What Causes Tennis Elbow?
Lateral epicondylitis, commonly known as tennis elbow, is a condition that causes pain and inflammation in the outer part of the elbow. Tennis players are especially prone to developing this condition, in fact, research indicates that at least half of all tennis players will experience tennis elbow at some point. But, it can affect anyone who performs repetitive motions with the wrist and forearm.
The biomechanical causes of tennis elbow are often related to the mechanics of the backhand stroke. During the backhand, the wrist and forearm muscles are used to generate force and control the racquet head. When these muscles are overused or strained, they can develop tiny tears in the tendons that attach them to the lateral epicondyle, a bony bump on the outside of the elbow. Over time, these tears can lead to inflammation and pain. In the past, it was believed that tennis elbow was mostly an inflammatory problem, but now we know that damage or degeneration of the tendons is the main cause.
To treat tennis elbow, athletes should first rest the affected arm and avoid any activities that cause pain. This may mean taking a break from tennis or other sports for a period of time. Ice and compression can also be helpful in reducing inflammation and pain. Over-the-counter pain medications like ibuprofen or acetaminophen can be used to manage pain as well. However, controlling the inflammation is only a small part of resolving tennis elbow.
Controlling the inflammation is only a small part...
Manual therapy, like Active Release Technique, can be an effective treatment option for tennis elbow. A therapist can also teach athletes exercises to strengthen the wrist and forearm muscles and stretching and massage techniques to help improve flexibility and reduce pain. But, the full resolution must include observation and correction of bigger movement patterns in related areas of the body.
Using the wrong form during a backhand can put undue stress on the elbow, leading to the development of tennis elbow. This is because the backhand stroke requires complex coordination of the wrist and forearm muscles to generate power and control the racquet head. If the technique is incorrect, the muscles may be subjected to excessive force, leading to overuse and subsequent injury.
Research has shown that highly skilled players tend to experience less tennis elbow than less skilled players. This is likely due to their ability to hit the backhand with the wrist in extension, which puts the muscles in a stronger position and protects them from injury. In contrast, less skilled players tend to hit the backhand with the wrist in a flexed position, which places more stress on the muscles at the point of impact and increases the risk of injury.
Using a two-handed backhand is also believed to be better for preventing tennis elbow. By using both hands on the racquet, the force of impact is distributed more evenly across the muscles of both arms, reducing the stress on any one muscle group. This can help prevent overuse and subsequent injury to the wrist and forearm muscles.
Exercises for Tennis Elbow.
Improving the strength of the shoulder and wrist muscles can help prevent tennis elbow by reducing the stress on the forearm muscles during the backhand stroke. When the shoulder and wrist are strong, they can better support the racquet and absorb the force generated during the stroke, which can reduce the load on the forearm muscles.
There are several exercises that can help improve shoulder and wrist strength. Some examples include:
Shoulder external rotation: This exercise targets the rotator cuff muscles, which are important for stabilizing the shoulder joint. Start by holding a resistance band with your elbow bent to 90 degrees and your forearm parallel to the ground. Keeping your elbow at your side, rotate your forearm outward as far as you can, then slowly return to the starting position. Repeat for several repetitions on each arm.
Shoulder press: This exercise targets the deltoid muscles in the shoulder. Start by holding a dumbbell in each hand at shoulder level, with your elbows bent and your palms facing forward. Press the weights up above your head, then slowly lower them back down to shoulder level. Repeat for several repetitions.
Wrist curls: This exercise targets the muscles in the forearm and wrist that are used during the backhand stroke. Start by holding a weight in your hand with your palm facing up. Slowly curl your wrist upward, then slowly lower it back down. Repeat for several repetitions on each arm.
Reverse wrist curls: This exercise targets the muscles in the forearm and wrist that are used during the forehand stroke. Start by holding a weight in your hand with your palm facing down. Slowly curl your wrist upward, then slowly lower it back down. Repeat for several repetitions on each arm.
By incorporating these exercises into your regular training routine, you can improve the strength of your shoulder and wrist muscles and reduce the risk of developing tennis elbow. It’s important to start with light weights and gradually increase the resistance as your muscles become stronger. Additionally, it’s important to maintain good form and avoid overexerting the muscles, as this can increase the risk of injury.
Spine Mobility and Tennis Elbow.
Poor thoracic spine mobility can also be a factor in the development of tennis elbow. The thoracic spine is the middle portion of the spine, consisting of 12 vertebrae that connect the cervical spine (neck) to the lumbar spine (lower back). Limited mobility in this area can lead to compensations in other areas of the body, including the shoulder and elbow, which can increase the risk of injury.
When the thoracic spine is mobile, it allows for proper rotation and extension of the upper body, which is important for generating power and control during the backhand stroke. However, when the thoracic spine is stiff or limited in mobility, it can cause compensations in the shoulder and elbow, leading to increased strain and potential injury.
To improve thoracic spine mobility, there are several exercises that can be done. Some examples include:
Thoracic extension: Start by lying on your back with a foam roller positioned horizontally across your upper back. Place your hands behind your head, elbows out to the sides. Slowly extend over the roller, arching your upper back. Hold for several seconds, then return to the starting position. Repeat for several repetitions.
Thoracic rotation: Start by sitting on the floor with your knees bent and feet flat on the ground. Cross your arms over your chest and rotate your torso to one side as far as you can, keeping your hips facing forward. Hold for several seconds, then return to the starting position and repeat on the other side.
Cat-cow stretch: Start on your hands and knees with your wrists directly under your shoulders and your knees directly under your hips. Inhale and arch your back, lifting your chest and tailbone towards the ceiling (cow pose). Exhale and round your spine, tucking your chin to your chest and bringing your tailbone towards your knees (cat pose). Repeat for several repetitions.
Forearm Brace isn't Very Effective.
While treating the inflamed tendon is important in managing tennis elbow, it’s not the only factor to consider. As mentioned earlier, changes in stroke mechanics, improving shoulder and wrist strength, and promoting thoracic spine mobility can also play a role in preventing and managing tennis elbow.
In a study published in the American Journal of Sports Medicine, researchers examined the effectiveness of various treatments for tennis elbow, including changes in stroke mechanics, using an elastic forearm brace, and a combination of the two. The results showed that changes in stroke mechanics were the most effective treatment, with 63% of participants experiencing significant improvement in symptoms. However, using an elastic forearm brace was found to be the least effective, with only 25% of participants experiencing significant improvement in symptoms.
These findings suggest that treatment and prevention of tennis elbow must be focused on looking at broader biomechanics and not simply addressing the inflamed tendon. By improving stroke mechanics, strengthening the shoulder and wrist muscles, and promoting thoracic spine mobility, athletes can reduce the risk of developing tennis elbow and improve their overall performance on the court. It’s important to work with a qualified healthcare professional or sports coach to develop a comprehensive treatment and prevention plan that is tailored to your individual needs and goals.