Written by Physiotherapist, Michael Tegerdine. Michael specialises in sport injuries and musculoskeletal rehabilitation.
Tennis elbow is actually more commonly diagnosed in people who don’t play racket sports, but who have occupations that involve manual loading tasks, repetition and poor posture. Tennis elbow is characterised by pain localised at the outside of the elbow / upper forearm. It affects the tendon which extends the wrist, and is often exacerbated by gripping (e.g. holding a racket). Men are more commonly affected compared to women and the average age of people being affected by tennis elbow is between 30 - 50, although it can affect anyone at any age.
What is it? Initally thought of as inflammation of the tendon, research over the last ten years has found that the inflammation phase is short-lived if it happens at all. What normally happens is that a sudden change in loading the tendon causes non-inflammatory thickening in and around the tendon. The actual pathology occurs when the player continues to load the tendon (e.g. playing with or through the pain). Over time, degenerative changes (changes in tissue) can result in micro tearing and scarring of the tissue. There may also be vascular / neural changes within the tissue, however this is beyond the scope of this article.
How do I know if I've got it? Symptoms include a sharp or twinging pain over the tendon when returning to play. This can occur when holding the racket or hitting the ball; particularly on backhand strokes. Symptoms can present as stiffness in the morning upon waking and also be more severe following a game or 24 hours after training or a game. This is often felt as a deep ache or pain down the outside of the forearm.
Tennis Elbow and Squash players The reliance of the wrist and elbow rather than the use of the whole body in squash can cause excessive strain on the wrist tendons. Correcting technique (e.g. wrist control) or modifying the player’s movement / footwork so their body is in the optimal position to hit the ball correctly is important. This can allow for the loading of the tendon to be absorbed by the whole body, which will reduce the risk of Tennis Elbow and help manage the condition more effectively.
Additional Risk Factors
- Excessive wrist extension
- Racket type
- Grip size (too large or too small)
- String tension (too tight)
- Age (between 30 – 50) High cholesterol
- Sudden change in activity (more or less sport / work)
- Previous injury
- Muscle imbalance (weakness)
Treatment Physiotherapy can help treat Tennis Elbow, this can include:
- Activity modification
- Stretching exercise prescription
- Eccentric / Concentric strengthening programme
- Advice of sport specific warm up and cool down
- Injury prevention strategies
Steps to dealing Tennis Elbow
- Visit your GP causes rule out any non-sport causes
- Consult a physiotherapist
**Disclaimer: This article is for general information only and should not be used as a basis for diagnosis or treatment**