By Kathleen Stroia
Special to SportsLine.com
How do I treat tennis elbow?
It is imperative to address the cause of the injury and not simply treat the symptoms.
Initial treatment: There are several, relatively simple steps that can be taken to treat tennis elbow at its onset.
- Modify activity - Rest the sore area allowing time to heal and prevent further injury. Try taking breaks from your computer at work and avoid any activity that aggrivates the injury.
- Use an elbow strap - A strap can help rest the area and take pressure off the tendon attachment. The strap can be worn during work and/or while playing tennis.
- Use a wrist brace/splint - This keeps the wrist from going backward and takes stress off of the muscles and tendons at the elbow.
- Anti-inflammatory medication (such as ibuprofen or aspirin)
- Physical Therapy/Athletic Training - Treatment may consist of soft tissue and joint mobilization to the shoulder, elbow, wrist and hand, as well as ultrasound, ice and/or iontophoresis (driving anti-inflammatory medication into the injured area) to the inflamed tissues.
Therapeutic exercises:
You can increase your elbow's range of motion by performing proper stretching exercises, particularly to the forearm. Therapeutic exercises strengthen the muscles which extend the wrist, affecting the backward movement of the wrist and hand through essentric movement (lengthening the involved muscle with controlled foreward movements of the hand and wrist while holding a weight)
- Scapular stabilization exercises of the shoulder will help achieve better stroke technique. The primary purpose of these exercises is to strengthen the stabilizer muscles which control the shoulder position and emphasize overall proper posture.
These should be followed by exercises of the dynamic muscles which perform the movement of the shoulder and arm (i.e. rotator cuff).
- Core trunk stabilization exercises will enhance lower body mechanics. The primary purpose of these exercises is to strengthen the trunk stabilizer muscles which control the trunk muscles and proper posture for ultimate mechanics of trunk movement.
Core trunk stabilization exercises also strengthen mobilzer muscles which are used to perform efficient and dynamic movement with power.
Studies show that modifying strokes, along with usual conservative treatment (stated above) achieved good results in 82-90 percent of patients diagnosed with tennis elbow. Therefore, early intervention, including physical therapy, is paramount.
Intermediate treatment: If conservative treatment has not been effective, your physician may recommend a cortisone injection. Proper rest following an injection is essential. Refer to your physician for recommended dose, frequency and precautions regarding cortisone injections. It has been documented that repeated cortisone injections could cause damage to healthy tendons surrounding the injury site.
Long term treatment (for chronic sufferers):
Surgery is rarely recommended unless symptoms continue and interfere with your daily activities or sleep. There are two common types of procedures most often performed today:
1. Removal of damaged tissue within the tendon (shaving down the bone and reattaching of the tendon)
2. Arthroscopic surgery - physical therapy is resumed following surgery.
Does your equipment measure up?
Grip size: A proper fit is essential. A grip that is too small or too big may result in less control and excessive wrist and forearm movement. Check with your certified tennis instructor to ensure the proper fit.
String size and tension: While higher string tension may improve ball control it also increases the amount of torque and vibration experienced at the arm. Loosen your strings to decrease this vibration. Also, using a thicker string can reduce vibration. Remember to change strings as often as necessary to insure integrity -it is recommended that recreational players change synthetic strings two times a year. Vibration dampening devices provide no significant decrease in the amount of vibration traveling into the arm.
Racket type: It is recommended that you test as many rackets as possible before deciding which to purchase. Consult with a pro or qualified salesperson to find one that is suited to your style of play.
- A graphite composite is considered best for shock (vibration) and torque control
- An oversized racquet has a larger sweetspot, however if the ball is hit outside this area it is more difficult to control, thus creating excessive torque or torsion (bad for tennis elbow)
- A more flexible frame generates less shock-load to the arm than a stiffer one
- Heavier rackets vibrate less - you can increase a racket's overall mass by adding lead tape to the racquet (add tape to the handle and NOT the head of the racket - head-heavy rackets cause more stress).
- The ideal racket has a high sweet spot, combined with a head-light balance and adequate mass. Customizing you racket with lead tape can help achieve this
Balls: Heavy balls may cause additional stress to the arm. It is important to change balls frequently especially when playing on clay.
How do I prevent tennis elbow?
- Select proper equipment
- Take tennis lessons from a certified tennis instructor, who will focus on technique
- Practice proper lower body mechanics such as forward weight transfer with trunk, neck and shoulder stability and mobility. This enhances stoke execution and decreases muscle tension overload.
- Check your health and fitness levels with a physician before beginning physical activity
- Do sport-specific exercise away from the court. Incorporate trunk and shoulder stabilization and flexibility programs into your general exercise routine (ask a physical therapist or certified athletic trainer for this program). If this is not incorporated, muscle imbalances may occur which could effect performance and increase your risk for injury.
- If pain occurs, immediately follow the guidelines listed in this article
It is important to address injuries, such as 'tennis elbow' at the onset. Early intervention can address the problem and keep you on the court. Prevention is the key to safely enjoying any activity. Following preventative tips will contribute to enhanced performance giving you that competitive edge!
Kathleen A. Stroia, MS, PT, A.T.,C. is the Associate Vice President of Sports Sciences and Medicine for the WTA. Miss Stroia earned a B.A. in Athletic Training from Purdue University, an M.S. in Athletic Training from West Virginia University and a B.S. in Physical Therapy from Chicago Medical School. Her position with the WTA includes setting standards for tournament physicians and overseeing the tour's Player Development Program.
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