Tennis elbow is a type of tendinitis that at some point sidelines about half of all amateurs who play tennis at least three times weekly. Professional players suffer from it, too.
Tennis players aren’t the only ones at risk for epicondylitis—the medical term for tennis elbow. In fact, the pain is not related to tennis in at least 95 percent of patients. Any activity that calls for forceful, repeated contraction of the arm muscles can bring on tennis elbowfor example, working with carpentry tools, shaking hands, gardening, raking leaves, even tightly gripping a briefcase handle. Baseball, golf, bowling, painting, racquet sports, even darts can bring it on. In most cases the dominant side of the body is affected.
Symptoms of Tennis Elbow
- Tenderness and pain in the muscle connected to the outer side of the elbow
- Pain in the elbow when hitting a tennis ball
- Pain in the forearm and elbow when turning the hand and arm, as in using a screwdriver or playing tennis
- Forearm and elbow pain when lifting a heavy object
What Causes Tennis Elbow?
The injury occurs when you flex, extend, twist, or contract your wrist or forearm excessively or improperly, and thus strain the tendons that connect muscles to the elbow joint. In time, the overstressed tendons develop microscopic tears, producing tendinitis (painful inflammation of the tendons) centered around the epicondyle, the point at which the tendons attach to the elbow. The pain can radiate down to the wrist and up to the shoulder. Moving your arm or gripping something aggravates the pain.
The elbow tendons can develop microscopic tears anytime they are exposed to a repeated stress greater than the tissues can withstand. Experts think it’s not the vibration that causes the tears but excess torsion—for instance, when the ball hits off center, the racquet twists your arm. Pain on the lateral side of your arm (the side your thumb is on) is 10 times more common than pain on the other (medial) side.
For most recreational tennis players, the backhand may be the main culprit causing the condition. However, the serve or forehand may also promote tennis elbow.
To some extent, whether or not you develop tennis elbow depends on the condition of your muscles and how much they are overused. In tennis, the injury occurs most frequently among recreational players who are 35 to 50 years old—a period during which muscles have begun to lose their resiliency—and who play at least two or three times a week. In a study of 2,600 amateurs, almost half of those who played daily got tennis elbow.
Occasional players are less vulnerable, as they tend not to play often enough or hard enough to overstress their arms. Pros are generally protected by superior conditioning and stroking technique, though they, too, can develop tennis elbow as they grow older.
Braces May Help
In one study of 2,633 tennis players who suffered from tennis elbow, 84 percent claimed an elbow brace improved the condition. The brace recommended by most health professionals is called a counterforce brace. This is different from the elastic braces you may find in sporting goods stores—elastic doesn’t give enough support. The counterforce brace functions as a constraint against muscle contraction and excessive movement of the tendons, thus reducing force and overload on the soft tissues of the elbow. A counterforce brace won’t interfere with your game because it does not prevent motion as does a brace with metal supports (such as a knee brace). You can get a counterforce brace through your physician; some sporting goods stores also carry them.
What If You Do Nothing?
Tennis elbow will clear up by itself if you are able to rest and stop performing the twisting motions to the wrist and forearm that initially brought on the pain.
Home Remedies for Tennis Elbow
- Take a break. If you develop tennis elbow, try to reduce the activity that is causing it—or stop completely—until the pain diminishes. If you must engage in the activity, at least try to warm up your arm for five minutes by stretching it and flexing your wrist. Once you start the activity, take frequent breaks.
- For pain relief, anti-inflammatories can help. For mild cases of tennis elbow, nonprescription NSAIDs—aspirin, ibuprofen, or naproxen—will reduce inflammation and pain while you are resting your arm.
- Apply ice or heat. For some people, immersing the elbow and forearm in warm water for 15 minutes several times a day may bring some relief. For others, an ice pack placed on the sore area for 15 minutes several times a day can help diminish the soreness.
- Try an elbow brace. For players persistently troubled by tennis elbow, some sports physiologists recommend the use of an elbow brace, which supports and protects the muscles and tendons of the forearm; this offers some pain relief without drastically restricting movement.
- Avoid repetitive motion and maintain good flexibility and strength in the arm muscle.
These two effective forearm strengtheners can help ward off tennis elbow.
Wrist curls (forearm flexors). Holding a light weight, lay your forearm on a table with your hand over the edge, palm up. Slowly curl up the weight, then lower it as far as possible; repeat. Then reverse the maneuver: turn your palm downward and repeat the curl. Switch arms and repeat.
Arm rotation. Sitting or standing, hold a light weight (one to three pounds) in front of you with your elbow bent at a 90-degree angle and your palm up. Slowly roll your forearm to palm-down position, then return to the starting position. Repeat 20 to 30 times. Switch arms and repeat.
If you play tennis regularly, here are the keys to avoiding tennis elbow. To prevent epicondylitis, beginners should remember that technique and conditioning are far more important than the size or type of racquet.
- Strengthen forearm muscles. This is the best defense for athlete and nonathlete. According to Dr. Robert Nirschl, director of the Nirschl Sports Medicine Clinic in Arlington, Virginia, half the tennis elbow sufferers he sees have some major strength deficits in the shoulder and upper back. The key therefore is to restore strength, endurance, and flexibility to the arm, shoulder, and back. (If you’re under treatment for tennis elbow, you should consult your doctor before embarking on an exercise program.) One simple forearm strengthener is to squeeze a ball 40 or 50 times with your arm extended horizontally in front of you.
- Work on your form. Power your serve and backhand with your legs, torso, and shoulder muscles rather than with your forearm and wrist. During a stroke, your elbow should be almost fully extended but not locked, and your grip should be firm but not viselike, so that force is transferred to your shoulder.
- Try a two-handed backhand. Some teaching pros recommend this technique to beginners. Players who use two hands seldom develop tennis elbow, since the second hand provides additional support.
- Choose the right racquet. Racquets can aggravate tennis elbow. Follow these tips when selecting your equipment.
- Try a midsize racquet. This style of racquet has a bigger sweet spot and absorbs vibration better than a small one. It plays softer and gives more power, so you don’t need to swing as hard. An oversize racquet, in contrast, can increase the risk of the racquet overtwisting if you hit the ball off center.
- Choose a flexible racquet, which will dampen shock effectively. According to Dr. Howard Brody, professor emeritus of physics at the University of Pennsylvania, composite racquets with an increased ratio of nylon matrix, as opposed to epoxy resin, are good models for absorbing shock.
- An increased grip size can also help. Too small a grip can lead to arm-muscle fatigue from overtightening. But too large a grip may put you at a strength disadvantage.
- Lower your string tension to dampen shock. Higher string tension does give more control, but it also increases the shock to your arm after ball impact.
- Consider tennis lessons. A tennis pro can easily help correct any faulty backhand technique and assist you in selecting the tennis racquet that best fits your grip.
Beyond Home Remedies: When To Call Your Doctor
Contact your physician if, despite self-care efforts, your symptoms don’t improve in two weeks.
What Your Doctor Will Do
After taking a medical history and performing a physical examination, your physician may prescribe anti-inflammatory medication and may recommend a course of physical therapy.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media