This painful condition, in more medical terms referred to as "lateral epicondylitis," develops on the outer portions of the elbow as a result of repetitive overuse.
It may not seem serious, but it can get worse. A mild case of tennis elbow may not seem like a big deal. If you don't take care of early symptoms, however, they can progress to a severe and chronic disability leaving you unwilling to open doors, shake hands or even drink soda with your injured arm.
It's important to treat elbow injuries early with conservative methods, including physical therapy, oral medication, rest and correction of poor technique. If these methods fail, you may need more drastic measures such as injections and/or surgery.
Tennis players aren't the only ones at risk for problems in the forearm and elbow; bowlers, golfers, cross-country skiers, softball players and racquet-sport players also are susceptible. Repetitive activities of daily living or employment - scooping ice cream, supermarket checking, gardening, lifting suitcases, carrying a briefcase - can also cause or aggravate elbow problems.
Inflammation of the muscle-tendon junction at either side of the elbow joint is called epicondylitis. It can occur in any activity that requires a repeated, forceful gripping motion and contraction of these muscles. The inflammation occurs when you strain the tendons that connect the muscles of the forearm to the side of the elbow joint.
Contracting, twisting, flexing and extending the muscles improperly cause microscopic tears and inflammation in the stressed tendon. The pain is usually burning, stabbing or tearing and is felt on the inner or outer side of the elbow.
It can radiate to the shoulder or the wrist and is usually made worse by gripping with your fist or extending the arm. In a severe case, even holding a cup or hairbrush can be painful.
Who's At Risk?
Beginners as well as experts can develop this problem. To some degree, susceptibility depends on strength, flexibility, technique and equipment. In tennis players, the injury often occurs among recreational players between 35 and 50 years old who play three or more times a week.
Does everyone who plays tennis get tennis elbow?
Almost half of those who play daily develop tennis elbow. Occasional players rarely play often enough or hard enough to overstress their arms, and professionals are usually protected by their muscle strength and training.
Epicondyle tendinitis often occurs in a weaker player developing a new stroke or using a tightly strung racquet. To stroke correctly use your legs, trunk and shoulder to power your stroke instead of flailing with your arm or wrist.
During a stroke, the elbow should be fully extended with a firm wrist so the force is transferred to your shoulder. Beginners can start with a two-handed stroke until they develop the necessary strength.
If the racquet is tightly strung or has a very stiff frame, impact from hitting the ball may be transmitted to your forearm muscles. Using a lighter, midsize, loosely strung racquet may help. Cushioned grip hands around the handle of a racquet or golf club may help reduce impact, shock and vibration.
Using a larger grip may also reduce the pain by decreasing the gripping pressure at the wrist. Biomechanical studies of skilled players have shown they reduce racquet acceleration to zero just before impact with the ball. This apparently lessens grip pressure.
Preventing Tennis Elbow
The best defense against tennis elbow is to strengthen and stretch the forearm muscles. One of the easiest exercises is to hold your arm and wrist straight out and squeeze a tennis or racquet bail 40 to 50 times. You also can use weights to strengthen the muscles. Stretch the muscles by doing prayer motions with fingers pointing up and down.
If you develop tennis elbow - reduce your activities until the pain disappears. Use ice (a pack of frozen peas works well) directly over the tender area 10 to 15 minutes three times a day. Begin a very gentle stretching program. With your arm extended, flex the wrist back until you feel tightness, then hold. Do not overstretch.
Use an elbow brace to support the forearm muscles and reduce the forces transmitted to the tendons. The brace constricts the muscle and takes the pressure off the tendon. See a doctor for further evaluation and a possible referral to physical therapy for a supervised stretching and strengthening program.
What else can you do?
Always lift objects such as backpacks and suitcases with your palm up to avoid irritating the tendon during daily activities. If you've been in pain for a while, don't overdo the exercises. Start slowly - it may take four to six weeks to regain substantial muscle mass.
Is Surgery Necessary?
If conservative treatment is unsuccessful, injections and/or surgery may become necessary. These more drastic measures may provide some relief, but they're unlikely to restore your arm to its preinjury strength and flexibility levels. If your elbow soreness doesn't disappear within two weeks, be sure to get treatment until the pain does disappear.
A two to three-month course of physical therapy is recommended before receiving an injection. You will learn a series of stretching and strengthening exercises that should become part of your training even after you have recovered, in order to prevent a recurrence.
Along with physical therapy your physician may recommend a two to three-week course of nonsteroidal anti-inflammatory drugs. These drugs, such as Clinoril, Feldene, Naprosyn and Motrin, can help reduce swelling and inflammation. They affect people differently, so if one type doesn't seem to work, ask your doctor for a different one.
Acupuncture has also been successful at treating tennis elbow, and a course of treatment of this mildly invasive procedure should be tried before submitting to the surgeon's knife.
A cortisone injection may provide some relief, but a recent study indicates that more conservative treatment works better in the long run. More than one or two injections may do more damage than good - too much cortisone can cause the tissues to deteriorate, giving the surgeon that much less to work with.
Surgery entails removing the tendon from the bone, scraping off built-up scar tissue and reattaching the tendon lower on the bone to release some of the tension. After surgery you'll need a long period of recovery and physical therapy before you return to action. Be cautious about injuring the site again.
More often than not, chronic elbow pain is caused by improper technique or overuse. Get some lessons to correct your form from a pro who's familiar with elbow problems, and treat your injury at the first sign of symptoms.