Tennis Elbow
(Lateral Epicondylosis)

Many individuals, not just tennis players, develop pain on the outer (lateral) aspect of the elbow. This is a form of tendon degeneration (wear and tear) called lateral epicondylosis or “tennis elbow.” Lateral epicondylosis is an overuse injury of the attachment point at the elbow of the tendons that extend (lift up) the wrist. These wrist extensor muscles pull the wrist and hand backward and contract strongly with any gripping or grasping activity of the hand.

Tennis Elbow A small common extensor tendon at the outside of the elbow anchors a large, powerful group of extensor muscles in the forearm. Repetitive gripping and strong use of these extensor muscles can cause tissue failure at the muscle-tendon junction, causing the tendon to degenerate and sustain “micro-tears.” This produces inflammation and pain on the outside of the elbow which radiates down the back of the forearm and sometimes into the hand.

Contributing factors

Weak muscles

Injury
Overuse – playing or working with excessive and repetitive forceful gripping and grasping
Improper equipment – incorrect grip size, worn grips, strings to tight on tennis racket
Racquets/tools that are too heavy or unbalanced
Poor playing technique – too much wrist action in tennis, jerky strokes, poor ball contact
Smoking – Smoking causes degeneration in muscle, tendon, bone, and ligament tissue

Treatment

Rest. Stop the aggravating activity. A period of rest is absolutely imperative to allow the injured area an opportunity to heal. You will make the condition worse by continuing the activity that causes the injury, especially if there is pain associated with the activity. Avoid heavy lifting or carrying, and avoidable repetitive activities such as shaking hands and opening doors.

Ice. Apply direct cold to the lateral (outside) part of your elbow a minimum of 3 times per day for at least 15-20 minutes and after active use of your arm. Protect your skin by placing a towel between your elbow and the ice.

Ice Massage***: Every night prop your elbow up onto a table and take an ice cube in your hand. For 15-20 seconds until it gets really cold, use the ice cube as a stone massage and dig into the affected area. Take a break for about 15 seconds and then repeat it. Do this every night for about 5-10 minutes.

Stretching. Stretching will help prevent stiffness and elongate muscle tissue making it a better shock absorber to dissipate the stress absorbed by the damaged tendon tissue.

Physical Therapy. Exercise to stretch and strengthen the forearm muscles are started as the pain subsides. Building flexibility and strength in the muscles will protect the damaged tendon tissue and prevent recurrence of symptoms in the future.

Medication. Occasionally, anti-inflammatory medications (such as aspirin, ibuprofen, Aleve) may be recommended to help reduce pain and inflammation. Please consult with your primary care physician before taking these medications.

Injection. Corticosteroid injections, though effective in temporarily reducing pain for hours or days, is not an effective treatment for tennis elbow. It will not replace the role exercise and will not change the duration of time required for recovery. If you receive a cortisone injection, you should not play sports or use the arm forcefully for at least 2 weeks.

Brace. A wrist splint or counter-force brace (an elastic strap worn 1-2 inches below the elbow over the extensor muscles) may be recommended. A wrist splint Brace for tennis elbow tries to rest the extensor muscles while a counter-force brace gives compression to the forearm muscles and tries to lessen the force absorbed by the damaged tendon attachment. Initially, the brace may be worn during all waking hours. As the pain subsides, it should be used only during activities that stress the injured arm.

Surgery. Surgery is rarely required but may become an option for chronic or recurrent tennis elbow that has failed at least 3 rounds of appropriate therapeutic intervention.

Returning to sports or strenuous activity

Warm up. Always warm up before you play or engage in strenuous activity. Place all of your major joints through their range of motion and work up a “sweat” prior to starting your activity. Always stretch your muscles thoroughly before you begin and at the end of your activity.

Your Racquet. Use a lighter weight racquet and move your hand “up” on the grip. Change to a racquet that has greater spring to absorb energy. Reduce the string tension. Discuss equipment with your local pro.

Your Stroke. In tennis, backhand strokes apply the most force to the outer aspect of the elbow, especially if wrist motion is incorporated in the mechanics. The 2 handed backhand is less stressful to the elbows. Focus on your strokes and good mechanics.

Your Game. Start back slowly. In tennis, play short periods of time and gradually increase once the elbow is healed. In golf, start with putting and chip shots and slowly work up from a few holes to a complete game.

After the Game. Stretch the muscles after you finish your activity. Apply ice to the elbow for at least 20 minutes.

Exercises

Exercises to stretch and strengthen the muscles attached to the injured and damaged tendon will help with the healing process. Strengthening exercises should be avoided until the stretching exercises no longer cause pain. The following exercises can be done every day until your symptoms subside. Continue to use these exercises as a warm-up prior to any strenuous gripping sport or activity. Continue to use these exercises to prevent recurrence of symptoms.

First Phase:

WRIST EXTENSOR STRETCH: Begin with elbow straight. With other hand, grasp at thumb side of hand and bend wrist downward. To increase the stretch, bend wrist toward small finger. Hold for 20 seconds, rest for 20 seconds. Perform one set of three repetitions, twice daily.

Second Phase:

RESIST WRIST EXTENSORS WITH WEIGHT: Hold a two pound weight with hand. Place forearm on table with hand off edge of table, palm down. Move wrist upward. Return to starting position. Perform two sets of 10 repetitions, twice daily.

RESIST WRIST FLEXORS WITH WEIGHT: Hold a two pound weight with hand. Place forearm on table with hand off edge of table, palm up as shown. Move wrist upward. Return to starting position. Perform two sets of 10 repetitions, twice daily.