Although it is called “Tennis Elbow”, not only tennis players get it. Actually, in 95% of the cases, tennis elbow is seen in people who are not sportsmen at all, but their profession requires them to overuse the hand extensor muscles (car mechanics, cooks, people who work on the computer, gardeners, violinists, etc.). Of course, people who play other sports can get it to, and they share the remaining 5% of the cases with tennis players – handball and hockey players, javelin throwers, climbers, CrossFit athletes, etc. As for recreational tennis players, reports say that 50% of them will report some degree of tennis elbow symptoms at least once during their career. This means that half of you out there will get it in case you don’t take it seriously.
Here are 5 things you need to know about tennis elbow in case you are a recreational tennis player.
The medical term for what we all know as “Tennis Elbow” would be lateral epicondylitis. The elbow attachment point of the muscles and tendons that extend the fingers and the hand gets damaged, and an inflammation develops, causing pain in the elbow area - the outer part of the elbow, to be more precise. It is one of the most serious elbow injuries a tennis player can develop.
Many people don’t pay attention to the early warning signs, or simply wait for the pain to pass. Not taking a step back after the pain starts often leads to many months of pain without treatment, and when a player finally seeks help, the damage has already been done.
The damaged muscles are located on the outer side of the forearm and are joined through the tendon to the outer side of the upper arm. Therefore, people with tennis elbow feel intensive pain in one particular spot of the elbow – lateral epicondyle. The pain sometimes expands all the way down to the wrist.
Other symptoms are:
The elbow pain is caused by the forearm muscle and tendon damage, and the damage is caused by overuse – frequent and repeated actions of the arm. The reason that the recreational tennis players suffer from tennis elbow is putting excessive stress on the tendons and muscles that are not prepared to handle it, and poor or wrong stroke techniques. Also, people who have poor shoulder motion tend to overuse their elbow as a substitute for the movement.
The most common cause of tennis elbow in tennis players is bad backhand technique (not hitting the ball in front of the body with a straight, firm wrist, but keeping it flexed), although it is quite common to get developed on forehands as well (for example, slapping on forehands would be one of the most frequent mistakes). Especially beginners tend to snap their wrist forward while hitting ground strokes or serves, so the repetitive flexion strains the tendons in the elbow at the point of insertion. The injury can also be the consequence of bad timing – being too late on the shot, because the player overuses and flexes the wrist in effort to pull the racket back and to save the shot.
The damage usually develops gradually – the muscle attachment develops tiny ruptures over longer period, but it is not uncommon to occur suddenly as well, usually as a result of a mishit. Quite common sudden injuries would be while hitting an overhead or a service. The injury occurs often when recreational players try hard to impersonate pro players and their advance shots while unprepared and under-skilled.
Another reason for developing a tennis elbow would be poor eyesight and poor hand-eye coordination, because the chances for hitting the ball in the sweet spot of the racket reduce with poor eyesight.
Wrong tennis equipment can also cause this injury, e.g. a racket that is too long, too heavy or too light, that has wrong kind of strings or wrong grip size (usually too small). Racket that is too light doesn’t have the strength to absorb the impact shock and the arm tends to twist more easily, and a racket that is too heavy places more weight on the tendon while snapping the wrist, causing it to stretch from the wrist to the top of the elbow. Racket strings that are too stiff, like super stiff Kevlar or poly strings, are extremely hard on the arm, because a lot of the impact shock goes straight to and through the arm, causing more repetitive jarring stress. Even hard-core string breakers start experiencing elbow problems after a while and are forced to find an alternative.
There are numerous tennis elbow treatment strategies and they depend on the stage and damage degree. Players who start to feel discomfort should modify their training techniques immediately make sure they don’t overdo it on the court, but take brakes.
When the pain starts, the first thing the doctor would say is to rest and cool the painful area with ice (15-20 minutes, few times a day), compress the arm and elevate it. Massaging the painful area is also a good remedy for tennis elbow, because a massage will improve circulation and sooth muscles that are sore.
After the resting period, there are various methods of physio (electrotherapy ultrasound, magnotherapy, shockwave therapy) and manual therapy, as well as daily stretching exercises that should be included, because they have very good results. The exercises are focused on improving the flexibility and strengthening the forearm muscles – flexor, extensor and grip muscles. Exercising is important, because too much rest and immobilization can result in weakness and muscle atrophy, and is helpful to bring fresh blood supply.
Some of the natural ways to cure tennis elbow would be consuming ginger and turmeric, because both have anti-inflammatory properties, and on top of that, turmeric is rich in antioxidants. Staying away from processed foods that are high in sugar, sodium, saturated and refined fats and alcohol would be a good idea. Stick to high-potassium and magnesium foods, like coconut water, greens, bananas and avocado. Choose clean proteins, berries, citrus fruit, pineapple and melon.
After the period of daily exercises, the next phase would be the return on the court. This should be carried out with much attention to the correct technique and timing, with minimal usage of strength. A player should start playing within the service-lines, focusing in the forehand and backhand. The next step would be moving to baseline and hitting forehands and two-handed backhands, then flat backhands and finally slice backhands. Volleys, smash and service should be introduced slowly, as well as a practice match, and finally, a real match.
Some players are prescribed a corticosteroid injection, which has proven to be a good short-term solution, but a bad long-term one, since it weakens the tendon tissue. Other conservative methods are local application of steroids, non-steroidal anti-inflammatory drugs, wearing a counter force tennis elbow brace
Last resort would be a surgery, usually if the issues prolong for more than a year, and the need of a surgery is extremely rare - in about only 5% of the cases.
Always bear in mind that some players were forced to withdraw permanently after trying to pull off a shot they were not ready for. Spending the rest of your life just watching other players play and not being able to play yourself is not worth skipping warmups and focusing on improving your techniques.
Prevention of Tennis Elbow is key and something you should always keep in mind if you are a tennis player, because this condition can be quite challenging to deal with if it progresses to a chronic level. Sometimes players deal with pain between six months and a year, before they can enter the rehab phase.
The best way to prevent the Tennis Elbow would be to constantly paying attention and working on developing correct techniques. Always bear in mind that proper tennis moves are smooth and easy, and of course – painless. Good would be to consider taking lessons to correct and perfect your form, as a good form will prevent placing unnecessary demands on your arm and body.
When hitting a forehand, try not to slap it, but swing the racket. The weight of the racket will create a momentum, so the wrist won’t break on contact and it won’t put the pressure on the tendon. When hitting a backhand, make sure the forearm is not rigid, wrist isn’t flexed and you follow through properly. Pay attention on the timing and setup in order to get the racket back early. Hitting the ball in the racket’s sweet spot reduces the vibrations and stress on the muscles and tendons.
Sufficient warm-up period and stretching should not be overlooked as well, although many players tend to (especially those weekend warriors). Especially important is stretching the shoulders, because the shoulders are the parts of your body which should absorb the impact shock. Plus, good shoulder motion will prevent a player to over utilize their elbow.
Each player should also pay attention to strengthening the hand, wrist and forearm muscles, as strong arm muscles will reduce the elbow strain. Working on other, larger muscles is a way to take the pressure off the elbow join, so a player needs to make sure his core, legs and back muscles are equally strong.
Tennis equipment is just as important, so a player needs to pick out a flexible racket, as the flexion would absorb much of the impact shock. The recommendation is to give that extra cash to string the racket with gut rather than synthetics, since some of the synthetics are harder and less forgiving.
The tension in the strings should be relatively low, as the impact shock duration would be less and the stress on the arm would reduce. Thinner strings are better that the thicker ones, as they absorb the impact shock more efficiently.
And the last and very important lesson would be to always bear in mind that although a high-level player, sadly, you are not a pro. Pro players spend most of their days on the court, they work intensively with experts to improve their conditioning, techniques and to use optimal equipment. Therefore, cases of pro tennis players suffering from tennis elbow are extremely rare and not as prevalent as in the recreational tennis player population. You shouldn’t overdo it either. Playing three sets, three or more times a week is too much, and tennis elbow symptoms are seen more often in players who are unrealistically overambitious. Just take it easy, enjoy the game and protect your health.