Causes and Prevention of Tennis Elbow

by Eli Reece

Causes and Prevention of Tennis Elbow

A booming first serve is met with a laser-like backhand return.  A rocket of a volley followed by an audible grunt of force sends the ball into the back left corner.

Game. Set. Match.

Since its adaption from an older game in 1873, modern tennis has dramatically grown to become one of the most prominent sports in the world, consistently ranked in the top 5 most popular sports worldwide. It’s estimated that tens of millions play the racquet sport in the United States alone, with players ranging from young children all the way to senior citizens.

Unfortunately, research has found that 40-50% of the tennis playing population develop pain within their elbows at some point during their career. “The mechanics of the tennis stroke require a tremendous amount of force to be transmitted through the elbow,” explains hand, wrist, and elbow surgeon Ian Smithson, MD. “The fundamental overhead nature of tennis mechanics and technique often places high levels of stress upon the elbow joint.”

With such a high incidence rate in tennis players, the condition was naturally called tennis elbow. However, tennis players are not the only individuals who are subject to this condition.

What is tennis elbow?

Forearm muscles and tendons are connected to the upper arm at two bony points of the elbow called epicondyles. Tennis elbow, otherwise known as lateral epicondylitis, is a form of tendonitis that affects the outer anchor point of the elbow.

Over time, symptoms develop due to repetitive body motions that lead to an overuse of the elbow joint. While pain appears in the elbow joint, the root cause is often due to strain put on the muscles in the forearm from wrist and hand extension. Motions that involve a pronated or palm down wrist can exert enough stress and force on the muscles and tendons to tear the fibrous tissue.

Hold your right arm straight out with your palm facing the ground and point your middle finger in the same direction. Trying to keep your arm and finger perfectly straight in this position, push down on your middle finger using your left hand. Where do you feel tension?

Your right elbow.

Symptoms may include pain that radiates from the elbow into the forearm and wrist when trying to

  • Open a door
  • Hold a coffee cup
  • Make a fist

What causes tennis elbow?

Numerous activities can lead to the development of tennis elbow, but they all involve overuse and over-stressing the tendons of the elbow past their tolerance point. Tennis players with a poor technique and lack of conditioning may try to “flick” or “reach” for the ball using the more vulnerable wrist and elbow.

Yet, as stated before, this issue is often caused by activities outside of the tennis court. “Any activity that results in an increased force generated by the forearm muscle can result in potential for microscopic damage to the tendons of the elbow,” states Wayne Chen, MD, a hand, wrist, and elbow surgeon.

Symptoms may develop from activities and professions such as

  • Carpentry
  • Carrying a briefcase
  • Gardening
  • Lifting heavy grocery or garbage bags
  • Painting
  • Plumbers
  • Using power tools

What is the treatment for tennis elbow?

Blood flow in the elbow area is poor, so the body’s repair mechanisms have a difficult time making a difference on their own. Paul McDermott, MD, a hand, wrist, and elbow surgery specialist, states, “Non-surgical treatment is aimed at promoting blood flow to the area, breaking up scar tissue and inflammation so that the body’s repair mechanisms can work as efficiently as possible.”

As soon as the injury occurs, known as the acute phase, several conservative treatments are viable to relieve symptoms.

  • Rest, ice, compression, and elevation or the RICE protocol.
  • Stretches of the forearm muscles.
  • Over-the-counter anti-inflammatory medication.
  • Ultrasound or electrical assisted topical steroid application with the aid of a hand or physical therapist.
  • Wearing a wrist brace to limit wrist extension.
  • If more ordinary pain medications are not enough, your doctor may recommend corticosteroid injections.

For pain that persists for 6-12 months and is not relieved from the above treatments, your doctor may recommend the following treatments.

  • Platelet-rich-plasma therapy: your own blood is centrifuged to concentrate platelets and growth factors and then injected into the site of the injury to promote healing.
  • Surgery may be performed to remove damaged non-healing tissues.

How can I prevent tennis elbow?

Strength and conditioning

  • When hitting a tennis ball, the entire kinetic chain of your body should be used. The power of the swing is created from the legs, hips, spine, shoulders, through to the elbow and wrist.
  • If there is a weak link anywhere in this chain, then other areas of the body will have more than their fair share of force to deal with.
  • Keep your entire body in shape by regularly training legs, core, arms, and shoulders.   

Proper technique

  • Identifying and correcting poor technique in the swing is crucial to prevent symptoms from appearing.
  • Instead of “reaching” for the ball by flicking the elbow and wrist, a player should lead with the shoulder and rotate their torso to deliver power and drive the ball into the desired direction.
  • Make sure your racquet is the correct size. A racquet that is too large or heavy increases your risk for injury.
  • After play, ice the elbow even if there is no pain present.

Warm up and stretch

  • Develop and consistently perform a warm up routine to ease into your training sessions and matches.
  • Stretch the entire body, but especially focus on the forearm muscles of both arms.
  • Start with gentle practice swings and progress into gently hitting a few balls.

Modify daily activity

  • Off the court, it is important to avoid activities that involve straining the forearm muscles and tendons.
  • Take regular breaks from painting and gardening.
  • Use both arms to carry an especially heavy grocery or garbage bag.
  • Use an over the shoulder briefcase instead of carrying one with a handle.