How To Manage Tennis Elbow


I wanted to talk about tennis elbow because I am experiencing a bout of it. The funny thing about being a physical therapist is that I wish I could treat the pain I am feeling with the knowledge that I have. However, it does not work that way. It is a good reminder for me as a patient that it’s not super exciting to do the work that it requires to get past a bout of pain. 

 

What Is Tennis Elbow 

 

The specific medical diagnosis of tennis elbow is lateral epicondylalgia. It used to be lateral epicondylitis because we thought it was an inflammation problem. However, it was found out that it was a problem due to repetitive activities. 

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I have seen tennis elbow with many tennis players. Some of the reasons why this happens to tennis players are the following:

 

Gripping the racket too tight – If you grip the racket too tight, you can see the muscle by your elbow that kind of protrudes out. That muscle is the one that gets irritated when you have tennis elbow. Gripping the racket too tight and for a really long time, it starts to fatigue the muscle out and causes the pain there. 

 

Using your arm too much – When you use your arm too much, you do not use your full body, your core, or your legs to generate power. Because you are only using your arm, it could cause irritation to the elbow. 

 

Hitting the ball late – If you hit the ball behind you rather than out in front of you, you are putting more load on your elbow because your wrist is at a funny angle. When you are hitting the ball right in front of you, you have length through your arm. When you are hitting the ball behind you, it’s a little more crunched in and increases the load to the elbow. 

 

Having improper form – One thing that comes to mind is when you are a tennis player who slices a lot on the court. You are not lengthening your arm and your wrist can be doing a lot of movement and this ends up putting a lot of strain up on the elbow. 

 

If you are not a tennis player, you can still get tennis elbow. The common causes that I see are the following:

 

Typing – If you are at a desk and your wrist and your hands are kind of back, rather than having a nice flat surface from your elbow all the way to your fingertips, it can cause irritation on your elbow and could eventually become tennis elbow. 

 

Caveat In Tennis Elbow 

 

Sometimes, you have neck issues and it can refer pain to your elbows. It might look like it is tennis elbow but it ends up being a neck issue. So the things I am going to share below will help you with your tennis elbow issue but if you notice that it will not help you, you might be experiencing a neck issue. 

 

What You Can Do To Help With Your Tennis Elbow Issue 

 

If you are current playing tennis right now, or you are typing a lot at your computer, you want to try to do things to alleviate the pain so you can continue doing those activities. 

 

The first thing you can do is to take some time to rest or a break from the activities you are doing a little more frequently. It does not mean to totally stop, but just find some time to take a break. For example, if you’ve been typing for an hour straight, now would be the time to take a break and move around so that your muscles get a little bit of rest. If you are playing tennis for a bunch of hours, make sure to take 15 or 20 minutes break so the muscles can have time to recover during your sessions. 

 

The next tip I have is heating up your muscles. Before I do any strengthening or mobility stuff for my elbow, it’s best to heat up the muscle there because it increases blood flow to the area. So when you are doing the mobility or strengthening activities, it improves your performance. If you want to use ice, it’s best to do this after doing the activities. Tennis elbow, like what I said, is not an inflammatory problem and is instead because of a repetitive use problem. Ice might not always help the issue per my experience because putting ice on your elbow makes it stiffer and more uncomfortable. So, I find that heat is a better option for me. 

 

Another tip is to do soft tissue mobilization. If you do not have a physical therapist or massage therapist working with you to help massage the elbow area, what I recommend is grabbing either a tennis ball or a yoga tune-up ball. You press the ball into the midi part of your elbow into the wall and roll the ball side to side and up and down. On top of that, once you’ve done that for two to three minutes, press the ball into the wall and move your wrist forward and backwards, side to side, and in circles to help the tendon glide better. With tennis elbow, the tendon gets a little bit stiff and by adding movement to the muscle on the tendon there, it would help decrease the stiffness and ideally decrease the pain, too.  

 

After doing soft tissue mobilization, I recommend moving right into the strengthening activities you need to do. The most obvious one is doing wrist extension, which essentially means putting a weight in your hand and having your hand off the edge of a couch or a table then pulling your hand back and lowering the weight down. I recommend using your opposite hand to help lift the weight up and slowly lower the weight. What this does is helps lengthen the muscle while strengthening at the same time. With tennis elbow, the issue is that the muscle is active in a shortened position. So this type of strengthening exercise helps to strengthen it in a lengthened position so the muscle starts to feel a little bit better and less sensitive. 

 

Other Wrist Strengthening Exercises You Can Do 

 

You can flip your palm up towards the ceiling or lift your hands up towards your nose in a way you can have your thumb up towards the ceiling. Flip your hand back and forth to help strengthen all those muscles up around the elbow. 

 

Working On Your Shoulder Strength 

 

The muscles between your shoulder blades can be strengthened through rows or using giant gym balls to make Is and Ts. Anything that helps strengthen the muscles between your shoulder blades is also helpful for tennis elbow because it helps take the pressure off of the elbow and put more off the load when you are doing your activities into your shoulder. 

 

This is particularly important in tennis because you don’t want to be particularly using your lower arm in the sport. You want to use your whole arm for it. 

 

Core Strengthening 

 

The more that you are strengthening up your core when you are doing activities like hitting your forehand or doing your volleys, you can take that movement from your trunk and displace the load from your elbow to your trunk. Doing rotational strengthening can be helpful to de-load the elbow particularly in tennis. 

 

When you are sitting in front of the computer, strengthening your core can help you have better alignment when you are sitting. When you have better alignment, your elbow will be in a better position so you won’t get so much pain in your elbow. 

 

Conclusion 

 

The thing to know about strengthening is it does take time. You might not see any strength changes for three to four weeks so it might take some time before the elbow is really starting to feel better. Mobility is the last piece I want to leave with you. Make sure that you stretch the muscles through your forearm, lengthen the muscle out, desensitize the tissue there so you do not get any pain, and ensure the mobility of your shoulders, your thoracic spine, your mid-back areas so you can be a little bit more open in your posture, which tends to lead to less stress to your elbows. Just make sure to move in and out of positions so it can help your elbow health and overall health. 

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