Tennis elbow is an inflammation of the tendons that join the muscles of the forearm to the outside of the elbow. It often occurs due to overusing the forearm muscles and tendons and those around the elbow joint.
Tennis elbow is also known as lateral elbow pain or lateral epicondylitis and is not necessarily related to tennis. However, tennis players often develop the condition because it stems from repetitive muscle use. Half of all tennis players will get tennis elbow in their career.
Fast facts on tennis elbow
- Tennis elbow is caused by small tears in the tendons that join the forearm to the outside of the elbow.
- 50 percent of tennis players will experience tennis elbow.
- Overuse of the forearm with incorrect wrist action can lead to tennis elbow.
- Physiotherapy, support devices, and steroid injections can be used to treat the condition.
- Certain exercises that provide strength to the supportive muscles in the arm and shoulder, such as the Tyler Twist, can help symptoms.
- Stretch carefully ahead of racquet sports to prevent tennis elbow.
The most common symptom of tennis elbow is recurring pain on the outside of the upper forearm, just below the bend of the elbow. Pain may also be felt further down the arm, towards the wrist.
Pain can occur when the individual lifts or bends the arm. It is also felt while performing basic actions, such as writing or when gripping small objects.
Tennis elbow can cause pain when twisting the forearm. This can be noticeable when turning a door handle or extending the forearm fully.
The cause of tennis elbow stems from repeating incorrect movements of the arm. This can lead to small tears in the tendon attachment at the elbow. In tennis, this translates to the repeated motion and force of hitting a ball with a racquet.
Incorrect technique can cause the power in the swing of a racquet to rotate through and around the wrist. This creates a movement on the wrist instead of the elbow joint or shoulder. This can increase pressure on the tendon and cause irritation and inflammation.
Most often, the extensor muscles become painful due this tendon breakdown. The extensor muscles are those that straighten the wrist.
Tennis elbow is associated with the extension of the fingers and the wrist. This is the kind of movement that allows the person to “snap” or flick the wrist, such as during a racquet swing.
Despite the name, tennis elbow refers to any injury to this particular tendon caused by overuse. Tennis elbow can stem from daily activities such as:
- using scissors
- cutting tough food
- sporting activities that involve high amounts of throwing
- manual work that involves repetitive turning or lifting of the wrist, such as plumbing, typing, or bricklaying.
Sometimes, there is no apparent cause.
There is an easy test that a person can do at home to decide whether they have tennis elbow.
Stand behind a chair and place your hands on top of the chair back, with downward-facing palms and straight elbows. Try to lift the chair.
If this action causes pain on the outside of the elbow, it is a likely indicator of tennis elbow.
An X-ray or MRI scan is sometimes needed to rule out other more severe conditions, such as arthritis or an elbow joint injury. However, imaging is rarely necessary. The doctor will test a range of motions with the arm before asking about the location and nature of the pain.
This is normally enough information for tennis elbow diagnosis.
An MRI gives a more detailed image than an X-ray, as it includes the soft tissues, muscles, and tendons inside the arm. This may be required if the outer elbow pain does not respond to conservative treatment after a year.
Electromyography (EMG) may be used to find out if the nerves are compressed.
Several treatment methods can be used at home or after consulting a physician.
Rest: Resting the arm is important. A break in activity allows the tears in the tendon attachment to heal. Tennis players treat more serious cases with ice, anti-inflammatory drugs, soft tissue massages, stretching exercises, and ultrasound therapy.
Physical therapy: Physical therapists commonly advise that racquet sports players strengthen their shoulder, upper arm, and abdominal muscles. This can help to reduce the wrist extensors during shoulder and arm movements.
Ice massages and muscle stimulating techniques: These can also help the muscles to heal.
Strapping or taping the forearm: Supporting the area can help realign the muscle fibers and relieve pressure on the area. A physician may recommend using a splint for 2 to 3 weeks to take the elbow out of action.
Steroid injection: If symptoms are very painful, and the condition is making movement difficult, a physician may recommend a steroid injection.
After a steroid injection, the person should rest the arm and avoid putting too much strain on it.
Other conservative treatments: Further options include injections of botulinum toxin, also known as Botox, and extra-corporeal shock wave therapy (ESWT).
ESWT is a technique thought to trigger the healing process by sending sound waves to the elbow. Heat therapy, low-level laser therapy, occupational therapy, and trigger point therapy are other options.
A newly available therapy is an injection of platelet-rich plasma (PRP), prepared from the blood of the patient. PRP contains proteins that encourage healing. The American Academy of Orthopaedic Surgeons (AAOS) describes this treatment as promising but still under investigation.
Surgery: This may be needed to remove the damaged part of the tendon and relieve the pain in the rare cases where nonsurgical treatment does not resolve symptoms in 6 to 12 months. Between 80 and 95 percent of patients recover without surgery.
To prevent further damage to the tendons, it may be useful to wear an arm brace or a wrist splint when using the arm. It can be taken off while resting or sleeping. A physician or physiotherapist can advise about the best type of brace or splint.
Stretches and progressive strengthening exercises involving the use of weights or elastic bands can be helpful. They can increase pain-free grip strength and forearm strength.
An article published by the Canadian Family Physician recommends a number of exercises using dumbbells that have helped muscle conditioning in patients with tennis elbow.
Exercising during a case of tennis elbow is vital for regaining muscle strength and reducing pain.
Despite painful sensations, it is possible to ease into an exercise routine through initial stretching. The most important part of managing tennis elbow is persisting with a daily regimen of stretches and lifts. Start with lower weights and increase the difficulty of the motions until it is only possible to complete ten lifts.
Here is an example of a simple exercise to improve tennis elbow symptoms.
The Tyler Twist
Find a long, thin object you can grip comfortably with both hands. It is preferable to use a flexible item that still provides resistance while being twisted. A rolled up towel can work. People practising the Tyler Twist often often use an exercise tool called a FlexBar.
- Hold the object vertically in front of your chest.
- Grip the object with both hands, with your hands facing the same way. Both wrists should be fully extended, or bent back.
- Move the wrist affected with tennis elbow into flexion, or a bent-forward position, around the object.
- Keeping the wrist in flexion, rotate the object into a horizontal position, as if you were holding the handlebars of a bicycle. Hold your arms straight out in front of your body.
- Move the unaffected wrist into flexion, joining the affected wrist.
- Perform three sets of 15 repetitions a day until symptoms improve.
This video demonstrates the required motion. However, completing these steps slowly is key.
There are other exercises available. Speak to a physical therapist about the best routine for your body.
To reduce the risk of tennis elbow, it is important to pay attention to movement techniques during exercise or exertion.
It is better to spread the load to the larger muscles of the shoulder and upper arm, rather than focus activity on the smaller muscles in the wrist and the elbow.
Warming up: Warming up before playing a sport that involves repetitive arm movements, such as tennis or squash, is essential. Gently stretching the arm muscles will help to avoid injury.
Using lightweight tools: Lighter sports equipment or racquets with a larger grip size will help reduce strain on the tendons. Damp tennis balls and older balls load the arm with unnecessary force.
Increasing the strength of forearm muscles: This can help support arm movement and prevent tennis elbow.
A physical therapist can also recommend suitable exercises to help strengthen the appropriate muscles.