The Bend on Tennis Elbow

Tennis elbow affects many recreational tennis enthusiasts at some point in their playing life. For some it’s a one-time occurrence, for others a chronic ailment.

There are a number of products out there to help keep the pain at bay but is playing with pain, even minimal, a bad idea?

Pete Sallay, M.D., an orthopedic surgeon with Methodist Sports Medicine / The Orthopedic Specialists in Indiana, (also an avid tennis player) offers some insight and solution to the problem.

Just briefly, what is tennis elbow?
Medically speaking ‘tennis elbow’ is a tendon injury. It is caused by partial tearing or degenerative changes to the tendon on the outside of the elbow that extends to the wrist.

Why do so many recreational players get tennis elbow?
First and most important is faulty mechanics. Most recreational players, especially at lower skill levels, lack adequate technique which results in awkward, inefficient ball striking. Arm motion is rarely fluid resulting in mistimed hitting and ‘wristy’ strokes. Also, it is important to couple leg, hip and torso movement so that power comes from the ground up. Many recreational players fail to do this and rely solely on arm strength to propel the ball.

A simple example is hitting the one handed backhand. If one hits the backhand with minimal loading/ shoulder turn and with the elbow in slight flexion the force necessary to stabilize the racket goes up several fold. If the ball is mishit off center the problem is compounded because the muscles then have to resist the twisting torque of the racket.

… [I]f one loads and uncoils into the ball with the elbow near full extension there is minimal load on the muscles. Have you ever seen a decent pro with a tennis elbow strap? No, because they exert such little force compared to the recreational player yet generate far more pace with their superior mechanics.

Does age have anything to do with a person’s tendency towards tennis elbow?
Age related degeneration of the muscles and tendons is an unfortunate fact and some of us are more prone to age related wear and tear than others. Certainly strength and flexibility exercises can be helpful and preventative but for some the die is cast by which parents we choose!

If I feel the pain coming on should I lay off the game for a while?
Modulate your activity. Overuse injury can occur at any age and is the most preventable cause of tennis elbow. The best treatment is prevention.

What should I do if I get tennis elbow?
Once tennis elbow occurs the treatment should include activity reduction, physical therapy, splinting/ strapping, and sometimes injections. Some milder cases can resolve in a few weeks while most cases take several months to resolve.

What do you think about steroid and other types of injections?
Injections historically have involved the use of steroid medication with hit or miss results. Newer techniques involve injecting growth factors into the damaged tendons to promote healing. Further studies are necessary to determine the efficacy of these new regimens.

Ok, so my elbow feels better but I’m scared to play again.
After treatment has been rendered the most important final step is re-introducing play. This is the most overlooked part of the treatment. It is vital to have the individual correct the mechanical deficiencies that led to their problem otherwise the symptoms will rapidly recur.

Pete Sallay, M.D., is an orthopedic surgeon with Methodist Sports Medicine / The Orthopedic Specialists, who specializes in shoulder and knee reconstruction, arthroscopic surgery, and sports medicine. For more information on Dr. Sallay visit his bio. Methodist Sports Medicine/The Orthopedic specialists are the team physicians for the Indianapolis Colts.

Karin Burgess is editor of Tennisidentity.com a site devoted to what’s new in tennis, tennis fashion, gear, essentials and more.