Physiotherapy & Recovery Archives

Even though tennis is not a contact sport, tennis players do not fall behind other athletes when it comes to injuries. Wrist, back, shoulder, hip, knee, ankle, and abdominal lesions are among the most common injuries for tennis players, in many cases forcing them to step away from the courts for several months. Even the best players in the world are subject to them - Roger Federer sat out for 6 months in 2016 due to a back injury, Nadal sat out for 7 months in 2012 due to a knee issue, and Andy Murray even retired from tennis for a while due to a hip injury. There are two reasons why tennis players have injuries so frequently. First, lower body injuries usually happen due to the frequency of sprinting, stopping, and direction-changing that happens during a tennis match. Second, upper body injuries happen due to the large number of times players need to hit the same shot over and over. While all the injuries mentioned above are fairly common, there is one injury that happens a lot more frequently than all others - tennis elbow. Tennis elbow is a painful condition that affects not only athletes who play racket sports, but even other athletes and non-athletes as well. Affecting over 200,000 people in the US per year (2 to 3%), tennis elbow can be a very debilitating injury that can affect several areas of your life. As a tennis player, you should have a good understanding of what tennis elbow is in order to avoid it and stay injury-free. In this article, we will cover exactly what tennis elbow is, how to treat it, and - most importantly - how to prevent it. The information below is outlined in the following way: What Is Tennis Elbow?Tennis Elbow CausesTennis Elbow SymptomsIs Tennis Elbow Painful?Can You Play Tennis With Tennis Elbow?Tennis Elbow TreatmentsHow Long To Heal Tennis Elbow?Tennis Elbow StretchesTennis Elbow Exercises What Is Tennis Elbow? Tennis elbow, also known as lateral epicondylitis, is a common injury among tennis players (and players of other racket sports) caused by an inflammation of the tendons in the outside of the elbow and forearm. What usually causes tennis elbow is a large and frequent number of repetitions of the same movement, inflaming the tendons and causing a lot of pain. Your elbow is where your upper arm bone (humerus) joins your forearm bones (ulna and radius). Surrounding these bones are several different ligaments, tendons, and muscles. The purpose of your forearms muscles is to move your hand and fingers, while the purpose of your ligaments and tendons is to connect your muscles to your bones. The tendons that join your forearm muscles to your humerus are called extensors, and tennis elbow is usually caused by an inflammation of the tendon called Extensor Carpi Radialis Brevis (ECRB). The humerus has a few bumps on its bottom, which are called either lateral (outside of elbow) or medial epicondyles (inside of elbow), and the ECRB is connected to the lateral epicondyle. This is why the scientific term for tennis elbow is lateral epicondylitis. Tennis Elbow Causes The causes of tennis elbow are usually exercises that put a strain on the person’s forearm muscles and that are extremely repetitive. The constant repetition causes muscles and tendons to inflame, which eventually leads to pain. Tennis elbow can also be caused by hitting your elbow somewhere. Despite its name, the majority of tennis elbow injuries are caused by activities other than tennis. Other racket sports like squash and badminton can easily lead to such injury. In addition, other activities that can cause tennis elbow include gardening, painting, brushing, plumbing, woodworking, typing, knitting, lifting weights, playing the violin, or using scissors. In tennis, tennis elbow injuries happen most of the times when players are hitting shots on their backhand side. By hitting a large number of shots using the wrong technique, these players end up causing inflammation in their elbows. This is mostly witnessed in beginners, who end up bending their elbows too much when hitting their backhands. Tennis Elbow Symptoms The main symptoms from tennis elbow are: 1) pain in the outside portion of your elbow that can extend to your upper arm, forearm, and hand; and 2) a lack of strength on your grip, which can make playing tennis very difficult. These symptoms can affect several activities in your life, as they will usually feel worse any time you use your hand or forearm - which can involve activities like turning a doorknob or even just holding a pen. These symptoms will start slowly and will aggravate as you continue to use your arm. Since you use your forearm in so many day-to-day activities, it is likely that you will end up aggravating the inflammation. Once the pain and weakness get to a certain point, it will be very difficult to continue playing tennis. Not only you will require more time to recover from this injury, but your body will most likely try to compensate for the pain by changing your technique - which can lead to other different injuries. As you can see in the photo above, the red areas are the ones that are normally affected by tennis elbow injuries. The yellow areas are not as common, but can also be affected if the injury becomes more extreme. Is Tennis Elbow Painful? Tennis elbow can be quite painful. Since your elbow is inflamed, any movement with your hand or forearm can cause further inflammation, which will generally be painful. In addition, hitting or knocking your elbow will also usually hurt if you suffer from tennis elbow. Can You Play Tennis With Tennis Elbow? This is a tough question, and there is no definite answer. If you can, you should stop playing tennis as soon as you realize you might be suffering from tennis elbow. If you continue playing, you might increase the damage to your elbow - which will make the recovery process slower and more difficult. However, we understand that sometimes you might not be able to quit tennis completely for months or even a year. If that’s your case, you should make sure that you work as much as you can on treating your injury and that you follow these tips when playing tennis: If your elbow starts hurting, stop playing immediately;Know what your priorities are - continue playing or recover 100% as quickly as possible. You can’t do both at the same time, so you need to figure out what is more important to you;Correct any technique that might be aggravating your injury;Strategize your match or practice according to your injury and avoid hitting shots that hurt your elbow;Take days off and don’t play for too long at once;Take off-court recovery VERY seriously - stretching, exercising, and icing might help you to continue playing tennis while healing your tennis elbow injury. Tennis Elbow Treatment Even though tennis elbow can be quite debilitating, the good news is that it shouldn’t require you to end your tennis career. In the majority of cases, tennis elbow will heal on its own, provided you take the necessary measures. In essence, tennis elbow pain is caused by inflammation and the pain will go away as soon as the inflammation does so as well. There are several things you can do to help your tennis elbow get better, most of which we will cover below. Icing The Injured Area One of the first steps you should take once you start feeling pain in your elbow is to ice the injured area. Notice that you should never ice an injury before exercising the injured area, as that could make the injury worse. Icing your elbow should help to reduce both pain and inflammation, which makes it one of the most effective measures for a fast healing. In order to ice your tennis elbow injury properly, you should follow the following tips: If you played tennis and your elbow started hurting, ice it immediately;Keep your icing sections between 15 to 20 minutes long, and never longer as that can make the injury worse;Give yourself at least one-hour breaks between icing sections, giving the injured area enough time to recover;Try to move the ice around the injury instead of just keeping it in one place;Never apply ice directly to your skin, as that can damage the tissue further. We found a very-well icing pack designed specifically for tennis elbow on Amazon, from ubertherm. This cool tool will keep your whole elbow icing and compressing while keeping it free from ice burns. Painkillers If your pain is too intense, you can consider taking a painkiller with anti-inflammatory properties, like paracetamol or ibuprofen. If you choose to do so, you may also purchase these items in a cream version, which you can apply directly to the affected area. These creams may help to reduce pain and inflammation, especially when combined with icing. Massages Another very useful treatment method is to massage your elbow. An effective massage will make more blood circulate to your tendons, which normally don’t get a lot of blood when they are injured. A deep-tissue massage will help your tennis elbow heal faster than it would by otherwise just letting it rest. You can choose to see a physical therapist to get a massage, but you can also choose to do it yourself. The following video contains a nice overview of what a tennis elbow massage should be like. https://youtu.be/_70oOs9dkwE?t=118 If you choose to take your self-massage a step further, I recommend that you buy a massage gun like this one. These tools will get really deep into your tissue and you can do it all while watching tv. They come with adjustable heads and speeds so you can figure out which one works better for you. Shockwave Therapy Another non-invasive method to heal tennis elbow is using shockwave therapy. When doing so, you connect small electrodes to the injured area and these electrodes keep sending electric stimuli to activate your muscles and tendons. This can be effective when combined with the other methods to increase circulation in the area and speed up the recovery process. While you can purchase your own shockwave therapy machines online, I suggest that you see a physical therapist if you are looking to use this method. Using Tennis Elbow Accessories If your pain is not too severe and you’re considering playing through the pain while waiting for your elbow to heal itself, you may want to consider using a tennis elbow accessory. The most commonly used accessory is the compression sleeve, which keeps your elbow compressed and reduces pain. These sleeves are worn during workouts and tennis matches, so they are only treating the symptoms and not the cause. If you decide to use them, you should still work on some of the other treatments mentioned on this page. Exercises & Stretches Exercises and stretches can be one of the most effective ways to heal your tennis elbow and keep it from coming back. These methods will strengthen the injured area, make it more flexible, and increase circulation - all good things to fight tennis elbow. We will cover these methods in more detail below, but for now, you should just know that exercising and stretching may be your best friends. Adjusting Your Technique Even if you are very disciplined with your tennis elbow treatments, nothing will keep it from coming back if you have a poor tennis technique. If your backhand is not properly executed, the elbow inflammation will continue to happen and so will the pain. You can be as strong and flexible as you want, but you can’t fight physics. Adjusting your technique is incredibly important in order to prevent further recurrences. If you want to learn a little more about the proper backhand technique, we have written a great step-by-step guide, and you can check it here: Tennis Backhand - Grips, Tips, Steps - (With Photos & Video). Steroid Injections & Surgery Finally, you also have the option of pursuing more invasive treatments like steroid injections and surgery. Personally, I highly advise you against those, as there is no need to take such extreme measures. A more holistic treatment will have a much better effect, and it will be a lot better for your body in the long-run. How Long To Heal Tennis Elbow? Depending on the severity of your tennis elbow injury and on how disciplined you are with your treatment, you should expect to heal your elbow in a period that can range from 1 to 18 months. On average, however, most tennis elbow injuries heal in 6 to 12 months. Tennis Elbow Stretches While some people prefer to hire a physical therapist when treating a tennis elbow injury, you can recover just as fast by doing stretches and exercises at home by yourself. Working on the exercises and stretches mentioned below will be the most important aspect of your treatment - not only for pain relief but for full and fast healing. If your injury is very painful and you are struggling to even move your elbow, we highly recommend that you start with the stretches. If your pain is not too bad, however, you may choose to start with a mix of stretches and exercises. We will give you a list of the best active recovery exercises for tennis elbow we know of, but it’s up to you to figure out which exercises work best for you. It is normal to feel a little discomfort in some exercises, but if you feel any pain, you should stop the exercise immediately. Stretch #1 - Wrist Activation - Closed Fist https://youtu.be/SJMAMqmHLFI Even though tennis elbow injuries are caused by an inflammation in your elbow, the majority of stretches and exercises involve loosening up your wrist and forearm muscles. By doing so, the relaxation of the muscles will allow for the inflammation and pain to decrease. The first stretch will be a great starting point if your pain is quite intense. Well, it’s not really a stretch but some kind of movement. You should follow these steps: Sit down on a chair comfortablyBend your elbows at a 90-degree angle, but keep it a few inches away from your legMake a fist with your hand, with the back of your hand facing the ceilingKeep it fairly loose - you’re not stretching yet, just activating itMove your fist in an up-and-down motion, keeping your elbow in placeComplete 2 sets of 10 reps each Stretch #2 - Wrist Activation - Hammer Grip https://youtu.be/1L4TliuxM-s This activation movement works similarly to the one mentioned above, but with a slightly different grip. This movement will activate different areas of your forearm, so you can do it immediately after the movement above. Rotate your fist 90 degrees to the right, as if you were holding a hammerMove your fist in an up-and-down motion (it will be a little awkward), keeping your elbow in placeComplete 2 sets of 10 reps each Stretch #3 - Wrist Rotation https://youtu.be/GxBdeIAjpRA The third exercise in this progression might be a little more difficult, but it is just as important. You should remain in the same position, and you can do it immediately after the previous two movements. Extend your fingers, while still keeping them close togetherBegin with the back of your hand facing the ceilingRotate your hand so the palm of your hand faces the ceilingRepeat that movement while keeping your elbow in placeComplete 2 sets of 10 reps each Stretch #4 - Wrist Extension Stretch https://youtu.be/saqeEnZyDM8 The next stretch in this list is the wrist extension, and it will stretch your forearm. This stretch will usually not get the exact spot where your pain is located, but you should do it nonetheless. By starting off with this one, you will make it easier to move on to the next stretches. Follow these steps for this stretch: You can either stand up or sit down for this exercise, just make sure you have a straight backExtend your elbow, but make sure you keep at least a slight bend. If you’re in a lot of pain, you can give it a good bendExtend your fingers, with the back of your hand facing you (as if you were telling someone to “stop”)Use your other hand to pull your fingers back - which will stretch your forearmHold it for 15 seconds, completing a total of 5 reps Stretch #5 - Wrist Flexion Stretch https://youtu.be/K0OKvf6kjUM This stretch is the opposite of the wrist extension, and it will generally hit right where your pain is. This time extend your fingers down, with the palm of your hand facing youUsing your other hand, push the back of your hand towards yourself until you feel a stretch on the outside of your armHold it for 15 seconds, completing a total of 5 reps Stretch #6 - Wall Squeeze Stretch https://youtu.be/VQU2F3fb8PY The last stretch is a little different, but it can give you a great deal of relief. Find a wall that has a corner in itWhile standing up, bend your elbow at a 45-degree angle and touch the outside of your arm (right above the elbow) against the corner of the wallWith your non-injured hand, form an “L” shape with your index finger and your thumbUsing the L shape, push the forearm of your injured arm against the wallKeep squeezing the hand of your injured arm into a fistSqueeze it 10 times, and do 3 sets of it Tennis Elbow Exercises If you’re feeling comfortable with the stretches listed above, you may want to move on to some exercises. By strengthening your forearm, you will not only initiate more blood circulation in the injured area but you will strengthen the muscles around it. By strengthening the muscles, you will minimize the chances of injuring your elbow again. Once again, if you feel any pain during these exercises, you should stop them immediately. Exercise #1 - Wrist Extension Strengthening https://youtu.be/mMiUxVE1E1g This exercise is essentially the exercise version of the stretch mentioned earlier. You should follow these steps: Lay your forearm against a flat surface, with your hand just barely hanging off the tableWith the back of your hand facing the ceiling, engage in an up-and-down motion while keeping your arm stillWith no weight, repeat that movement 30 times once a day. If you were able to finish it without pain, you can move on to adding weight to your hand. Start with no weight, then use either small dumbbells (1, 2, 3 lbs) or canned foods if you don’t have any dumbbells Exercise #2 - Flexion Strengthening https://youtu.be/H0yFnJOxjd8 Follow the same steps as the exercise mentioned above, but in the other direction. Exercise #3 - Hammer Swing https://youtu.be/anPEJ3YrbCg For this exercise, you should remain in the same position as the exercises mentioned above. Use the “hammer” grip we mentioned earlier for the Wrist Activation - Hammer Grip stretchYou can either choose to use a dumbbell here or a hammer. A hammer may even be better, as it has most of its weight on the tip.Move your wrist from one side to the other - as if you were simulating a windshield wiperRepeat this movement 10 times, and complete 2 sets of it Exercise #4 - Stress Ball Squeeze Another helpful exercise involves a stress ball. These are generally very cheap (you can buy them on Amazon, like this one with different resistance levels), and they can be very useful. All you need to do is: Keep your elbow at a 90-degree positionSqueeze the stress ball slowly, and release it slowlyRepeat it 10 - 20 times, once a day Exercise #5 - Towel Twist https://youtu.be/iv4O81CbdIc This is one of the best exercises for tennis elbow, as it will build up strength in just the right muscles. All you need to do this one is a towel. Sit comfortablyRoll a hand towel a few times, and hold it with both handsExtend your elbows in front of you, keeping a slight bendRotate the hand of the injured arm back and forth, twisting the towelIf it’s too easy, roll the towel a few more times to make it more difficultComplete 2 sets of 10 reps each Exercise #6 - FlexBar Twist The final exercise is essentially a modification of the towel twist using a tool specially designed for strengthening the forearm. It’s called the FlexBar, and you can buy it on Amazon here. The manufacturer of this brand claims that it reduces elbow pain by 81%; I’ve used it in the past and I can tell you that these little things are pretty neat. In order to use this, here’s what you should do: Sit comfortablyIf you want to flex your wrist (move it downwards), you can start by holding the Flexbar as you would in a regular hammer grip. If you want to extend your wrist (move it upwards), you should bend your wrist down before holding the FlexBar (see pictures below). Grab the Flexbar with your other hand and extend your elbows, keeping a slight bendRotate your wrist according to the exercise you’re going for - there should always be resistance against the movementComplete 3 sets of 10 reps each Final Thoughts While tennis elbow can be a pretty debilitating injury, there’s no need to panic about it. As long as you’re responsible and take your treatment and recovery pretty seriously, you will be back on the tennis court in no time. Remember that you should use a combination of the treatments mentioned above in order to fully heal your injury, and that your best choice might be to correct your tennis technique in order to avoid future tennis elbow occurrences!