Treating elbow tendonitis or as it’s more fearfully recognised - Tennis elbow

For many amateur racket-sport athletes, elbow tendonitis or ‘tennis-elbow’ is an all too frequent injury – often resulting in stiffness, soreness, and outright pain.

Basically, elbow tendonitis 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.

Elbow tendonitis 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, hence why amateur players are the worse sufferers of the condition.

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

The frequency of elbow tendonitis increases with age and the number of years of play. Sadly for veterans, it takes longer to correct in older players too also.

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 leading 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.

Further useful ideas

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

Elbow tendonitis doesn't have to 'ace you out' of your favourite racket 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.