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Coping with Tennis Elbow | by Tiffany Steinke
What is tennis elbow?
The term tennis elbow is not a very good term because you don’t have to play tennis to have this condition. Any combination of repetitively rotating your wrist and using force can cause epicondylitis, activities such as; rowing a boat, throwing a ball, using a manual screw driver, fine movements of the hand. Lateral epicondylitis or tennis elbow, is an inflammation or minor tears of tendons of muscles in the forearm that “extend” the wrist. Pain is located on the outside of the arm just at and below the elbow joint. Medial epicondylitis, known as “golfer’s elbow” or “Little League Elbow” affects the tendons of muscles in the forearm that “flex” the wrist. Pain and inflammation is located on the opposite side of the elbow.
In tennis, lateral epicondylitis usually occurs due to the poor backhand stroke technique of the average club player. The poor timing, off center ball contact, and poor body-weight transfer, all contribute to a “leading elbow” backhand. Medial epicondylitis mainly occurs in the expert player who has a defect in their spinning technique during their performance of the American twist serve.
What are some signs and symptoms to look for if I have tennis elbow?
• Symptoms usually develop insidiously and tend to get progressively worse over time.
• Tenderness is localized on the bony prominence along the outside of the elbow- the lateral epicondyle.
• Pain can occur when shaking hands, turning knobs, or lifting a suitcase.
• There is seldom visible bleeding beneath the skin that look like blue or purple patches called, ecchymosis.
• Weakness of various muscles in shoulder, forearm, and wrist.
• Decrease in range of movement and flexibility in the wrist.
• Muscle spasms can occur in lower arm area.
If you currently have these symptoms, you should consult your physician immediately.
In tennis, what are some causes of lateral epicondylitis or tennis elbow?
• Grip size of your racquet is too big.
• Hitting tennis backhand shots with the wrist in slight extension, try to maintain a stable, neutral wrist position during sports and other activities.
• Weight of the racquet is too heavy, lighter is better! Some titanium racquets weigh only seven ounces!
• Strings are strung too tight! On the side of your racquet, the manufacturer displays the correct high and low tension for that particular racquet. It is not recommended to go above that high tension. Tightly strung racquets can produce continuous forces of vibration that will be conducted up the arm when the ball is hit off center. Especially dangerous for novice players.
As trainers or coaches we must identify that our client is ready for a post-rehabilitation program. Exercise is just as traumatic if it is not done correctly. Not everyone is a candidate for exercise. Before designing a program for someone who has had an injury, first look for these symptoms. If symptoms exist, refer the client back to their doctor or therapist. Remember to never diagnose an injury yourself!
• Radiating pain
• Numbness or tingling
• Loss of range of motion
• Loss of function (something that they normally do, now is giving them problems)
• Open wound and/or swelling called “edema”
• Chest pain and/or shortness of breath
Treatment for lateral epicondylitis?
• Rest, ice, compress, and elevation (see June/July UltraFitt article).
• Immobilize or rest the arm in a sling.
• Avoid tennis activity for a number of days.
• Anti-inflammatory medication can be taken with physician approval.
• Stretch and strengthen only when not symptomatic.
• Have a pro check your stroke techniques and grip size.
• An elbow band or splint should be worn just below the elbow in conjunction with a wrist brace. The compression or counter force of the band is to diffuse the forces of muscle contraction over a wider area and help decrease the strain on the lateral epicondyle.
• Some studies indicate that magnets could be an effective therapy for pain management. The theory behind magnets, is that the magnetic fields applied to an injured area improve blood flow and oxygen exchange to enhance the body’s natural healing process.
• For the professional tennis player who has a chronic case, it is recommended that one hour before playing, apply ice or heat, depending on which modality seems to offer best results for the particular athlete. Massage the tender area and surrounding muscles. A half an hour before playing, the athlete should take two aspirin. Before going on the court, the athlete should do calisthenic exercises to raise the body temperature, and then perform rehabilitative stretches outlined in this article.
• Practice with less intensity if you are an advanced or expert tennis player- avoid playing “all-out”- lessen the pace in practice, and when serving reduce amount of spin.
• Physical therapy-Ultrasound with hydrocortisone may be a treatment option for someone with chronic tennis elbow. Physical therapists can use high-voltage galvanic stimulation over the tender area may enhance the contractile properties of the extensor muscles in the wrist.
• Medical treatment-For chronic cases, anti-inflammatory medications may not be enough to manage the pain. Cortisone injections can be given and sling immobilization can be used during flare-ups.
• In chronic cases and in rare circumstances, surgical intervention is a last resort.
Sally Cone of Greenfield, IN. stated “I was diagnosed with tennis elbow and I am not sure of what exercises I should be doing?”. Sally these are some exercises you can do only if you are not symptomatic. To add power to your swing and to possibly prevent re-injury or diminish soreness during and after your game, be sure to add these exercises to your overall exercise program. If you're more likely to “hit the net” but not on the court (on the computer), these wrist/forearm/finger exercises could help prevent carpal tunnel syndrome as well as help your tennis elbow. Start out with a lower weight to stretch and work up to a heavier weight to strengthen. After you work up to a strength training program, still incorporate stretches into your routine. If you need pictures of these exercises, please email: tisteinke@iquest.net.
Perform 3 sets, 10 repetitions on each hand for all exercises.
Finger and Wrist exercises:
1) Put an elastic band/rubber band around all five fingers at the knuckle nearest to your fingernails. Place your lower arm on a flat surface, with palm down and your elbow bent. Slowly spread and close your fingers.
2) Use a one to two pound dumbbell or soup can. Place your lower arm on a flat surface for support, hang your hand, palm up, over the edge of the surface. Use your wrist to slowly raise and lower the dumbbell trying to gain as much range of motion as possible.
3) Place your lower arm on a flat surface so your hand hangs over the edge. Hold a light dumbbell or a hammer by its end. Now as if you were hammering, use your wrist to slowly lower the dumbbell/hammer slightly below the surface edge, then lift it as high as you comfortably can.
4) Adapt Exercise 2, by having your palm face to the side, not towards the ceiling or floor. This exercise will help to strengthen the supinators and pronators in the wrist. Use your wrist to slowly lift a (1lb dumbbell- work up to heavier weight) side to side trying to gain as much range of motion possible.
5 ) Stretch your wrist by moving in a clockwise and counter clockwise (rotation) movement, and then moving side to side.
6) Stretch your wrist and elbow muscles by straightening your arm, and with other hand push fingers back gently. Repeat for other side.
7) Stretch your elbow muscles by bringing your arm in towards your chest, with palm up, as you come past the shoulder, palm down, press palm towards the floor and follow through to extend the arm.
8) Ball squeezing exercise-squeeze a small rubber ball that fits into the grip of your hand.
Shoulder and Arm exercises:
1) Codman’s pendulum exercises- For exercises listed below, perform 3 sets of 10 repetitions and use a light dumbbell.
a) Bend over at the waist, let your arms relax and hang freely.. make small circles that slowly increase in size- (first move arms clockwise and then counterclockwise).
b) Bend over at the waist, let your arms relax and hang freely.. then swing one arm at a time in towards the body (adduction), then away from the body (abduction).
2) Flies-Standing, bending forward with arm vertical, with dumbbells in each hand, move arms past the back and then move arms to the side. If you have also been diagnosed with a rotator cuff tear, refrain from doing these shoulder exercises.
3) Tricep-elbow extension-using a dumbbell, the elbow is extended and flexed slowly, do not allow the elbow to rapidly snap into extension. The non-exercising arm supports the humerus.
These are the most important exercises for a muscle-strengthening program for “tennis elbow”, but more weight training exercises can be added to make a more complete exercise program.
Last month I received email from a few individuals with questions. I appreciate your questions and comments. Next article will focus on common lower extremity injuries so please write in your questions and comments to tisteinke@iquest.net.•
What are your thoughts? If you have any comments or questions regarding this article or have questions about fitness in general, please write to Ask The Trainer, Tiffany Steinke at UltraFitt. 7462 East Fishers, Station Drive Suite 437, Fishers, IN 46038 or Email: editor@ultrafitt.com
Tiffany Steinke has always had a passion for fitness and enjoys sharing it with others. She has a Master's degree in Kinesiology from Indiana University in Bloomington. Her emphasis is in Rehabilitation and Conditioning of Special Populations and Sport Athletes. She is also a certified instructor of Community CPR and First Aid by the Red Cross. Tiffany is an accomplished marathon runner, and is currently training for future marathons and triathlons. She is Team Captain for Team-N-Training for the Indiana Chapter Leukemia Society of America. Tiffany is Head Trainer at Family Fun & Fitness in Greenfield.
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What is tennis elbow?
The term tennis elbow is not a very good term because you don’t have to play tennis to have this condition. Any combination of repetitively rotating your wrist and using force can cause epicondylitis, activities such as; rowing a boat, throwing a ball, using a manual screw driver, fine movements of the hand. Lateral epicondylitis or tennis elbow, is an inflammation or minor tears of tendons of muscles in the forearm that “extend” the wrist. Pain is located on the outside of the arm just at and below the elbow joint. Medial epicondylitis, known as “golfer’s elbow” or “Little League Elbow” affects the tendons of muscles in the forearm that “flex” the wrist. Pain and inflammation is located on the opposite side of the elbow.
In tennis, lateral epicondylitis usually occurs due to the poor backhand stroke technique of the average club player. The poor timing, off center ball contact, and poor body-weight transfer, all contribute to a “leading elbow” backhand. Medial epicondylitis mainly occurs in the expert player who has a defect in their spinning technique during their performance of the American twist serve.
What are some signs and symptoms to look for if I have tennis elbow?
• Symptoms usually develop insidiously and tend to get progressively worse over time.
• Tenderness is localized on the bony prominence along the outside of the elbow- the lateral epicondyle.
• Pain can occur when shaking hands, turning knobs, or lifting a suitcase.
• There is seldom visible bleeding beneath the skin that look like blue or purple patches called, ecchymosis.
• Weakness of various muscles in shoulder, forearm, and wrist.
• Decrease in range of movement and flexibility in the wrist.
• Muscle spasms can occur in lower arm area.
If you currently have these symptoms, you should consult your physician immediately.
In tennis, what are some causes of lateral epicondylitis or tennis elbow?
• Grip size of your racquet is too big.
• Hitting tennis backhand shots with the wrist in slight extension, try to maintain a stable, neutral wrist position during sports and other activities.
• Weight of the racquet is too heavy, lighter is better! Some titanium racquets weigh only seven ounces!
• Strings are strung too tight! On the side of your racquet, the manufacturer displays the correct high and low tension for that particular racquet. It is not recommended to go above that high tension. Tightly strung racquets can produce continuous forces of vibration that will be conducted up the arm when the ball is hit off center. Especially dangerous for novice players.
As trainers or coaches we must identify that our client is ready for a post-rehabilitation program. Exercise is just as traumatic if it is not done correctly. Not everyone is a candidate for exercise. Before designing a program for someone who has had an injury, first look for these symptoms. If symptoms exist, refer the client back to their doctor or therapist. Remember to never diagnose an injury yourself!
• Radiating pain
• Numbness or tingling
• Loss of range of motion
• Loss of function (something that they normally do, now is giving them problems)
• Open wound and/or swelling called “edema”
• Chest pain and/or shortness of breath
Treatment for lateral epicondylitis?
• Rest, ice, compress, and elevation (see June/July UltraFitt article).
• Immobilize or rest the arm in a sling.
• Avoid tennis activity for a number of days.
• Anti-inflammatory medication can be taken with physician approval.
• Stretch and strengthen only when not symptomatic.
• Have a pro check your stroke techniques and grip size.
• An elbow band or splint should be worn just below the elbow in conjunction with a wrist brace. The compression or counter force of the band is to diffuse the forces of muscle contraction over a wider area and help decrease the strain on the lateral epicondyle.
• Some studies indicate that magnets could be an effective therapy for pain management. The theory behind magnets, is that the magnetic fields applied to an injured area improve blood flow and oxygen exchange to enhance the body’s natural healing process.
• For the professional tennis player who has a chronic case, it is recommended that one hour before playing, apply ice or heat, depending on which modality seems to offer best results for the particular athlete. Massage the tender area and surrounding muscles. A half an hour before playing, the athlete should take two aspirin. Before going on the court, the athlete should do calisthenic exercises to raise the body temperature, and then perform rehabilitative stretches outlined in this article.
• Practice with less intensity if you are an advanced or expert tennis player- avoid playing “all-out”- lessen the pace in practice, and when serving reduce amount of spin.
• Physical therapy-Ultrasound with hydrocortisone may be a treatment option for someone with chronic tennis elbow. Physical therapists can use high-voltage galvanic stimulation over the tender area may enhance the contractile properties of the extensor muscles in the wrist.
• Medical treatment-For chronic cases, anti-inflammatory medications may not be enough to manage the pain. Cortisone injections can be given and sling immobilization can be used during flare-ups.
• In chronic cases and in rare circumstances, surgical intervention is a last resort.
Sally Cone of Greenfield, IN. stated “I was diagnosed with tennis elbow and I am not sure of what exercises I should be doing?”. Sally these are some exercises you can do only if you are not symptomatic. To add power to your swing and to possibly prevent re-injury or diminish soreness during and after your game, be sure to add these exercises to your overall exercise program. If you're more likely to “hit the net” but not on the court (on the computer), these wrist/forearm/finger exercises could help prevent carpal tunnel syndrome as well as help your tennis elbow. Start out with a lower weight to stretch and work up to a heavier weight to strengthen. After you work up to a strength training program, still incorporate stretches into your routine. If you need pictures of these exercises, please email: tisteinke@iquest.net.
Perform 3 sets, 10 repetitions on each hand for all exercises.
Finger and Wrist exercises:
1) Put an elastic band/rubber band around all five fingers at the knuckle nearest to your fingernails. Place your lower arm on a flat surface, with palm down and your elbow bent. Slowly spread and close your fingers.
2) Use a one to two pound dumbbell or soup can. Place your lower arm on a flat surface for support, hang your hand, palm up, over the edge of the surface. Use your wrist to slowly raise and lower the dumbbell trying to gain as much range of motion as possible.
3) Place your lower arm on a flat surface so your hand hangs over the edge. Hold a light dumbbell or a hammer by its end. Now as if you were hammering, use your wrist to slowly lower the dumbbell/hammer slightly below the surface edge, then lift it as high as you comfortably can.
4) Adapt Exercise 2, by having your palm face to the side, not towards the ceiling or floor. This exercise will help to strengthen the supinators and pronators in the wrist. Use your wrist to slowly lift a (1lb dumbbell- work up to heavier weight) side to side trying to gain as much range of motion possible.
5 ) Stretch your wrist by moving in a clockwise and counter clockwise (rotation) movement, and then moving side to side.
6) Stretch your wrist and elbow muscles by straightening your arm, and with other hand push fingers back gently. Repeat for other side.
7) Stretch your elbow muscles by bringing your arm in towards your chest, with palm up, as you come past the shoulder, palm down, press palm towards the floor and follow through to extend the arm.
8) Ball squeezing exercise-squeeze a small rubber ball that fits into the grip of your hand.
Shoulder and Arm exercises:
1) Codman’s pendulum exercises- For exercises listed below, perform 3 sets of 10 repetitions and use a light dumbbell.
a) Bend over at the waist, let your arms relax and hang freely.. make small circles that slowly increase in size- (first move arms clockwise and then counterclockwise).
b) Bend over at the waist, let your arms relax and hang freely.. then swing one arm at a time in towards the body (adduction), then away from the body (abduction).
2) Flies-Standing, bending forward with arm vertical, with dumbbells in each hand, move arms past the back and then move arms to the side. If you have also been diagnosed with a rotator cuff tear, refrain from doing these shoulder exercises.
3) Tricep-elbow extension-using a dumbbell, the elbow is extended and flexed slowly, do not allow the elbow to rapidly snap into extension. The non-exercising arm supports the humerus.
These are the most important exercises for a muscle-strengthening program for “tennis elbow”, but more weight training exercises can be added to make a more complete exercise program.
Last month I received email from a few individuals with questions. I appreciate your questions and comments. Next article will focus on common lower extremity injuries so please write in your questions and comments to tisteinke@iquest.net.•
What are your thoughts? If you have any comments or questions regarding this article or have questions about fitness in general, please write to Ask The Trainer, Tiffany Steinke at UltraFitt. 7462 East Fishers, Station Drive Suite 437, Fishers, IN 46038 or Email: editor@ultrafitt.com
Tiffany Steinke has always had a passion for fitness and enjoys sharing it with others. She has a Master's degree in Kinesiology from Indiana University in Bloomington. Her emphasis is in Rehabilitation and Conditioning of Special Populations and Sport Athletes. She is also a certified instructor of Community CPR and First Aid by the Red Cross. Tiffany is an accomplished marathon runner, and is currently training for future marathons and triathlons. She is Team Captain for Team-N-Training for the Indiana Chapter Leukemia Society of America. Tiffany is Head Trainer at Family Fun & Fitness in Greenfield.
Join the FREE Fitness Club Now for Weight loss, Strength and Fat Burning Workouts!
BACK TO ARTICLES