Tennis elbow

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What is it

Tennis elbow is a type of tendinitis that at some point sidelines about half of all amateurs who play tennis at least three times weekly. Professional players suffer from it, too.

Tennis players aren’t the only ones at risk for epicondylitis that medical term for tennis elbow. In fact, the pain is not related to tennis in at least 95 percent of patients. Any activity that calls for forceful, repeated contraction of the arm muscles can bring on tennis elbow for example, working with carpentry tools, shaking hands, gardening, raking leaves, even tightly gripping a briefcase repeatedly. Baseball, golf, bowling, racquet sports, even darts can bring it on. In most cases the dominant side of the body is most frequently affected.


  • Tenderness and pain in the muscle connected to the outer side of the elbow.
  • Pain in the elbow when hitting a tennis ball.
  • Pain in the forearm and elbow when turning the hand and arm, as in using a screwdriver or playing tennis.
  • Forearm and elbow pain when lifting a heavy object.

What causes it

The injury occurs when you flex, extend, twist, or contract your wrist or forearm excessively or improperly, and thus strain the tendons that connect muscles to the elbow joint.

In time, the overloaded tendons grow microscopic tears, creating tendinitis (aching swelling of the tendons) focusedĀ  around the epicondyle the point at which the tendons attach to the elbow. Pain can emit down to the wrist and up to the shoulder. Moving your arm or fascinating something worsens the pain.

The elbow tendons can develop microscopic tears anytime they are exposed to a repeated stress greater than the tissues can withstand. Experts think it’s not the vibration that causes the tears but excess torsion for instance, when the ball hits off center, the racquet twists your arm. Pain on the lateral side of your arm (the side your thumb is on) is 10 times more common than pain on the other (medial) side.

For most recreational tennis players, the backhand may be the main culprit causing the condition. However, the serve or forehand may also promote tennis elbow.

To some extent, whether or not you develop tennis elbow depends on the condition of your muscles and how much they are overused. In tennis, the injury happens most often among amusing players who are 35 to 50 years old when muscles have started to drop their resiliency and who play at least 2 or 3 times per week. In a study of 2,600 amateurs, almost half of those who played daily got tennis elbow.

Occasional players are less vulnerable, as they tend not to play often enough or hard enough to overstress their arms. Pros are generally protected by superior conditioning and stroking technique, though they too can develop tennis elbow as they grow older.

What if you do nothing

Tennis elbow will clear by itself if you are able to rest and stop performing the twisting motions to the wrist and forearm that initially brought on the pain.

Home remedies

Take a break

If you develop tennis elbow, try to reduce the activity that is causing it or stop completely until the pain diminishes. If you must engage in the activity, at least try to warm up your arm for five minutes by stretching it and flexing your wrist. Once you start the activity, take frequent breaks.

For pain relief, anti-inflammatories can help

For mild cases of tennis elbow, nonprescription NSAIDs aspirin, ibuprofen, or naproxen will reduce inflammation and pain while you are resting your arm.

Apply ice or heat

For some people, immersing the elbow and forearm in warm water for 15 minutes several times a day may bring some relief For others, an ice pack placed on the sore area for 1 5 minutes several times daily may also be helpful.

Try an elbow brace

For players persistently troubled by tennis elbow, some sports physiologists recommend the use of an elbow brace, which supports and protects the muscles and tendons of the forearm; this offers some pain relief without drastically restricting movement.


If you play tennis regularly, here are the keys to avoiding tennis elbow. To prevent epicondylitis, beginners should remember that technique and conditioning are far more important than the size or type of racquet.

Strengthen forearm muscles

This is the best defense for athlete and non-athlete. According to Dr. Robert Nirschl, director of the Virginia Sports Medicine Institute, half the tennis elbow sufferers he sees have some major strength deficits in the shoulder and upper back. The key therefore is to restore strength, endurance, and flexibility to the arm, shoulder, and back. (If you’re under treatment for tennis elbow, you should consult your doctor before embarking on an exercise program.)

One simple forearm strengthener is to squeeze a ball 40 or 50 times with your arm extended horizontally in front of you.

Work on your form

Power your serve and backhand with your legs, torso, and shoulder muscles rather than with your forearm and wrist. During a stroke your elbow should be almost fully extended but not locked, and your grip should be firm but not viselike, so that force is transferred to your shoulder.

Try a two-handed backhand

Some teaching pros recommend this technique to beginners. Players who use two hands seldom develop tennis elbow, since the second hand provides additional support.

Consider tennis lessons

A tennis pro can easily help correct any faulty backhand technique and assist you in selecting the proper tennis racquet that best fits your grip.

Choose the right racquet

Racquets can aggravate tennis elbow. Follow these tips when selecting your equipment:

  • Try a midsize racquet, which has a bigger sweet spot and absorbs vibration better than a small one. It plays softer and gives more power, so you don’t need to swing as hard. An oversize racquet, in contrast, can increase the risk of the racquet over-twisting if you hit the ball off center.
  • Choose a flexible racquet one that is injection-molded or that contains a high proportion of fiberglass which will dampen shock effectively. According to Dr. Howard Brody, professor of physics at the University of Pennsylvania, composite racquets with an increased ratio of nylon matrix, as opposed to epoxy resin, are good models for absorbing shock.
  • An increased grip size can also help. Too small a grip can lead to arm-muscle fatigue from over tightening. But too large a grip may put you at a strength disadvantage.
  • Lower your string tension to dampen shock. Higher string tension does give more control but it also increases the shock to your arm after ball impact.


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