The Mystery Behind Tennis elbow

Some of the causes may surprise you

By Greg Besson, MSPT at Moore

April 9, 2010

One of the more nagging injuries that has a higher likelihood of occurring during the spring and summer is “Tennis Elbow” (or lateral epicondylitis).  Contrary to its nickname “tennis elbow” does not always occur from playing tennis.  As the weather gets nicer we tend to do more outdoor activities, and we tend to jump right in without taking into consideration the inactive winter months.   Tennis elbow can come about by performing any number of repetitive gripping, grasping, squeezing or lifting tasks.  Some of the most common causes are having a new racquet grip or change in racquet string tension.  An increase in activity level such as squeezing gardening shears, playing more tennis or other sports that require frequent gripping of equipment can cause these symptoms as well.   Incorrect posture and arm/hand placement while typing can produce a repetitive strain.  Sometimes the position your wrist is in while sleeping can be a cause of this pain.   It may be surprising to learn that weakness and or tightness in the shoulder, neck, upper back, core and/or hips can be a leading cause of tennis elbow.   For example, if your shoulder isn’t strong enough, your elbow/forearm musculature will be overworked in order to complete your tennis stroke or other task.  This is a frequent cause of “tennis elbow”.

What is actually causing the pain?  The symptoms come on when your wrist extensors are over worked and the common wrist extensor tendon “tugs” on your lateral epicondyle (or the bone on the outside of your elbow).  This repetitive trauma causes irritation and inflammation at the point of attachment of the wrist extensor tendon and the lateral epicondyle. 

 

Do I have “Tennis Elbow” Lateral Epicondylitis?  If you answer yes to any of the following questions you may have “tennis elbow”: (Please note that there are other tests and assessments that the Physical Therapists at Moore would be able to perform to better diagnose if this is “tennis elbow” or some other condition.) 

• Do you have pain on the outside of your elbow? 
• Is the bone on the outside of your elbow tender to the touch?
• Does your elbow hurt when grasping or lifting objects?
• One Diagnostic test:  When your elbow is straight with palm down to floor, bring wrist and fingers up.  Use other hand to push the wrist down but resist this motion with the involved wrist.  Does this increase your pain? 

With the diagnosis of “tennis elbow” the more important question is why it may have occurred.  This is important so that you can not only help to decrease the symptoms but also make changes to reduce the risk of this injury reoccurring.  The sooner you diagnose the problem and seek treatment for it, the quicker this condition will go away, which is true for almost any injury.  If you ignore or play through the pain, it can become chronic and cause pain for many months sometimes for the better part of a year.

What can I do to treat it?

• First, try and decrease the inflammation.  Ice at least 3 times within the first 24 hours of noticing your pain. Ice no longer than 15 minutes.
• Don’t aggravate it further.  Take a break from what may have caused this.  Don’t grip things as tight.  When lifting lift with palm to the ceiling.  If something is painful, stop.  Listen to your body.
• Stretch.  Straighten elbow, lightly clench fist, bend wrist down and use other hand to push the wrist in this direction.

 

• Strengthen your shoulders.  While there are many exercises that you can do and a wide variety that may be specific to your deficits, the most important thing is to strengthen your upper back and shoulder blade stabilizers.  Laying down on your stomach on a theraball (as pictured) or simply with your shoulders off the edge of the bed, keep arms straight and out to your side and raise them up while pinching your shoulder blades together. Make a “T” formation with your arms.  Do 3 sets of 15 repetitions. 

•  Get blood flow to the area.  Self massaging the area by using a little lotion.  Find the tender spot near the outside elbow bone and put pressure on the spot and go front to back with massage. 

 

Can I wear an elbow brace?  The preferred method is to rest your elbow and to treat it.  This will be the quickest way to recover, but if you must continue to do the tasks that aggravate your symptoms, you should wear a brace.    The brace recommended by Moore is Hely and Weber’s Universal Matt Strap.  You can order them through Moore by calling 203-762-2900.

There are many other treatment techniques, manual therapy procedures and modalities that are performed in Physical Therapy.  Moore’s Fitness division and Physical Therapy treatments focus on what your strengths, deficits and asymmetries are and work to improve your strength and flexibility to decrease your pain and prevent further injuries.  For questions or if you would like to be evaluated by a Moore Physical Therapist please call 203-762-2900 in Wilton, 203-656-2229 in Darien, 203-975-1545 in Stamford.  Click here to learn about our tennis fitness program. 

Greg Besson, MSPT is a Physical therapist, and partner at Moore.  He graduated with his Masters in Physical Therapy from Sacred Heart University in Fairfield, CT.  Greg is 1 of only 155 Etcheberry Tennis Certified Trainers worldwide.  Moore has 2 employees who are certified.