CARING FOR ATHLETES
TENNIS ELBOW: A TROUBLESOME CONDITION THAT CAN BE SEEN YEAR ROUND
Although winter is approaching, our clinic sees tennis elbow year round. If you suffer from “tennis elbow, it doesn’t necessarily mean you have been playing tennis. In fact, you may have acquired this painful, sometimes incapacitating, ailment from playing softball or bowling. Even assembly-line workers who repeat certain arm movements, politicians who do a lot of handshaking and carpenters who do a lot of screwdriving are frequently affected. However, of the 35 million tennis playing Americans, at least half have had or can expect to have a tennis elbow episode and, not uncommonly, a series of recurrences.
Tennis elbow is usually caused by excessive strain on the tendons and muscles of the forearm, which attach at the elbow. These tendons and muscles produce forward and backward movement at the wrist. The pain is usually felt at the side of the elbow and is experienced suddenly in about 25 percent of cases. The remaining 75 percent experience pain gradually. As the pain progresses, sufferers usually seek sports-medical attention in six to eight weeks.
Tennis plays suffer from two types of tennis elbow. Forehand tennis elbow is common in professional tennis players as a result of wrist snapping in booming serves. Forceful serves strain the tendons and muscles that bend the wrist. These tendons and muscles attach on the inner side of the elbow and consequently the pain occurs at this site. Backhand tennis elbow is frequently seen in novice or weekend players. The pain arises from hitting backhand strokes incorrectly. A backhand stroke stresses the tendons and muscles that straighten the wrist. These tendons and muscles attach to the outer side of the elbow.
Rod Laver, Tony Roche, and Arthur Ashe all ended up with tennis elbow. They hit the ball primarily with their wrists. This puts tremendous force on the elbow. Pancho Gonzales, Ken Rosewall, and Pancho Segura were immune to tennis elbow. They hit the ball from the shoulder down.
Players who try to hit the ball with a wrist movement rather than using their entire upper arm are generally more susceptible to tennis elbow. A wrist type swing puts tremendous stress on the muscles of the forearm. It follows, therefore, that the stronger your forearm munches the more protected you are from this condition. In addition, I’ve yet to see a tennis player with a two-handed backhand suffer tennis elbow. Evidently using two hands provides the necessary strength tolerance to safely manage the endured stresses. The theory that tennis elbow results from repeated stress to an unprepared or weakened tendon and muscle has been substantiated by a recent research study conducted at the Lenox Hill Hospital in New York.
Here are some additional factors that put added stress on the tendons and muscles that may result in tennis elbow:
Using too heavy a racket. The heavier the racket, the more stress on the arm. Playing on grass or cement. The ball bounces off these surfaces with a greater velocity, hitting the racket with a greater force, which is transmitted to the elbow. Using heavy balls. The heavier the ball, the greater force against the racket. Having too much tension on the strings. If the strings are too tight, they do not give sufficiently when the ball hits and a greater force is transmitted to the elbow. And maybe the most common cause of tennis elbow is an ill-fitted grip, using an oversized, or more frequently an undersized grip. If the racket is held insecurely, the ball will be hit with a wobbly stroke and the elbow absorbs the shock.
Some physical therapists feel that an aluminum racket is superior to a wooden one because it bends more when the ball hits it. Wooden rackets are sometimes stiffer.
However, some tennis players report that aluminum rackets recoil after the initial impact and hurt their elbows even more. Regardless of the type of tennis racket you use, if you develop tennis elbow, hitting the tennis ball will aggravate the condition.
TREATMENT
If you experience elbow pain immediately after performing repetitive wrist bending, apply ice to the area in pain. If the pain persists, get a sports medicine consultation. Usually ice and rest followed by stretching and strengthening the injured tendons and muscles is the most effective treatment. In severe cases, induction via ultrasound or electrical stimulation of a local anesthetic and a cortisone-like anti-inflammatory drug may be needed (iontophoresis and phonophoresis). Occasionally a compression bandage is applied to the forearm to immobilize and relieve stress on the painful tendons and muscles. Relatively rare is surgery needed to lengthen a tendon or repair a partial tear.
PREVENTION
How can you avoid tennis elbow? Most amateur players have an improper grip and a poor stroke, which contribute to this condition. A few tennis lessons can improve a novice player’s technique and preventative stretching and strengthening exercises for the forearm tendons and muscles will increase your immunity to tennis elbow.
Exercises for the Prevention and Treatment of Tennis Elbow
When you first develop pain in your elbow, stop playing tennis. After waiting two to seven days for the pain to disappear, start the following exercises. Perform each twice a day.
For forehand tennis elbow: Lay your arm flat on a table, letting your hand extend over the edge, your palm facing up. With a five-pound weight, flex your wrist ten times. Repeat until you tire.
For backhand tennis elbow: Lay your arm flat on a table, letting your hand extend over the edge, your palm facing down. With a five-pound weight, flex your wrist ten times. Repeat until you tire.