Adherence to a rehabilitation program is key to recovery from tennis and golfer's elbow.
“Elbow tendinopathy,” commonly called tennis or golfer’s elbow, is an overuse injury. Playing tennis or golf can cause this, but so can other things. It’s the most common condition affecting the elbow.
Recovery can take three to four months, although pain can go away in 6-12 weeks. Left untreated, patients can end up with chronic pain.
Treatment focuses on resting and protecting the injured tendon so it can heal, swelling go down and muscle strength improve. Patience and careful adherence to a rehabilitation program is key to improvement.
Tennis elbow versus golfer’s elbow
Patients sometimes confuse tennis elbow and its cousin golfer’s elbow with carpal tunnel syndrome because elbow pain can extend into the forearm.
Tendons are tough bands of tissue, which connect muscles to bones. They help your muscles move your bones.
- Tennis elbow is an injury to the outer elbow tendon.
- Golfer’s elbow is an injury to the inner elbow tendon.
Tennis players with tennis elbow
Beginning tennis players are candidates when they frequently contract their wrists on strokes, don’t follow through sufficiently and lead with their elbows. Over half of the force for a tennis serve should come from the hips and pelvis. Not from the wrist.
Many tennis pros recommend staying away from a lightweight racquet with a heavy head and a grip that’s too small. Lower string tension transmits less force to your elbow.
For more information, read racquet research.
Elbow tendinopathy symptoms
If you’re right handed, you’ll be more likely to get tennis or golfer’s elbow in your right elbow. Left-handed people usually experience pain in the left elbow.
Symptoms include:
- Elbow pain that gets worse
- Pain from the outside of your elbow to the forearm and back of the hand when grasping or twisting
- Pain when shaking hands or turning a doorknob
- Hard to hold a coffee cup
Risk factors
- Performing repetitive movements for two or more hours daily
- Improper weight lifting techniques when routinely lifting 44 pounds or more
- Poor tennis and golf techniques and inappropriate equipment
Diagnosis
A medical professional can diagnose your problem after performing a physical exam. He'll listen to your signs, symptoms and description of pain.
There’s often pain when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow. You may also have pain near your elbow when the wrist is extended against resistance or bent backwards, like revving a motorcycle engine.
Treatment
The goal of treatment is to relieve pain and swelling, then increase muscle strength.
Pain relief
In the beginning: Acetaminophen (Tylenol and other brands) in limited amounts may offer pain relief. Usually, two 375 mg tablets every four to six hours as needed. But don’t take more than 4000 mg of Acetaminophen a day. Talk with your doctor before taking this if you have liver disease or drink alcohol regularly.
Nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil and other brands) or naproxen (Aleve and other brands) can also be used sparingly. Patients can take 400-800 mg of ibuprofen every six to eight hours, but no more than 3200 mg per day. If naproxen is preferred, 440 mg every 12 hours.
Reduce the swelling
For up to three days after an injury, ice your elbow for 20 minutes every two hours to help reduce swelling. Keep the elbow above your heart level when possible to limit swelling.
Support in the beginning
A tennis elbow brace or strap can apply pressure to your forearm muscles, reducing pressure on your elbow’s injured tendon. I like arm braces with an ice pack and most drug stores sell these for $10-20.
When you put the arm brace on, make sure the cushion rests on your forearm muscles, three to four inches from the tip of your elbow bone. The brace may be helpful for the first six weeks following your injury.
Only wear the brace when you’re working or playing sports. When you’re not wearing the arm brace, bend and stretch your elbow in a pain-free range of motion.
Ultrasound
Using a deep heat setting from ultrasonography, high frequency sound waves vibrate tissues deep inside the injured area, creating heat. Then more blood can get into the soft tissue damaged area so healthy tissue can grow.
This reduces pain and inflammation; speeds healing; reduces muscle spasms and increases range of motion.
Sound-Assisted Soft Tissue Mobilization (SASTM)
SASTM can break up adhesions in the muscles and reduce chronic inflammation. Chiropractic adjustments to the elbow and wrist can also help in the healing process.
Stretching
A stretching program helps relieve muscle spasms and lengthen shortened muscle-tendon units you get after an injury.
Your doctor can guide you in preventing further injury by giving you a gradual warm-up exercise program involving your major muscles. Later, he'll give you stretching exercises to do after muscles are warmed up.
Hold stretches your doctor gives you for 20-30 seconds. Longer holds provide no additional benefit. Stretch three to five days each week.
Flexibility gains from only one stretching session last 90 minutes. Benefits from regular stretching sessions last for weeks.
Flexibility exercises can improve your arm’s strength and ability to move.
Tennis elbow
While standing or sitting upright, hold your injured arm straight out in front of you and lower your fingers. Your fingers will be pointing toward the floor.
Then use your other hand to cup your injured hand. Press your thumb on the injured palm and use your fingers to stretch the wrist further. Hold for 30 seconds; repeat three times every day.
Golfer's elbow
Stand an arm’s length away from a wall with your injured arm closest to the wall. Place your palm on the wall with fingers pointing down.
Apply gentle pressure to the hand. Hold for 30 seconds, repeating three times several times daily.
Strengthening exercises
After your flexibility has improved and you have little or no pain, your medical professional will give you strengthening exercises. These can cause symptoms to get worse in the beginning as weight placed on the tendons increase.
Your medical professional can make sure that weight is heavy enough to promote healing, yet not too heavy. Too much weight can make your injury worse, impair function, cause excessive pain and discourage you.
Prevention
- Stretch your forearm muscles at your wrist before and after use.
- Strengthen forearm muscles.
- Tennis and golf players can take lessons to improve technique and get advice in choosing equipment.
- Lift weight with a rigid stable wrist to reduce the force your elbow feels.
- Apply ice to the outside and inside of your elbow for seven minutes after heavy use.
