Tennis Elbow

(Lateral Epicondylitis)

Tennis elbow is an overuse injury. It's caused by repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist. The repeated motions and stress to the tissue may result in inflammation or a series of tiny tears in the tendons that attach the forearm muscles to the bone at the outside of your elbow.

Tennis elbow (lateral epicondylitis) is one of several overuse injuries that can affect your elbow. Tennis elbow is most common in adults ages 30 to 60, but the condition can affect anyone who repetitively stresses the wrists. Tennis players, carpenters, gardeners, dentists and musicians may be at particular risk. Left untreated, tennis elbow can result in chronic pain, especially when lifting or gripping objects.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to the bony prominence on the outside of your elbow (lateral epicondyle). Pain can also spread into your forearm and wrist.

Signs and symptoms of tennis elbow may include

  • Pain that radiates from the outside of your elbow into your forearm and wrist
  • Pain when you touch or bump the outside of your elbow
  • Pain when you extend your wrist
  • A weak grip
  • A painful grip during certain activities, such as shaking hands or turning a doorknob

Initial treatment of tennis elbow may include:

  • Analyzing the way you use your arm. Your doctor may suggest that experts evaluate your tennis technique or job tasks to determine the best steps to reduce stress on your injured tissue. This may mean going to a two-handed backhand in tennis or taking ergonomic steps at work to ensure that your wrist and forearm movements don't continue to contribute to your symptoms. By keeping your wrist rigid during tennis strokes, lifting or weight training, you use the larger muscles in the upper arm, which are better able to handle loading stress.

  • Rehabilitation. Your doctor or therapist may suggest exercises to gradually stretch and strengthen your muscles, especially the muscles of your forearm. A Corrective Exercise Specialist is trained to locate and address muscular and functional imbalances that may have contributed to the forearm pain. A specific rehab program needs to be designed for each patient for every injury is different.

  • Physiotherapy: Conservative treatment including ultra-sound, electrical stimulation and joint mobilization. Active Release Techniques (ART) is a very effective way to treat tennis elbow. A Certified Chiropractic Sports Physician is trained to adjust the elbow for proper realignment. The wrist, shoulder and spine should also be adjusted for proper alignment.

These steps may help you prevent a tennis elbow injury:

  • Review your technique. Have a tennis professional review your technique to see if you're using the proper motion. Swing the racket with your whole arm and get your entire body involved in the stroke, not just your wrist. Keep your wrist rigid during ball contact. Also, make sure you have the proper racket grip size and string tension. Lower string tension of around 55 pounds transmits less force up to the elbow.

  • Build your strength. Prepare for any sport season with appropriate preseason conditioning. Your exercise program should be designed by a professional, such as a Corrective Exercise Specialist or Performance Enhancement Specialist, for optimal results.

  • Keep your wrist straight. During any lifting activity, including weight training — or during tennis strokes, try to keep your wrist straight and rigid. Let the bigger, more powerful muscles of your upper arm do more of the work than your smaller forearm muscles do.

  • Warm up properly. Gently stretch the forearm muscles at your wrist before and after use.

  • Use ice. After heavy use of your arm, apply an ice pack or use ice massage. For ice massage, fill a sturdy paper or plastic foam cup with water and freeze it. Then, roll the ice directly on the outside of your elbow for five to seven minutes.

Follow the instructions for P.R.I.C.E. — protection, rest, ice, compression, elevation:

  • Protection. Protect your elbow from further injury by not using the joint. If a particular sport or work activity causes symptoms, you may have to stop the activity until your symptoms improve.
  • Rest. Give your elbow a rest. But don't avoid all activity. Sometimes, wearing a forearm splint at night helps reduce morning symptoms.
  • Ice. Use a cold pack, ice massage, slush bath or compression sleeve filled with cold water to limit swelling after an injury. Try to apply ice as soon as possible after the injury.
  • Compression. Use an elastic wrap or bandage to compress the injured area.
  • Elevation. Keep your elbow above heart level when possible to help prevent or limit swelling.