What is Tennis Elbow?
Tennis elbow develops when the tendons in the forearm become damaged. Tendons are flexible bands of strong fibrous connective tissue that attach a muscle to bone. They are located at each end of a muscle and as the muscle contracts, the attached tendon pulls the bone into movement.
When a tendon is overstretched or torn, it’s known as a strain. When a tendon is inflamed, it’s known as tendinitis. In lateral epicondylitis – tennis elbow – a bit of both is happening. Through repeated overuse, the tendon develops microscopic tears which do not heal completely. In turn, both the tendon and muscle become inflamed, creating pain and tenderness on the outside of the elbow.
What Causes Tennis Elbow?
The elbow joint is made up of the two bones in the forearm, the radius and the ulna, as well as the humerus, the long bone in the upper arm. Each end of the humerus has small bony bumps called epicondyles, which is where the tendons of the forearm attach.
Tennis elbow is most commonly caused by damage to a specific forearm muscle on the lateral side, known as the extensor carpi radialis brevis (ECRB). The ECRB is the muscle that helps stabilize the wrist when the elbow is straight. When the ECRB is overused, microscopic tears form in the tendon where it attaches to the lateral epicondyle, the fancy name for the bony bump located on the outside of the forearm.
Tennis elbow is a degenerative process that occurs when the tears within the tendon do not heal completely. Through repeated use, both the tendons and muscles become inflamed. Repetitive motions, like gripping a racket during a swing can strain the muscles and put too much stress on the tendons, leading to pain and tenderness on the outside of the elbow.
Who Gets Tennis Elbow?
You don’t have to be Serena Williams to develop tennis elbow. In fact, you don’t even have to like tennis. Many people who develop tennis elbow simply participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle. Generally speaking, most people who get tennis elbow are between the ages of 35 and 65, although anyone can develop the condition if certain risk factors are present. The occurrence is equal among men and women, although the condition does occur in the dominant arm in about 75 percent of cases.
In racket sports like tennis, improper stroke technique and improper equipment play large risk factors. However, the repetitive motion of gripping a racket during a swing in itself can damage the ECRB, leading to tears in the tendon. Likewise, other people at risk of developing tennis elbow either professionally or recreationally include:
- Painters
- Plumbers
- Carpenters
- Gardeners
- Knitters
- Auto workers
- Cooks
- Butchers
- Golfers
- Fencers
Essentially, people who work with or use their hands frequently are at a higher risk of developing tennis elbow than those who are more sedentary.
Symptoms of Tennis Elbow
Tennis elbow pain is felt on the outside of the elbow, known as the lateral side. Pain is intensified by grasping objects and cocking back the wrist such as when holding a cup, turning a wrench, or shaking hands. In most cases, pain begins as mild and slowly worsens over the following weeks.
Common signs and symptoms of tennis elbow include:
- Morning stiffness of the elbow
- Pain or burning in the outer part of the elbow
- Pain radiating down the forearm
- Pain that worsens when lifting objects
- Weak grip strength
- Difficulty or pain making a fist
Types of Tennis Elbow Treatment
If you have been diagnosed with tennis elbow, or believe you may have it, you’ll be relieved to know that a majority of patients experience symptom relief with conservative treatment. In fact, approximately 80 to 95 percent of patients have success with nonsurgical treatment.
At ChiroCare of Florida, the first step our physicians will take is ensuring that your injured tissue has had a chance to rest. This means that you will need to stop participating in sports or other activities that may be causing repeated use of the forearm or elbow. Using a brace centered over the back of your forearm may help relieve symptoms by stabilizing the ECRB and allowing the muscles and tendons to rest.
Next, your ChiroCare of Florida physician will develop a treatment plan that incorporates hands-on techniques to alleviate pain symptoms, inflammation, and help you regain grip strength. Your chiropractor will tailor your treatment to fit your unique needs. For instance, if you’re experiencing an extreme amount of morning stiffness, mobilization and range of motion techniques will be incorporated early on into treatment.
Tennis elbow treatment at ChiroCare of Florida includes:
- Instrument-Assisted Soft Tissue Mobilization (IASTM): As its name suggests, instrument-assisted soft tissue mobilization uses chiropractic tools to stretch affected tissue. Known as a myofascial technique, IASTM stretches both the myo (muscles) and the fascia (connective tissue, like tendons). Those suffering from tennis elbow will experience pain and inflammation in the forearm, and IASTM helps to relieve stress from the area.
- Hot and Cold Therapy: For years, physicians have harnessed the power of heat and cold to alleviate inflammation and provide pain relief. At ChiroCare of Florida, our physicians utilize laser treatments and ultrasound therapy to target heat directly into damaged tissue to promote healing and decrease inflammation. Cold therapy temporarily reduces nerve activity, which limits pain signals in the forearm. It also releases anti-inflammatory molecules, endorphins, and toxins.
- Physical Therapy: Patients with tennis elbow can experience difficulties lifting objects or even making a fist. While this can be troublesome in itself, this lack of motion can also pose a great risk for injury. Physical therapy helps patients regain their range of motion while also safely exercising damaged muscles and tendons. Not only does physical therapy help alleviate current symptoms, but it also helps prevent future injury.
- Strengthening Exercises: As with physical therapy, strengthening exercises are necessary not only to alleviate current symptoms but also to prevent future injury. In patients with tennis elbow, the damage is caused by repeated motion and use of the same muscles and tendons. Strengthening exercises help build strength in the forearm to prevent tears within the tendon with overuse.
- Stretching: Once the muscles and tendons of the forearm are rested, you run the risk of developing scar tissue within the tendon. Stretching exercises improve blood flow, and alleviate pain and inflammation, as well as ensure that you retain full mobility once healed.
- Acupuncture: Acupuncture utilizes designated acupoints to relieve stress and trigger the body’s self-healing mechanism. The use of needles placed strategically into the skin causes the body to release endorphins as well as serotonin to alleviate pain and encourage faster healing.
10 Tennis Elbow Exercise to Reduce Pain and Improve Mobility
There are many tennis elbow treatment options, but one of the best things you can do is exercises for strengthening and stretching to help reduce pain and improve mobility. Before trying any of these exercises, wait until any swelling goes down and check with your healthcare professional.
1: Wrist Flexor Stretch
You may be surprised when you try this exercise. You may feel it all the way up your arm, but you’ll definitely feel the stretch on the inside of your forearm.
Step 1: Begin with the affected arm straight out in front of you, wrist flexed so that your fingers point up.
Step 2: With your other hand, gently pull your fingers back towards your face.
Step 3: Hold the stretch for 15-30 seconds. If that is too much, start with 10 seconds and work up to 30.
Do three repetitions and switch sides.
2: Wrist Extensor Stretch
Once you’ve stretched your wrist flexors, move on to stretch the opposing muscle group, the wrist extensors. This will help improve the range of motion in your wrists. You should feel this stretch throughout the top of your forearm.
Step 1: Begin with the affected arm straight out in front of you, wrist flexed down.
Step 2: With your other hand, gently pull the fingers down. You can gently curl your fingers into a loose fist for more of a stretch.
Step 3: Hold the stretch for 15-30 seconds.
Do three repetitions and then switch sides.
3: Fist Clench/Stress Ball Squeeze
A weak grip is often a symptom of tennis elbow. This exercise targets and strengthens your grip. In addition to providing relief from tennis elbow, improving your grip strength can make many daily activities easier. Use a rolled-up sock or towel, stress ball, or tennis ball, depending on your grip strength and what you have handy.
Step 1: Hold the rolled-up sock or towel, stress ball, or tennis ball in your hand.
Step 2: Make a fist and squeeze tightly for as long as you can, up to 10 seconds.
Step 3: Release.
Repeat up to a total of 10 reps, then switch hands.
4: Wrist Turn
This exercise works the muscle responsible for turning the palm upward. Strengthening this muscle can help reduce the pain of tennis elbow.
Step 1: Bend your elbow at a right angle with the palm facing up.
Step 2: Rotate the wrist until your palm is facing down.
Step 3: Hold for 5 seconds.
Repeat a total of 10 times, add more sets as you get stronger. Switch arms.
5: Wrist Turn with Weight
This exercise is the same as the one above, except it is done with a light dumbbell.
6: Wrist/Forearm Curls
This exercise isolates the movement in your wrist and strengthens your forearm. You’ll need a light dumbbell — 1-2 pounds should do it — and a tabletop or desk. If a dumbbell is too much for you to begin with, you can do this exercise without a dumbbell. Make a fist, keep your arm engaged, and following the steps below.
Step 1: Sit or stand near a desk or table with a dumbbell in one hand. Keep your feet approximately shoulder width apart.
Step 2: Rest your arm on the tabletop, palm, and dumbbell facing the ceiling. Keep the working hand hanging off the desk or table. This will ensure you have the full range of motion during the exercise.
Step 3: Curl the dumbbell towards your face, then lower it down towards the ground. The wrist is the only part of your arm that should move.
Do 10 repetitions and switch arms. Work up to three sets on each arm.
7: Reverse Wrist Curves
Remember, we’re all about working complementary muscles to achieve a full range of motion, so next, you’ll want to do reverse wrist curls as part of your stretching for tennis elbow treatment.
Step 1: Begin as you did in the exercise above, except place your palm facing down.
Step 2: Curl your wrist down as far as you can, then pull the dumbbell up as high as you can.
Do 10 repetitions and switch arms. Work up to three sets on each arm.
8: Supported Bicep Curl
Strengthening your arm will help reduce the pain of tennis elbow. Doing a supported bicep curl will help remove some of the stress of doing a bicep curl. You’ll need a chair and dumbbell.
Step 1: Grasp a dumbbell with one hand, sit in the chair, knees apart. Place your elbow on your mid-thigh with your arm hanging off your leg. Place your empty hand on your other thigh.
Step 2: Extend your arm down as far as you can without locking your elbow.
Step 3: Hold this extension for a second, and then curl your arm back up.
Do 10 repetitions on each side, working up to three sets.
9: Towel Wring/Towel Twist
The towel twist really works the natural movements of the wrist. We often think of the elbow as a joint that moves up and down. However, it also rotates your arm. When dealing with tennis elbow, your arm needs to be able to move in all directions.
Step 1: Hold a loosely rolled-up towel with a hand at each end, shoulders relaxed.
Step 2: Twist the towel as if wringing water out of it.
Do 10 repetitions, then do 10 in the other direction.
10: Hammer Rotations
You can use a hammer for this exercise if you wish, but a dumbbell works just fine. You’ll also need a chair and a side table or desk to rest your arm on.
Step 1: Seated in the chair, rest your arm on the table, hold the dumbbell with your hand and wrist hanging off, wrist facing up.
Step 2: Turn your wrist in, palm facing down, in a slow windshield wiper motion.
Do 10 repetitions on each side, working up to three sets.
Avoid These 4 Things When Suffering from Tennis Elbow
While there are stretches and strengthening exercises you can do to relieve pain from tennis elbow, there are also some things you should avoid when you are suffering from tennis elbow.
Avoid Over Working Your Elbow
This is not a time to work through the pain. At the first sign of inner or outer elbow discomfort, stop and rest. Working through the discomfort can only make the pain worse and can turn it into a chronic issue.
Avoid Over Resting
Alternatively, don’t over rest it either. Your arm needs to move to increase blood flow to the injured area. Use these muscles in a low-load capacity will help the healing process.
Avoid Hyperextending the Elbow
When the elbows are hyperextended, the load is no longer balanced properly on the joint. This can also cause your triceps to stop working, and you want this large muscle group to do its job. In addition, the smaller muscles will quickly become overworked trying to do a job they weren’t to designed to do. Keeping a micro-bend in your elbows can help avoid injury.
Avoid the Death Grip
It’s easy to get carried away when playing and grip your racquet for dear life. Try to remember to release your grip between hits. This will help keep your arm muscles happy both as you play and after. If you never loosen your grip, your muscles never get a chance for a micro-rest and are more likely to become over-worked.
Lifestyle Tips for Tennis Elbow Recovery
In addition to these stretching and strengthening exercises, there are some lifestyle changes or home remedies you can try.
1) Diet
It may seem strange to talk about diet when discussing how to treat tennis elbow. However, cleaning up your diet helps reduce inflammation throughout your body, including your tennis elbow. Reducing inflammation decreases pain and is especially helpful in managing tennis elbow. Eating little or no grains, dairy, red meat, and sugar for 30 days may help reduce the pain caused by inflammation.
2) Ice
Ice an effective tennis elbow treatment that offers almost immediate relief. It reduces swelling, which in turn reduces pain. It can also prevent the progression of tennis elbow. Keep a cold pack at the ready in the freezer.
3) Compression Sleeves and Braces
Compression sleeves and braces are effective management tools. They work to ease pain in two ways: by reducing inflammation and providing support to your muscles. This enhances blood flow and oxygen delivery to the muscle, helping minimize the pressure in the muscle and keeping it from reaching the pain point in your elbow.
4) Massage
Give yourself a simple massage by applying firm pressure to the area where your arm is sore. This can help reduce pain. With two fingers of your opposite hand, rub the area in a circular motion for approximately five minutes.
Tennis Elbow Treatment at ChiroCare of Florida
Whether you’re spending hours on the court playing tennis, knitting a new sweater, or chopping veggies in the kitchen, tennis elbow can strike at any time. Luckily, the team at ChiroCare of Florida is available in 11 offices throughout the South Florida area to help you eradicate pain and promote healing.
If your career or lifestyle is continuously putting you at risk of developing tennis elbow symptoms, contact ChiroCare of Florida today. Tennis elbow is about to get served.
