Between 10 and 50 per cent of players suffer from tennis elbow. Here's what science says about tennis elbow treatments and preventing tennis elbow.
Before seeking to eradicate the symptoms, you first need to be aware of the tissues you have injured. The elbow is a hinge joint, allowing both flexion and extension. Functional stability in your elbow is gained through its bony anatomy and its ligaments (Noteboom et al, 1994). We are purely concerned with the lateral (outside) aspect of the elbow. Tennis elbow involves injury to the extensor muscles of your forearm and its tendinous origin.
There is more than one joint involved in movements at your elbow. The joint utilises three articulations (how the three bones of the arm move against each other) to allow movement at the elbow joint. The three bones in question are the humerus (upper arm) and the radius and ulna (bones of the forearm). The radio-ulnar joint is most crucial in this injury as it plays a role in pronation (turning the palm of your hand towards the floor) and supination (turning the palm of your hand away from the floor. The humerus's two condyles (found at the far end of the humerus) give articulating surfaces at your elbow joint (Noteboom et al, 1994). Above the condyles are the medial and lateral epicondyles. It is the lateral epicondyle where you will find the origin for the extensor-supinator group (forearm muscles that provide extension and supination). Your forearm extensor muscles are in action during wrist extension and are particularly important in the backhand stroke. Tennis involves repeated gripping and twisting movements, which work your extensor muscles.
Why tennis elbow happens
Tennis elbow injuries mostly occur if repetitive micro-trauma is placed on the tissues in question. The micro-trauma involves forces that the tissues are unable to cope with. These forces can be worsened by several predisposing factors. If you buy a new racket or use one with strings that are too taut or with a handle that is too large, you could be putting yourself at risk. In addition, if you suddenly increase your playing intensity coupled with a poor technique - essentially the backhand - you reduce your body's ability to withstand these forces.
There are many factors that can lead to tennis elbow:
1 If the amount of external rotation in your shoulder is restricted, it can lead to extra strain being placed on the elbow (Bender, 1994)
2 An overuse injury during wrist extension can occur if your extensor carpi radialis brevis (forearm muscle involved in wrist extension) takes on the role of flexing the elbow ahead of the biceps (Bender, 1994)
3 A lack of mobility in your back (Bender, 1994)
4 Poor flexibility (Kelley, 1994)
5 Playing surfaces: harder ones mean increased forces (Crisp, 1994)
Faults in technique can also contribute. A comparative study (Kelley et al, 1994) using tennis elbow sufferers and a non-symptomatic control group revealed several differences. Sufferers showed poor body positioning and greater involvement of their forearm extensor muscles. They also showed rapid change from wrist flexion to wrist extension when striking the ball and early in the follow-through. This placed the wrist in an unstable position to withstand repeated forces. Importantly, the backhand stroke heightened these differences.
Tennis elbow treatments
If you are suffering from tennis elbow, you will most likely have pain radiating down the lateral side of your elbow or stiffness in this area. Your symptoms may disappear if you stop playing, but this is obviously self-defeating. Other primary treatments can include anti-inflammatory drugs (NSAIDs), injections, and by following the RICE (rest, ice, compression and elevation) method. These, however, merely treat the symptoms and don't address the underlying factors that caused the injury.
Noteboom (1994) categorises five stages of treatments for tennis elbow:
1. Reduce pain
2. Reduce inflammation
3. Induce the healing process
4. Maintain fitness
5. Control force placed on injured tissues.
To follow the latter, of course, you must first get an accurate diagnosis, pinpointing the injured tissues. Physiotherapy is needed, both for this and to explain how to reduce the contributory forces being placed on your elbow.
Tennis elbow exercises and rehabilitation
Stretching your forearm extensors is important in establishing a full range of motion and in achieving alignment during tissue repair. Begin your first stretch by extending your arm with the palm of your hand facing downwards and then pull your hand upwards towards your forearm. The second stretch is a reversal of this, meaning that you pull your hand downwards towards the underside of your forearm. If this stretch proves painful, simply keep your arm bent during the stretch to reduce the intensity (Hannafin & Schelkun, 1996).
As you begin to show signs of improvement, resistance exercises can be added. The weight should be light at first, perhaps with dynabands being used before progressing to dumbbells. Wrist curls are a good exercise that works the underside of the forearm muscles. Grasp a dumbbell in each hand and sit down. Then lay your forearms on your thighs with your hands dangling over your knees, your palms facing upwards. Begin your first repetition by curling the weight upwards at the wrist and then slowly lowering. A similar exercise to work the tops of your forearms can be performed by starting with your palms facing downwards. Initially, three sets of 10 repetitions should be performed daily; once you achieve 25 reps, add an extra two-kilogram weight (Hannafin & Schelkun, 1996).
You could also include isometric exercises. The first requires you to squeeze a tennis ball in the palm of your hand and hold it momentarily before releasing. The second is a rubber band exercise, where the band should be placed at your fingertips. Start the exercise by extending your fingers outwards and then hold for a few seconds before releasing. Aim to perform these exercises twice a day.
Once your overall strength improves, other elbow extension exercises can be included where appropriate. The important point is to maintain your aerobic fitness by cycling, say, or jogging - any exercise that doesn't strain the elbow. This will help smooth your transition back on to the tennis court.