What is Tennis Elbow

So what is ‘Tennis Elbow’?

Tennis elbow, or to give it its medical term ‘lateral epicondylitis’, is a painful condition that affects the bone  Tenni Elbowon the outside of the elbow (the lateral epicondyle). The elbow joint is surrounded by muscles that move the elbow, wrist and fingers. Tennis elbow is thought to be a degenerative condition that develops when the tendon (the common extensor tendon) that joins the muscles in your forearm to the upper arm (the humerus) tears and becomes inflamed. If the aggravating activity is continued the tears may worsen and in extreme cases can lead to a rupture to the common extensor tendon.

It is most common in people aged 40-50years old and depending on the severity can take anything between 2 months and 2 years to fully heal, although 90% are thought to recover within a year.

What causes tennis elbow?

Contrary to the name, this condition is not always caused by playing tennis or other racket sports. It is however, caused by repetitive movements of the elbow, wrist and hand that can occur during racket sports such as rotation and gripping, hence the term ‘tennis elbow’. Heavy tennis balls and racket factors i.e. weight, string tension, grip size can cause tennis elbow in amateur players. A recent research article has found that the most common cause for tennis elbow is poor technique leading to over loading of the muscles in the forearm.   
It may occur as a result of weakness in the muscles which are attached to the outside of the forearm or due to an increase in the frequency of playing racket sport or a particular activity such as painting/decorating. Weakness can lead to overloading of the muscles and result in tears as described above, this is possible whether your use your forearm muscles regularly or not.

Less commonly tennis elbow occurs as a result of a single activity such as lifting something heavy.

Management of Tennis Elbow

  • Rest is crucial to allow the tendon to heal
  • Application of ICE or a bag of frozen peas wrapped in a towel may help to reduce the pain
  • Full recovery is likely to require a change to the activities which caused symptoms
  • An anti-inflammatory medicine or gel may help to reduce symptoms. This should be discussed with your GP prior to use
  • Never return to sport or exercise if the activity leads to greater than moderate discomfort or 4/10 pain
  • As the tendon heals it is important to stretch the muscles around the elbow to help the alignment of the healing tissues
  • Doing regular strengthening exercises will allow the injured muscles to recover prior to return to sport – SEE EXERCISE OF THE MONTH
  • Acupuncture, deep tissue massage, ultra-sound, may also be beneficial

Lots of people wear elbow supports during the aggravating activity to support the muscles in the forearm. Supports and splints can be expensive, so please do not hesitate to contact us for further advice

If conservative methods are not affective we can advise you regarding referral on to an appropriate professional.

Prevention of Tennis Elbow

  • Always warm-up before playing tennis or completing repeated upper limb activities
  • Never play sport or engage in activities for a prolonged period if they lead to greater than moderate discomfort     
  • Don’t forget to rest in between activities. Your muscles need rest as much as exercise
  • Your string tension may also affect the load through the forearm. Strings should be changed regularly even if they have not broken. Reducing string tension may help to absorb some of the vibration through the racket at contact
  • Make sure that you have good technique with all of your shots, in particular the point at which you strike the ball should be in front of you with your elbow supple, but straight
  • Using a racket that is too heavy will increase the load on the muscles in your forearm
  • Regular exercise aimed at stretching and strengthening the muscles in your forearm is important – SEE EXERCISE OF THE MONTH 
  • Regularly change the tennis balls you use. Older or damp balls will become heavier and increase the impact through the muscles
  • Ask a physiotherapist/professional tennis coach for advice regarding the appropriate grip size for you

You should then check your grip size regularly. Grips will wear with frequent play which will affect your grip size

WHETHER YOU ARE ALREADY SUFFERING FROM TENNIS ELBOW OR ARE WOULD LIKE ANY ADVICE REGARDING PREVENTION, ANY OF THE PHYSIOTHERAPISTS AT THE BRISTOL PHYSIOTHERAPY CLINIC WOULD BE HAPPY TO ADVISE YOU.

References

BUPA (2008) Tennis Elbow. Available at: http://www.bupa.co.uk/health-information/directory/t/tennis-elbow

Calfee, R. P., Patel, A., Da Silva, M.F. and Akelman, E. (2008). Management of Lateral Epicondylitis: Current Concepts. Journal of the American Academy of Orthopaedic Surgeons, 16 (1): 19-29

Cluett, M.D. (2011) Tennis Elbow (Updated 24.1.11). Available at: http://orthopedics.about.com/od/tenniselbow/tp/Tennis-Elbow.htm

De Smedt, T., de Jong, A., Van Leemput, W., Lieven, D. and Van Glabbeek, F. (2007) Lateral Epicondylitis in Tennis: Update on Aetiology, Biomechanics and Treatment. British Journal of Sports Medicine, 41:816-819

Elenbecker, T. S. and Mattalino, A. J. (1997) The Elbow in Sport. Human Kinetics: Leeds

Hatch, G. F., Pink, M.M., Mohr, K. J., Sethi, P. M. and Jobe, F. W. (2006)  The Effect of Tennis Racket Grip Size on Forearm Muscle Firing Patterns. The American Journal of Sports Medicine, 34 (12): 1977-83

NHS Choices (2010) Tennis Elbow (Updated 7.12.10). Available at: http://www.nhs.uk/Conditions/Tennis-elbow/Pages/Introduction.aspx
SportEX Medicine. Advice For ‘Tennis Elbow’ Injury. Available at: www.sportex-medicine.com