By Jennifer Jenkins, DPT
CPAT Columbia
Its springtime! That means that it is time to get back to all your favorite outdoor activities! But don't forget to protect yourself. One injury that pops up frequently in the spring is tennis elbow. However, tennis elbow does not only occur after playing tennis. Other sports, gardening, typing, driving, carpentry, knitting, and painting are just a few of the many activities that can cause tennis elbow.
Tennis elbow is the common name for a condition clinically known as lateral epicondylitis. Lateral epicondylitis is a pathology that forms in the tendons of the muscles that extend the wrist. These are the muscles that work to bring the back of the hand toward the elbow. The tendons become strained or overused and an inflammatory process takes over that can lead to degeneration of the tendon.
Symptoms: A patient with tennis elbow will feel pain on the outside of their elbow that is worse with wrist movements. This pain is usually initiated by repeated wrist extension against resistance. This motion occurs commonly with many racquet sports because the athlete must stabilize the racquet in the hand against the force of the ball. The onset of pain may occur due to one large force that strains the muscles. More commonly however, it is the result of repetitive wrist motion against small amounts of force. In these situations the pain may be delayed up to 24 to 72 hours.
Treatment: Treatment in the initial phase of injury centers upon rest and ice. The tendon needs time for the healing process to occur. Soft tissue therapy, taping techniques, and modalities such as ultrasound and electrical stimulation are also beneficial to promote healing and decrease pain. Gentle stretching at the wrist and elbow are initiated as pain allows. Strengthening must be component of the rehabilitation program in order to return to full function. It is also critical to address any dysfunction occurring throughout the arm, shoulder, neck, and core. Especially with sports, limited motion, weakness, or instability throughout the body can put the wrist and elbow at risk for injury. Without a comprehensive rehabilitation program, injuries are likely to reoccur.
Prevention: Proper form plays an important role in prevention of lateral epicondylitis while playing tennis, squash, or racquetball. Poor backhand technique with the elbow leading and an unstable wrist is the most common predisposing factor. Hitting with excessive top spin on the forehand or with increased wrist motion during a serve can also amplify strain at the elbow. It is important for all shots that the athlete's body is in correct position so the power comes from the body instead of the relying on only the forearm muscles. Playing with a new racquet, wet balls, or into the wind can compound the abnormal forces occurring due to the problems with form and create elbow pain.
Proper equipment can also reduce the risk of injury during racquet sports. Newer racquets are lighter and stiffer which increases power. However, these modern racquets do not shock absorb as well as the older, wooden racquets. To decrease the force transmitted from the racquet to the arm, alter the racquet by lowering string tension, increasing the size or weight of the racquet head, or grip higher on the handle. Changing the grip size can also reduce risk of injury. In general, experts recommend a mid-sized, graphite racquet with a comfortable grip.
These concepts of proper form and equipment also apply to pain prevention with activities not related to sports. For proper rehabilitation, it is important to identify the activity that causes the pain in order to ensure the tools and techniques used are minimizing the amount of stress on the wrist and elbow.
It is important to remember that not all lateral elbow pain is lateral epicondylitis. Pain in the elbow can stem from numerous sources including nerve entrapment and degenerative diseases. It is also very common for pathology at the neck to mimic symptoms in the elbow. Therefore, it is always best to seek professional medical evaluation and treatment from a physical therapist or medical doctor when experiencing elbow pain.
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