Although tennis players to the south enjoy their passion outdoors throughout much of the year, those in the northern tier of states are confined to indoor courts until the warm summer breezes finally arrive. To maximize the competitive pleasures of those precious fair weather months, it’s important for players to minimize the impact of common injuries like tennis elbow.
What is Tennis Elbow?
According to the Mayo Clinic, lateral epicondylitis, commonly referred to as “tennis elbow,” may develop when tendons and muscles are subjected to undue strain. Repetitive motions, excessive activity and/or a grip that is too tight may bring on the condition. According to Drs. Finestone and Rabinovitch, overuse specifically “causes micro-tears near the origin of the extensor carpi radialis brevis (ECRB) at the lateral epicondyle.” This process may lead to the, “formation of fibrosis and granulation tissue.” Tennis elbow is often diagnosed with the aid of an ultrasound or an MRI.
Many tennis players suffer from tennis elbow at some point in their lives. The Cleveland Clinic estimates that approximately 10-50 percent of players will develop tennis elbow. Overall, the condition afflicts between one and three percent of the population, in part because it plagues athletes and workers alike. For example, carpenters, painters, plumbers, and butchers may develop the condition as well. It is relatively common in any sport that requires a strong grip, including tennis, golf, baseball and bowling. The injury is somewhat more prevalent among men than women.
Treatments for Tennis Elbow
There are a wide array of tennis elbow treatment options. Mild cases of tennis elbow are sometimes self-healing – that is, they may get better over time even without treatment. However, many tennis players and others with the affliction often resort to a number of readily available treatments to speed recovery:
Anti-inflammatories – Since inflammation is the problem, treatment with over-the-counter, non-steroidal anti-inflammatories (NSAIDS) is common, like ibuprofen, aspirin or naproxen. However, long-term use of these anti-inflammatories can cause side effects like gastric distress.
R.I.C.E – As with other joint and tissue injuries with inflammation, self-treatment often consists of R.I.C.E – rest, ice, compression & elevation. First, it is important to rest the injured area to avoid aggravating the injury. However, rest does not mean immobilization. It is vital to keep the elbow mobile enough that blood properly flows to the impacted area. Icing the injured area reduces inflammation. There are slightly different recommendations regarding the frequency and duration of icing, although icing the inflamed area for 10-15 minutes per hour is a good rule-of-thumb. Compression can reduce swelling, although it is important to avoid compression to the point of inducing pain or tingling. Finally, elevation of the arm above heart level further reduces swelling by limiting any pooling of blood in the injured area. In most cases, R.I.C.E treatment should continue every 4-6 hours for 48 or even 72 hours after the injury occurs.
Massage – Self-massage can improve blood flow and loosen tendons, ligaments and muscles. A licensed massage therapist may offer targeted treatment that addresses the underlying issues in a more focused way.
Physical therapy – A physical therapist can customize a structured treatment protocol for each patient. Rubber band and ball squeeze exercises may be part of the prescribed regimen. A tennis player can learn exercises and stretching techniques for use in the future as well.
Acupuncture – An article published by the Healthcare Medicine Institute suggests that acupuncture may be effective in treating tennis elbow. It highlights the results of a study in which 90 athletes participated. Thirty subjects received acupuncture only, and 30 more received massage only. The 30 other subjects received both acupuncture and massage. The researchers at the Guangzhou Physical Education Institute concluded that acupuncture is both safe and effective in the treatment of tennis elbow.
Ultrasound – Physical therapists, trainers, chiropractors and others often use ultrasound treatments to accelerate healing. Ultrasonic waves improve blood circulation and loosen tight tissue. It is also possible for an injured athlete to invest in an FDA-approved portable ultrasound unit. Although consultation with one’s physician is always important, it may be advisable to treat the elbow area for 15 minutes at a time up to three times a day. A gel is applied to the area, and the ultrasound wand is moved in small circular motions. Ultrasound treatments may allow a player to return to the court more quickly, or to move on to stretching and other therapeutic exercises that further loosen the joint and surrounding tissues.
Injections – When significant symptoms persist for 6-8 weeks or so, corticosteroid injections may be an option. Such injections can reduce persistent swelling and promote healing.
Surgery – Approximately five percent of patients will not respond to more conservative therapies. In these more difficult cases of tennis elbow, a primary care provider will often refer a patient to a specialist. An orthopedic surgeon may examine a more severe case of tennis elbow to determine whether surgery is appropriate.
There are a number of things an athlete can do to minimize the chance of future episodes of tennis elbow.
Stretching – Stretching the fingers, wrist, forearm, and elbow may offer both short-term relief and long-term resistance to further injury. One key advantage is that it is possible to do stretching exercises almost anywhere, at any time.
Exercise regimen – A regimen of concentric and eccentric exercises was first proposed in 2003 by Dr. Ernest Johnson, an Ohio State University researcher. In 2008, Drs. Finestone and Rabinovitch followed up on the earlier research by publishing a specific exercise regimen in the August 2008 issue of Canadian Family Physician. The study’s co-authors conclude by asserting, “The eccentric and concentric treatment regimen that we describe is inexpensive, convenient, and, in our experience, effective.”
A player may begin with a one or two-pound dumbbell and move up to heavier weights over time. First, one sits on a chair, adjacent to a table. With the palm up, the elbow is flexed to 90 degrees before it is extended to 180 degrees. The dumbbell is slowly raised and lowered to a maximum of 10 reps. After the first set of up to 10 reps, the player rests for several minutes before proceeding to a second set. The player should not continue if there is excessive pain. Also, it is important to consult with your physician if the exercise regimen does not reduce pain after several weeks. Otherwise, exercise with the dumbbell daily for approximately three months.
Aerobic activity – As with virtually every sports injury, prevention is the best “cure.” Regular aerobic exercise improves cardiovascular health which promotes blood flow to soft tissue, including elbow tendons. For example, a regular aerobic activity might consist of 20-30 minutes of exercise, five times per week.
Tennis Elbow Brace
Bracing may reduce the incidence of tennis elbow by targeting pressure across the extensor muscles. To relieve pain, the Cleveland Clinic suggests “the use of a counterforce brace, an elastic band that wraps around the forearm just below the injured elbow.”
Mueller Sports Medicine offers several elbow supports, including the HG80® PREMIUM TENNIS ELBOW BRACE. This brace is very comfortable, thanks in part to the use of an improved inner liner material and a soft-feel gel pad. Mueller’s very own HydraCinn® fabric is a latex-free, breathable material wicks moisture away from the skin, and it includes an AEGIS anti-microbial treatment. The HG80 brace is available in both regular and large sizes. For more information about Mueller’s elbow braces and supports, please contact us.