateral epi - 1

At the beginning of the disorder, this is truly just an inflammatory reaction. Ice, rest, anti-inflammatory medications, and simple stretching of the wrist extensors (without reproducing pain) will likely do the trick to get rid of the inflammation.

Lateral epi - 2

However, treating the inflammation is treating only half of the problem. This is where many people go wrong when trying to treat their tennis elbow. Remember that lateral epicondylitis is caused when the force on the wrist extensors exceeds the strength of the muscles. If the wrist extensors can’t handle the force of gripping the tennis racket while hitting a ball at speed, the epicondylitis will just come back!

Preventing re-injury

So how do you make sure that it doesn’t come back? Focus on strengthening of your wrist extensors. Research shows eccentric strengthening of the wrist extensors is best to improve strength and control and decrease the risk of lateral epicondylitis reoccurring. What is eccentric strengthening you might ask? It is a way of strengthening a muscle while the muscle lengthens throughout a movement. A good example of an eccentric exercise for the wrist extensors is pictured below:

Lateral epi - 3

In order to complete this exercise correctly, one would use the unaffected hand to lift up the wrist. Fully extended the wrist at the top of the range, then slowly control the weight all the way down. One could start with a small weight, and then slowly work up to bigger weights. Eventually, it would be good to work up to being to control the weight of a tennis racket moving quickly. The most important thing to remember is that the exercise should not increase pain. You can always ask a personal trainer to help you out if you have questions on eccentric exercises.

This all applies if your elbow pain hasn’t persisted for long (>6 months). If the pain has become a chronic issue, the literature indicates that it is not an inflammatory problem at all. Researchers have found that if lateral epicondylitis is left for too long, the integrity of the tendon itself is changed. If your pain has lasted for > 6 months, see your MD or a physical therapist to start working on the tendon.  Hopefully these simple tips will help you control your elbow pain and get you onto the courts pain-free in the Spring!

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Diana grew up in a small suburb north of Boston. She received her clinical doctorate degree in Physical Therapy at Boston University in 2006. Diana started practicing as a physical therapist at Massachusetts General Hospital. While at MGH, she developed a specialty in the evaluation and treatment of complex lumbopelvic dysfunction. Diana is currently practicing at Spaulding Rehabilitation Hospital in Boston where she is the Orthopedic Clinical Supervisor of the Spine program. She is presently a Boston resident and her interests outside physical therapy include cooking, walking on the Esplanade, and international travel.

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