Tennis Elbow

Tennis elbow (lateral epicondylitis) is one of several overuse injuries that can affect your elbow. As you might guess, playing tennis is one cause of tennis elbow — but many other common activities can cause tennis elbow, too.

What is it?

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to the bony prominence on the outside of your elbow (lateral epicondyle). Pain can also spread into your forearm and wrist.

Tennis elbow is similar to golfer's elbow. But golfer's elbow occurs on the inside — rather than on the outside — of your elbow.

Tennis elbow is most common in adults ages 30 to 60 — but the condition can affect anyone who repetitively stresses the wrists. Tennis players, carpenters, gardeners, dentists and musicians may be at particular risk.

What causes it?

Tennis elbow is an overuse injury. It's caused by repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist. The repeated motions and stress to the tissue may result in inflammation or a series of tiny tears in the tendons that attach the forearm muscles to the bone at the outside of your elbow.

As the name tennis elbow indicates, playing tennis — particularly, repeated use of the backhand stroke with poor technique — is one possible cause of the condition. However, many other common arm motions can cause tennis elbow, too — including using a screwdriver, hammering, painting, raking, weaving and others.

What are the symptoms?

• Pain that radiates from the outside of your elbow into your forearm and wrist.
• Pain when you touch or bump the outside of your elbow.
• Pain when you extend your wrist.
• A weak grip.
• A painful grip during certain activities, such as shaking hands or turning a doorknob.

The pain often gets worse over weeks or months. Sometimes you may feel pain even when your arm is still.

Are there any natural therapies?

Initial treatment of tennis elbow usually involves self-care steps such as using the R.I.C.E. method – rest, ice, compression, elevation.

If these steps don't help and you still have pain and limited motion, you may need to:

• Analyse the way you use your arm.
• Exercises to stretch and strengthen the muscle.
• Other treatments for tennis elbow are under investigation. Some treatments being studied include low-energy shock wave treatment, acupuncture, botulinum toxin, orthotic devices, such as braces or straps, and treatment with topical nitric oxide.

What else can I do?

• Review your technique. Have a tennis professional review your technique to see if you're using the proper motion. Swing the racket with your whole arm and get your entire body involved in the stroke, not just your wrist. Keep your wrist rigid during ball contact. Also, make sure you have the proper racket grip size and string tension. Lower string tension of around 55 pounds transmits less force up to the elbow.
• Build your strength. Prepare for any sport season with appropriate preseason conditioning. Do strengthening exercises with a hand weight by flexing and extending your wrists. Letting the weight down slowly after extending your wrist is one way of building strength so that force is absorbed into your tissue.
• Keep your wrist straight. During any lifting activity — including weight training — or during tennis strokes, try to keep your wrist straight and rigid. Let the bigger, more powerful muscles of your upper arm do more of the work than your smaller forearm muscles do.
• Warm up properly. Gently stretch the forearm muscles at your wrist before and after use.
• Use ice. After heavy use of your arm, apply an ice pack or use ice massage. For ice massage, fill a sturdy paper or plastic foam cup with water and freeze it. Then, roll the ice directly on the outside of your elbow for five to seven minutes.

Did you know?

The technical name for tennis elbow is “lateral epicondylitis”.