What Causes Tennis Elbow, and How To Fix It

Tennis elbow is an inflammation of tendons connecting muscles of the forearm to the outer side of the elbow. It often results from repetitive use of the forearm muscles and tendons, as well as those surrounding the elbow joint. Known by physiotherapists and medical professionals as lateral epicondylitis, this painful condition is not always related to tennis— it earned its name since it afflicts about one-half of all regular tennis players.

This painful condition typically occurs in adults from 30 to 50 years of age. Repetitive overuse of the forearm in combination with unnatural or incorrect wrist movements can result in the development of tennis elbow. The pain that accompanies this condition is actually due to small tears in tendons connecting the forearm to the exterior elbow region.

Causes of Tennis Elbow

The most common cause of elbow pain is incorrect arm movements that are frequently repeated. In the sport of tennis, this condition can result from forceful and repetitive swings of the racquet and the impact of hitting the tennis ball. When you use incorrect wrist positions and technique as a tennis player, the racquet may rotate around your wrist, causing unnatural and potentially injurious wrist movements under stress of hitting the ball.

When the wrist handles the major movement and stress of your racquet stoke as it makes contact with the tennis ball, this puts extra pressure on the tendons connected to your wrist, causing a lasting inflammation. When your racquet stroke is performed correctly, with your wrist held steady, your elbow joint and shoulder bear the pressure and stress of the impact of ball and racquet connecting. Damage to your wrist tendons then causes pain in the extensor muscles that are responsible for straightening the wrist and holding it steady.

Along with initiating pain, this condition inhibits your ability when playing tennis. It makes it difficult to coordinate the extension of your wrist and fingers, which is necessary for flicking or snapping your wrist during racquet swings in fast-paced tennis matches. Similar unnatural twisting or rotating motions of your wrist under pressure can occur in such activities as gardening, pitching a baseball, swimming, cutting tough foods or materials with scissors or a knife, typing, laying stones or heavy tiles or lifting and carrying heavy items.

Some work crews involved with lifting and using heavy hand-operated equipment use wrist guard supports to help steady the wrist and avoid injury. Many serious tennis players also wear supportive flexible wristbands as braces to help steady and reinforce wrist movements. When the wrist wobbles or moves out of alignment with the motion of your arm during these activities, your elbow can also move incorrectly. This may cause muscle and tendon strain and irritations that can lead to persistent inflammation and pain.

Symptoms of Tennis Elbow

The most frequently reported symptom of tennis arm injury is pain focused in the outer side of the upper forearm, directly beneath the elbow bend. This pain may radiate down the arm, closer to the wrist, and may increase when the forearm is twisted or when you bend or lift your arm. The pain is often more intense during such actions as writing, gripping items, rotating a door handle or fully extending your forearm.

As your body attempts to compensate for the loss or reduction of elbow and wrist stability and movement, additional areas of the arm, shoulder, neck and hand of your affected arm may also develop pain. Other symptoms and occurrences of this painful, annoying and often persistent condition include the following:

• Pain During Sleep: Pain and discomfort in and around your elbow may intensify at night, interfering with your sleep patterns.
• Stiffness in Your Elbow: Your elbow may be stiff when you awaken in the morning.
• Spreading of Pain: If left untreated, the pain in your elbow and other parts of your arm, shoulder, neck, wrist and hand may occur during even mild actions like opening a jar of food, picking up an empty coffee cup or when turning your door key in the lock. You may even experience pain when your arm is completely still and inactive.

Diagnosing Tennis Elbow

If you develop symptoms that you think indicate tennis elbow affecting your arm and its ability to perform normal tasks, you should be examined by a physician for appropriate testing and evaluation. There is also a simple test that you can perform at home as a preliminary measure before seeking medical attention.

While standing behind a chair, position your hands on top of the chair back. Your palms should face downward, and your elbows should be straight. Next, attempt to lift the chair. If this action results in pain in the outer area of your elbow, it is an indication that your painful condition may be tennis arm injury. When you visit your physician for a medical diagnosis, he or she will most likely test your arm’s capacity for completing a range of motions. Based on your reactions and arm mobility, the physician may order one of the following diagnostic tests to determine the cause of your elbow and arm pain:

• X-Ray:  X-ray imaging produces images of your body’s interior. These pictures display different parts of your internal system in varied shades of black and white since different body tissues absorb different levels of radiation during the imaging process.
• MRI Scan: A magnetic resonance imaging (MRI) scan produces detailed and accurate images of your bodily organs and tissues with use of radio waves and a strong magnetic field.
• EMG:  An Electromyography can help determine whether or not nerves of the body are compressed. An EMG reveals muscle responses or electrical activity as a response to nerve activation of this muscle. The purpose of the test is to identify neuromuscular abnormalities. The test involves one or more electrodes (small needles) being inserted inward through the skin to penetrate the muscle tissue.

In some cases, one or more of these types of imaging is necessary for ruling out more serious conditions.

Treatment for Tennis Elbow

For anyone with symptoms of tennis elbow, resting the affected elbow and arm is essential, both before and during use of other treatment methods. Treatment methods frequently used by medical doctors and sports medicine clinics include the following:

• Physical Therapy: Physical therapists work with tennis arm injury patients, instructing them in practicing movements and exercises to gain strength in their shoulders, upper arms and abdominal muscles. Strengthening these muscles will lessen stress on wrist extensors during sports and other activities focused on strenuous arm and shoulder use.
• Ice Massages: Ice massage with the use of an ice pack has proven to lessen swelling and inflammation in people suffering pain from sports injury to an elbow.
• Muscle Stimulation: Electrotherapy treatments are used by physiotherapists to alleviate pain and encourage healing of tennis arm injury. During this process, electric currents enter the tissues for stimulating muscular functionality.
• Forearm Strapping, Taping or Splinting: By strapping, taping or splinting forearms of sports elbow injury patients, physicians and therapists brace and support weakened and painful muscles and tendons, enabling them to heal more quickly without further stress or injury.
• Steroid Injection: If the pain is acute in the affected elbow and arm and the patient is having difficulty performing normal daily activities, a medical doctor may use a steroid injection to lessen pain and stiffness.
• Botox Injections: Injections of botulinum toxin can also be helpful in alleviating the pain and stiffness of tennis arm damage.
• ESWT: Extracorporeal shock wave therapy (ESWT) is a type of ultrasound treatment that provokes a healing response in injured body tissues. Research has shown that in more than 75% of tennis arm injury patients tested, ESWT has been effective.
• PRP Injections: This fairly recent, innovative treatment for alleviating arm pain from injuries incurred during tennis playing or other activities contains proteins that promote healing. The injection of platelet-enriched plasma (PRP) is made with the patient’s blood.
• Surgery: If pain cannot be eliminated within 12 months after onset, surgery may be necessary for removal of damaged tendon tissue. In most cases, other treatment methods will heal tissues and eliminate pain between six to ten months.
• Exercises: Performing stretches and exercises for strengthening muscles and maintaining flexibility are important after tennis elbow injuries. One helpful exercise is the Tyler Twist, which involves a series of hand, arm and wrist exercises with the use of a FlexBar or similar item for resistance.

A highly successful, healthy and non-invasive treatment method for eliminating pain from elbow injury due to tennis playing and other injuries of the muscles and tendons is the use of the Electro-Acuscope. Used currently by the experienced, respected practitioners at Dynamic Physiotherapy, this complete pain management system is one of the most effective forms of treatment for relief of pain today. It operates by introducing low-voltage micro-current electrical waves to injured body tissue, resulting in more rapid rates of self-repair by cells. By enhancing metabolism at the cellular level, it enables your body to repair the damage. This outstanding treatment system can relieve the majority of common pain syndromes, whether acute or chronic.

If you or someone you know is suffering from Tennis Elbow, contact Dynamic Physiotherapy, online or send us an email to book a consultation today.