Today's Fitness Question of the day comes from Karen from Montgomery, Texas. She asks, "I can't work out the way I want because of my tennis elbow. How can I make my arm better?"
Tennis Elbow aka Lateral Epicondylitis
"Tennis elbow" or lateral epicondylitis is a condition in which the outer part of the elbow becomes sore and tender. The forearm muscles and tendons become damaged from overuse — repeating the same strenuous motions again and again. This leads to pain and tenderness on the outside of the elbow.
The term tennis elbow first appeared in an 1883 paper by Major called Lawn-tennis elbow.
Tennis and other activities, which involve the overuse of the extensor muscles of the forearm can cause acute and lead to chronic tendonitis of the tendinous insertion of these muscles at the lateral epicondyle of the elbow. The condition is also common in manual laborers whom repetitively swing different tools with the forearm.
Signs and symptoms of Tennis Elbow include the following
- Pain on the outer part of the elbow (lateral epicondyle).
- Specific tenderness over the lateral epicondyle—a prominent part of the bone on the outside of the elbow
- Difficulty with gripping and other movements of the wrist, especially wrist extension and lifting movements.
- Discomfort from normal activities (shaking hands, opening/closing doors) that use the muscles that extend the wrist.
In addition to the aforementioned repetitive, overuse causes of tennis elbow, sudden trauma caused by a direct blow or forceful pull of the epicondyle can also cause tennis elbow. Also, contrary to popular belief that tennis elbow is only an "inflammation" issue, other studies show that in some cases, the tissue is not inflamed, but rather degenerative, meaning that the normal tendon tissue is replaced by a disorganized arrangement of collagen. This pathology is referred to as "tendonosis" rather than "tendonitis".
Another factor of tennis elbow injury is sports specific experience and ability. Poor technique increases the chance for injury like any other sport. Therefore, an individual must learn proper technique for all aspects of their sport. Although mostly novice tennis players risk injury from poor technique, more experienced tennis players are at equal or more risk of injury due to overuse from playing for several years in addition to developing and not correcting bad tennis techniques.
Sports Specific Preventative Measures
For the novice and experienced tennis player, here is a list of preventative measures, one can take to lessen the incidence of tennis elbow:
- Decrease the amount of playing time if already injured or feeling pain on outside part of the elbow.
- Stay in overall good physical shape.
- Strengthen the muscles of the forearm: (pronator quadratus, pronator teres, and supinator muscle)—the upper arm: (biceps, triceps)—and the shoulder (deltoid muscle) and upper back (trapezius). Increased muscular strength increases stability of joints such as the elbow.
- Like other sports, use equipment appropriate to your ability, body size, and muscular strength.
- Avoid any repetitive lifting or pulling heavy objects (especially over your head)
Physician Diagnosis of Tennis Elbow
A physician can diagnosis tennis elbow by performing a battery of tests in which he or she places pressure on the affected area while asking the patient to move the elbow, wrist, and fingers. X-rays distinguish possibilities of existing causes of pain that are unrelated to tennis elbow, such as fracture or arthritis. MRI screening can confirm excess fluid and swelling in the affected region in the elbow, such as the connecting point between the forearm bone and the extensor carpi radialis brevis.
Epicondylitis often becomes a chronic problem if not cared for properly. For this reason, it must be stressed that the rehabilitation process should not be progressed until you experience little or no pain at the level you are performing. Regaining full strength and flexibility is critical before returning to your previous level of sports activity.
REHABILITATION for tennis elbow
Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), has laid out a comprehensive rehabilitation plan that's divided into three phases:
Goals: decrease inflammation and pain, promote tissue healing, and delay muscle atrophy. During the acute stage of your injury, follow the RICE principle:
Rest - this means avoiding further "overuse" not absence of activity. You should maintain as high an activity level as possible while avoiding activities that aggravate the injury. Absolute rest should be avoided as it encourages muscle atrophy, deconditions tissue, and decreases blood supply to the area, all of which is detrimental to the healing process. Pain is the best guide to determine the appropriate type and level of activity.
Ice - is recommended as long as inflammation is present. This may mean throughout the entire rehabilitation process and return to sports. Ice decreases the inflammatory process slows local metabolism and helps relieve pain and muscle spasm.
Compress and Elevate - if appropriate to assist venous return and minimize swelling.
Goals: Improve flexibility, increase strength and endurance, increase functional activities and return to function.
Stretching - Gentle stretching exercises including wrist flexion, extension and rotation. The elbow should be extended and not flexed to increase the amount of stretch as required. These stretches should be held for 20-30 seconds and repeated 5-10 times, at least twice a day. Vigorous stretching should be avoided - do not stretch to the point of pain that reproduces your symptoms.
Strengthening - With the elbow bent and the wrist supported perform the following exercises:
1. Wrist Extension Place 1 lb. weight in hand with palm facing downward (pronated);
support forearm at the edge of a table or on your knee so that only your hand can move.
Raise wrist/hand up slowly (concentric contraction), and lower slowly (eccentric contraction).
2. Wrist Flexion Place 1 lb. weight in hand with palm facing upward (supinated); support
forearm at the edge of a table or on your knee so that only your hand can move. Bend
wrist up slowly (concentric), and then lower slowly (eccentric)(similar to exercise above).
3. Combined Flexion/Extension Attach one end of a string to a cut broom stick or similar
device, attach the other end to a weight. In standing, extend your arms and elbows
straight out in front of you. Roll the weight up from the ground by turning the wrists.
Flexors are worked with the palms facing upward. Extensors are worked with the palms
4. Forearm Pronation/Supination Grasp hammer (wrench, or some similar device) in
hand with forearm supported. Rotate hand to palm down position, return to start position
(hammer perpendicular to floor), rotate to palm up position, repeat. To increase or
decrease resistance, by move hand farther away or closer towards the head of the
5. Finger Extension Place a rubber band around all five
finger tips. Spread fingers 25 times, repeat 3 times. If
resistance is not enough, add a second rubber band or
use a rubber band of greater thickness which will provide
6. Ball Squeeze Place rubber ball or tennis ball in palm of
hand, squeeze 25 times, repeat 3 times. If pain is
reproduced squeeze a folded sponge or piece of foam.
Goals: Improve muscular strength and endurance, maintain and improve flexibility, and gradually return to prior level of sport or high level activity. Continue the stretching and strengthening exercises emphasizing the eccentric contractions of wrist flexion and extension. In this regard, since the eccentric contractions are movements with gravity, do not let the weight drop too quickly; lower the weight in a controlled fashion. With the combined wrist flexion/extension exercise, work on increasing speed when rolling up the string with the attached weight as this will improve endurance. When your symptoms are resolved and have regained full range of motion and strength, you may gradually increase your level of playing activity. An example of one gradual progressive return to tennis is as follows:
- 15 minutes forehand only
- 30 minutes forehand only
- 30 minutes forehand and two handed backhand
- 45 minutes forehand and backhand
- 45 minutes all strokes
- Full play
- Competitive play
Does the tennis racquet contribute to tennis elbow?
Considering all the above points and recommendations for treatment, lastly, one should consider if the tennis racket itself is also contributing to tennis elbow. There are a couple of factors one should consider when selecting a tennis racquet:
1. Tennis Racquet Weight: The average tennis racquet is lighter and stiffer today more than it was several years ago and they are marketed to the masses as a superior racquet, but that not necessarily the case at all, and sometimes it can end up being worse and causing more problems in the elbow area. Each time a tennis ball strikes the string bed a collision occurs which creates energy and shock. At the moment of impact/collision the energy has to go somewhere. In the past, heavier racquets have essentially served as shock absorbers, taking the brunt of the collision before the shock could be transmitted to the player's arm. With the advent of lighter weight racquets, the shock is no longer absorbed by the racquet, but rather transmitted directly to the player's body. While some players experience no immediate pain with this added shock, others are quite sensitive to it and their bodies respond with pain. The following recommendations should be considered when selecting a racket that will decrease the risk of developing tennis elbow:
Weight - Racquet greater than 12 ounces.
Length - Racquet less than 27 inches.
Stiffness - Racquets with a stiffness/flex rating of 69 or less.
Balance - Racquets that are less head heavy.
2. Type of String: Most professional players use poly-based strings. So again, most companies are going to market these strings to the masses to buy with the promise that these strings will make them as good as the top professionals. Some poly based strings, have a tendency to drop tension quickly. After just a few hours on the court the limited dampening properties of these strings are exhausted and additional shock is transmitted directly to the body. Playing with a stiff, dead string is one of the most prominent causes of tennis elbow. It is essential to evaluate your style of play as well as the specifications of your frame before jumping into the world of poly based strings. Please contact a professional stringer before to determine if you need a poly-based string or a hybrid counterpart.
In closing, I hope this article helps you better understand the causes/symptoms of tennis elbow, how to prevent and treat tennis elbow, and how to select a proper racquet that lessens the potential for tennis elbow or exacerbates a preexisting condition further. With these tools at your disposal, I'm sure you'll be back on the court, playing the best matches of your life pain free!
If you're a parent that has an athlete that you want to help take to the next level or if you're athlete yourself, and you're looking for the extra edge on your training, please contact DMP Fitness today.
Until next time - ENVISION, BELIEVE, EXECUTE and SUCCEED
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