Are you an avid tennis player that struggles with elbow pain? Many tennis players do at some point in time. The pain on the outside of your elbow is more commonly referred to as “tennis elbow” or more technically as lateral epicondylitis. Back in the 1800s, the sport of tennis spread rapidly in popularity and consequently, so did the amount of people developing this condition called lateral epicondylitis. Therefore, it was given the name of “tennis elbow”, for short, despite the fact that some people who never played tennis still developed it.
Tennis elbow is an overuse injury of the wrist extensors. There could be a couple of tendons involved, but the primary tendon involved is the extensor carpi radialis brevis tendon, or what we sometimes call, the ECRB tendon. The ERCB functions to extend the wrist (not the elbow) so that is why it is classified as a wrist extensor. The wrist extensors have an attachment on the lateral epicondyle of the humerus bone at the elbow, which is a boney protrusion on the outside of the elbow. Any activity that requires the repetitive motion of having the elbow fully extended while the wrist is also extended places excessive stress on the ECRB tendon. That is the reason why swinging a tennis racket can potentially be a cause of lateral epicondylitis; because, in order to control the ankle of your shots you must extend the elbow while you’re engaging the wrist extensors. When the tendon becomes damaged due to over-stress and repetitive strain, then inflammation moves into the area to try to repair the damage. The infiltration of inflammation into the tendon is what causes the pain.
Tennis elbow is characterized by a dull ache at rest but sharp pain with activity. A knowledgeable physical therapist can perform a few tests to confirm the diagnosis of tennis elbow. After determining that a patient has tennis elbow, the physical therapist can perform gentle stretching, ultrasound, cross-friction massage or even a technique known as dry needling to help decrease the pain and swelling around the ECRB tendon. Resting from the activity that caused the pain is essential and icing several times a day are also important components of rehab from tennis elbow.
For the tennis athlete, there are several things you can do differently to reduce the stress on the ECRB tendon. First, on your backhand stroke, make sure that you aren’t using your elbow and wrist extensors to generate power. The correct form is to use your shoulder external rotators for power on a backhand stroke. Second, use a relaxed grip on your racket. Gripping too tightly can stress the ECRB tendon. Third, hit the ball in the center of the racket and use a lighter racket. Interesting it has been shown that avoiding net play can also decrease stress on the extensors; so if at all possible let your partner take care of the net ☺.
Just a good rule of thumb, if you experience pain with any repetitive activity, it is best to discontinue that activity for a short time; however I know how hard that is for some of you avid tennis players out there. So, seek the advice of a knowledgeable physical therapist early on in order to limit any time away, if any, from tennis and keep your tennis team happy ☺.