Tennis Elbow is also known as lateral epicondylitis and presents as a weakness in your grip and pain in the hand, wrist or forearm, especially when holding something heavy, such as a kettle, and is a common condition in tennis players, aggravated by holding a racket. The pain is caused by inflammation of the muscles in the upper outer part of the forearm where these muscles attach to the bony part (lateral epicondyle) of the elbow.
Why do people get it?
The cause can be due to many factors working together. Some of the causes are not related to tennis but then tennis can cause the condition to last for longer than expected:
- Too much tennis (if you never give it a rest the chance of recovery is slim!).
- Too little tennis (you never build up enough muscle in the arm to cope with the demands).
- Playing with the arm in the wrong position or with a stiff upper body or holding the racket too tight (the muscles are too tense to allow enough blood perfusion).
- Wrong racket grip size, the racket is too heavy (needs a strong grip to control it) or the racket is too light (you have to use a lot of force to hit the ball hard enough).
- Stiffness in or around the upper back, shoulders, elbow or wrist – all of which will respond well to Osteopathy.
- Bad sitting posture resulting in upper back stiffness and prolonged computer/mouse use can cause tightness in the forearm and wrist.
- DIY – using a screwdriver or painting for long periods can lead to TE.
- Accidentally knocking the elbow.
If you have had it a long time, it is hard to get rid of completely even though you may have resolved the underlying cause. This is because long term inflammation turns the muscle near the elbow into fibrotic tissue and this reduces the efficiency of the muscle. If you haven’t had it very long and it is not getting better quickly then you need to seek advice and treatment as soon as possible to stop it becoming a chronic long term condition which could end your tennis career!
What can you do about it?
Come and see an Osteopath – We can give you advice and treatment, including soft tissue massages and stretches which will relax the upper back, shoulder complex, elbow and wrist. We can teach you how to do some massage into the muscle so that it will loosen up and also some stretches so the inflammation will calm down. We would advise that you do this massage several times a day quite firmly (and definitely in the evening after a match) so that the condition starts to improve, as soon as possible. In the beginning, this will be painful but with time it will get easier. You could even massage and stretch the muscle in between sets.
Ice the area or use a cold gel pack (we sell these at the clinic and they are always useful to have in the freezer for any injury) – Place the ice (put some cubes in a plastic bag) or use the gel pack over the tender area. It is best to wrap the ice in a cloth so it doesn’t burn the skin. Keep this on for 10 minutes and repeat as many times as you can throughout the day. It is best to use the ice after you have had your Osteopathic treatment, or done your daily massage and stretches. Don’t use the arm for anything strenuous for at least twenty minutes afterwards. If you want to get this condition better, you must massage, stretch and ice several times a day.
Come and see an Acupuncturist – Acupuncture works by stimulating the primitive parts of the brain which deal with pain and help to reset these pathways. Also using needles around the area can relax the muscles without causing as much discomfort as direct tissue massage.
Wear a TE support while you play – this is not a cure, but it will minimise the pain and damage when you do play. The support works by gripping the muscle and stops excessive pull of the muscle on the tendon and therefore prevents the inflammation around the bone from getting any worse. However, long term this affects the blood flow to the muscle and can cause the muscle to become weaker. If you must use a support to get through a match, take it off as soon as you have finished playing and gently massage and stretch the muscles.
What will my GP do?
Your GP will recommend that you stop playing for a while and will suggest that you take some anti-inflammatories (such as ibuprofen or diclofenac) which can be effective but may be harmful to the digestive system, so must be taken after food. If you start getting heartburn/indigestion then you must stop and return to your GP for further advice. You can also try an anti-inflammatory gel which can be applied to the area.
You may also be referred to a physiotherapist who may do some local soft tissue work and will recommend some stretches. However, referral times can be an issue.
If your symptoms don’t resolve with time then your GP may suggest a steroid injection. This can be effective but it may only work for a short time and the symptoms can reappear.
In the long term what should I do to prevent it coming back?
If you regularly massage, stretch and ice the area and your symptom haven’t fully resolved, you should also consider addressing some of the issues which may have caused the problem in the first place:
- Try some sessions with a coach to see if there is a fundamental problem with your technique and they can also advise you about your racket.
- Consider having some regular Osteopathy or Acupuncture treatment to help keep the tissues supple.
- Start Pilates which will address some of the postural problems and also improving your core muscle strength will help your game in the long term.
- A regular Sports massage can also be beneficial.
- Look at your computer set up either at work or at home. If you use a laptop, then a stand and external keyboard and mouse would be a good idea.