Tennis elbow doesn’t have to be the unwelcome opponent on your game day. Are you grappling with the discomfort of aching swings during your pickleball or tennis sessions? Perhaps you’ve heard whispers about this troublesome condition and are eager to fortify yourself against it. Join us as we delve into the intricacies of tennis elbow, offering insights and strategies to swing smart, ensuring that you stay on the courts with confidence and ease.
What is Tennis Elbow?
Most of us have heard of tennis elbow, but what exactly is it? Let’s start with some anatomy. Our elbow is made up of 3 main bones: the humerus, the ulna, and the radius. In the upper arm our biceps and triceps are the main muscles responsible for flexion and extension at the elbow. Moving down to the forearm the main muscle groups are the extensor muscles (lifts your wrist up in a palm down position) and flexor muscles (moves your wrist down in a palm down position).
In general, most of us do a lot of gripping activities in our daily lives and develop strong wrist flexors. This may lead to an imbalance of strength with the wrist flexors being significantly stronger than the wrist extensors. With persistent weakness our extensor muscles may become tight as they try to provide stability to the forearm and wrist but are lacking appropriate strength.
This tightness in the extensor muscle group then pulls on the common extensor tendon where all these muscles attach, creating the pain and inflammation that we see with tendonitis. With tennis elbow, pain is felt at the outer edge of the elbow often after an increase in activity (such as ramping up your hours playing pickleball). Tennis elbow is caused by repetitive stress to the forearm extensor muscles and tendon, such as a backhand.
Tennis elbow occurs within the extensor muscle group and at the common extensor tendon. It is a tendonitis of the elbow and is also called lateral epicondylitis. If left untreated it can become chronic and turn into a tendinosis. For an explanation on the difference between the two check out our article on that topic here HERE.
Prevention and Treatment
Key ways to directly treat and prevent tennis elbow are to work on the strength and mobility of the forearm muscles. Strengthening our forearm, specifically our wrist extensors, will provide increased stability to the elbow and wrist. Loading the common extensor tendon with appropriately dosed exercise will also make the area more resilient to the stresses placed on it, and facilitate healing if a tendonitis has developed. Below are two exercises for wrist extension strength.
Wrist Extensor Eccentric Exercise for Tennis Elbow
Wrist Extension Isometric Exercise for Tennis Elbow
Mobility is another area that needs to be tackled. Self mobility work such as using a release ball or massaging the area can reduce tightness in the forearm musculature. Stretching is also useful. We recommend dynamic stretching prior to playing and static stretching after. Below is a video on forearm stretching.
Forearm Stretches for Tennis Elbow
The Shoulder and Thoracic Spine
For injury prevention and treatment of tennis elbow, we must also look up the chain at the shoulder and even the thoracic spine, or mid back. If mobility or stability is limited at the shoulder, it can cause downstream consequences as it plays a very important role in elbow and wrist stability. If we are tight in either of these areas we often compensate by overworking our elbows and wrists to get those more difficult shots.
For example, let’s say there is underlying weakness resulting in poor stability in our shoulders and we pick up a racket and meet up with some friends down at the courts. Each time the ball is hit a force is applied into our arm and the rest of our body. If strength is lacking in the shoulder guess where most of that extra force ends up being absorbed- the elbow! This puts strain on our elbow which will mostly affect the weakest muscle group there, which is our wrist extensors. The wrist extensors then tighten up to try to provide stability to the elbow and wrist, creating the tightness dynamic and pull on the common extensor tendon described above.
Let’s keep our shoulders and spine healthy to decrease our risk of developing tennis elbow. For more information and specific exercises for pickleball players check out this article on that topic.
I hope you learned something about the management of tennis elbow. To summarize, strength issues and mobility deficits of the spine, shoulder, and arm can contribute to the development of tennis elbow. Strengthening and stretching the wrist extensors of the forearm is often key in the treatment and prevention of this condition, as well as addressing possible impairments in the shoulder and spine. As always, if further guidance is needed get in touch with us and we will get you headed in the right direction!
If you’re curious about more ways to prevent injury, talking with a Doctor of Physical Therapy is a great place to start.
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