As in other racquet sports such as squash or badminton, hitting in tennis involves asymmetrical stresses on the body, resulting in considerable muscular imbalance for athletes and a number of potential injuries, such as the so-called “Tennis Elbow.”
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What is Tennis Elbow?
Tennis elbow is one of the most common injuries in the tennis environment and describes getting tendonitis around the player’s elbow.
To be precise, it is an inflammation of the proximal insertion of the forearm tendon. In more scientific terms, we call it Lateral Epicondylitis because of the anatomic region affected (Epicondylitis) situated at the low extremity of the humerus.
It’s a bony bump on the outer side of the elbow, a region which involves the forearm and, especially, the extensor muscles, which control the wrist and finger extension.
If the clinical way to call it is Lateral Epicondylitis, it’s more common to call it Tennis Elbow.
As the name implies, tennis is, unfortunately, an excellent way to make this injury happen due to specific and repetitive wrist and forearm movements, especially with backhand strokes. This motion requires extension of the wrists and fingers, which causes successive extension and elongation of the muscles and tendons.
Consequently, the overuse of the extensor muscle’s tendons of the forearm leads to the appearance of the Tennis Elbow. Before describing the possible causes of this injury, let’s focus on the symptoms that may appear in players and that serve as indicators of the Tennis Elbow.
What are the symptoms of a Tennis Elbow?
The first sign of a potential emergence of Tennis Elbow is pain around the articulation of the elbow and, mainly, on the external face of the joint. Pain may occur when performing specific elbow and wrist movements, especially those involving backhand-like actions.
However, the same pain can also occur during other common everyday actions that many people do without noticing or paying attention, such as carrying shopping bags, turning door knobs, or even shaking hands. Not only due to the movements, even touching the joint zone could also be painful due to the inflammation of the tendon on the bony bump.
Being a tendonitis, it can also generate inflammation that, in some cases, can be accompanied by a notable stiffness in the elbow that can spread throughout the arm and reach the wrist and even the fingers, a clear symptom that evidences the aggravation of the injury. In less severe cases, players may experience more weakness than normal throughout the arm, mainly due to a marked decrease in muscle efficiency and loss of strength in the area.
This injury should not be treated as something minor since, in many cases caused by playing tennis, the sufferer may be forced to stop doing certain daily actions and even be sidelined from the courts for some time if Tennis Elbow is not detected promptly.
Therefore, players and coaches need to recognize these potential Tennis Elbow symptoms and consult a doctor as quickly as possible to avoid worsening the potential injury.
Experts can perform a series of tests and examinations to diagnose the emergence of Tennis Elbow. Among them exists Maudsley’s test, which consists of an extension of the middle finger against resistance while performing an extension of the elbow to recruit the muscles responsible for the Tennis Elbow selectively. There are also other viable tests, such as the X-ray to observe the state of the bones, a Magnetic Resonance Imaging (MRI) to take a look at the tendons, or an Electromyography to check the nerves of the area.
What are the possible causes of Tennis Elbow?
As explained above, the main cause behind the onset of tennis elbow is the repetition of specific movements involving overuse of the forearm muscles and tendons.
However, there are certain particular conditions that can also increase the risks of the onset of the injury, such as everyday actions in which we force the same area excessively.
From the tennis player’s perspective, there are two causes that can be directly avoided by the players themselves: hitting with inadequate technique, especially in the backhand position, and using defective or worn-out equipment, such as old rackets.
To recap, a twitching during the strokes, a lousy gesture, or a bad grip can cause excessive pressure on the forearm, and, mainly, it is recommended to tennis players from a very young age to hit the ball relaxed and with a good posture. As a reminder, the power of the stroke does not come from the force with which we hold the racquet but from the efficiency and performance of the gesture, the posture, and the transfer of energy from the body.
Furthermore, a good selection of the material employed in matches and practices is essential to avoid injuries. Many studies reveal that professional tennis players are much less affected by tennis elbow than semi-professional or amateur players, even practicing and playing much more than them. Tennis Elbow most commonly appears in adults between 30 and 50 years, so we can also identify age as another potential cause.
What are the treatment options?
Firstly, it’s highly recommended to stop practicing tennis whenever the first symptoms arise to avoid any risk of aggravation. In case of high-intensity pain, many experts consider the total immobilization of the elbow for daily life as one of the most effective measures.
In addition to these actions, the application of ice to the affected area several times a day is another way to relieve pain and reduce inflammation.
However, there are also a series of compression techniques to increase the proprioception of the region and avoid excessive contraction of the arm, for which there are also orthopedic devices that help protect the arm.
Moreover, taking some over-the-counter pain medication can reduce the ache and allow the players to set up some physical therapy exercises. This medication can be replaced with cortisone injections if the players want to reduce the medication and avoid its side effects.
However, it is essential to state that the interest and goal of this medication are not to treat the injury directly but to facilitate the practice of physical therapy, stretching, and strengthening exercises.
Just to name a few stretching examples, we can perform wrist extensors by doing eccentric strength exercises of the wrist’s extensors or by doing strength movements to pass from supination to pronation with an object in hand.
Finally, if the injury is severe and the player doesn’t seem to recover despite using all these options and techniques, surgery can appear as the only way to heal the injury.
How to prevent Tennis Elbow?
There are some preventive actions that reduce the risk of the emergence of the Tennis Elbow. The first is also the most typical and well-known, as it helps prevent many injuries: warming up properly before training or playing. This enables the activation and better effectiveness of your muscles and tendons and reduces the risk of injury.
Also, as we have previously mentioned in the causes of tennis elbow, players must ensure the condition and quality of the materials used, such as the tension of the strings of the racquet, as well as checking that the technique and posture used during the blow is correct, making sure to grip the racquet well and not to exert more force or pressure than necessary.
While performing repetitive movements, especially in backhands, taking breaks between strokes is very important to avoid putting too much pressure on the area and also to allow the player to get hydrated, which also helps prevent Tennis Elbow. Staying in good physical condition reduces any risk of injury.
To summarize, Lateral Epicondylitis is a tendonitis of the muscle’s extensors of the forearm, mainly used during tennis strokes, which justifies his analogous term: Tennis Elbow.
The pain is generally felt on the outer side of the elbow but can be spread all along the arm, wrist, and fingers, depending on the gravity of the lesion. Some techniques can be helpful in treating the injury, like applying ice, compression, physiotherapy exercises… However, nothing is more effective than rest and time.
To prevent this injury from happening to you one day, pay close attention to your striking technique, the equipment used, proper warm-up, and trying to maintain optimal fitness.
After reading this article, you will have many weapons to avoid Tennis Elbow and enjoy playing tennis for many years to come!