Tennis elbow is a condition — which has been described since 1900 — that occurs in amateur as well as the professional athlete without prejudice, and is feared by both.
Tennis elbow is only a general term for pain in the elbow for a variety of reasons. The most common case of elbow pain is due to an overuse or overload condition on the tendons and muscles about the elbow, leading to inflammation of the involved area. In many cases, the tendons about the elbow are damaged or partially torn, which leads to continued pain whenever the activity is performed.
Factors Leading to Tennis Elbow (involving one or a combination of those listed below):
Obviously, many of the problems with “tennis elbow” have to do with overall tennis form, style and the way in which the racquet is used. In tennis, tremendous forces and torques are generated in the forearm, arm and shoulder. Improper technique can magnify these forces injuring tendon and joint structures. Specific problems can arise in performing forehand, backhand and services.
Forehand problem areas can be categorized into late ball contact; roll of the wrist; elbow swing and stiff arm. The swing involves total arm involvement, and the shock of the hit should be absorbed by the entire extremity. Late ball contact means the arm is past the optimum position to strike the ball and therefore an adjustment to late contact can concentrate undue forces on the arm. In striking and swinging motions, if excessive wrist roll or twisting occurs, this can lead to stretching and pulling of proximal forearm muscles.
Having the elbow bent past 45° may lead to an elbow swing rather than a swinging of the entire arm. In this position, the motion and impact is imparted on the elbow joint, which can be injurious. The bent elbow position is usually caused by getting too close to the ball when swinging due to poor habits or form. On the other extreme, if you swing with the arm too stiff it will lead to aggravated amounts of tension on the entire arm.
The backhand is generally found to be the prime cause of tennis elbow in non-professionals due to the complexity of this stroke. Again, a bent elbow or “swinging” just at the elbow and not the entire arm, all related to improper form, causes excess torques and forces in the elbow region. It is important to remember that it is rare to see a “tennis elbow” in people who use a two-handed backhand.
Other causes of tennis elbow are:
- Late backhand stroke with hyper-extended wrist.
- Too tight of grip.
- Excessive wrist “pop” on overhand serve.
- Forehand stroke with excessive wrist movement.
Finally, your swing must be a smooth, rhythmic swing. Any jerky or non-rhythmic movements in the step and swing will lead to abnormal absorption of the shock.
Serving is a common problem in all tennis players. There are many different styles and techniques. Two common problem areas are in wrist movement and in hitting the ball behind the head. Most American tennis players place a great deal of spin on the ball, having to use excessive wrist movement. The second problem is contact of the ball behind the head, which would force over-extension of the arm with increased tension at the elbow.
The second major cause of an elbow problem (besides form and technique) involves the racket itself, including the grip, weight, design and type of racket. There are two types of rackets: wood or metal. There are many controversies as to the type of racket which is most helpful once you develop a “tennis elbow” problem. We generally recommend the wooden type due to its ability to absorb some shock of the hit. Too rigid a racket is as important as the racket when it comes to absorbing shock. It is suggested non-professionals string the standard racket anywhere from 52 to 60 pounds of tension. A medium head racket should be strung 62 to 67 pounds and an oversize should be strung 72 to 78 pounds. An entirely open throat is lighter in weight and thus much preferable to a heavy racket.
Grip size and style are important to decrease the amount of tension in the forearm muscles and hand to hold onto the racket. One should not have to hold the racket as if “holding on for dear life.” A grip too small or too large can cause problems. As a rule for grip circumference, use as the measure of distance the inches from the tip of the fourth finger and the last (digital) transverse skin line in the palm. The grip should be the same if you were attempting to shake a hand, although the grip pressure may be somewhat higher.
It is better to err on the side of a larger grip than a smaller one since the smaller grip requires much greater muscle power to steady the racquet against torques in hitting the ball and therefore earlier muscle fatigue.
Treatment of tennis elbow is often difficult due to the many factors which play a part in causing the condition in the first place. Unless each problem area is addressed, the condition often becomes chronic. The acute symptoms of pain can be treated in a number of ways: medicines, injection, or physical therapy, all depending on the physician’s orders. Still, it could be realized that there are many ways to accomplish the same goals; therefore, treatment programs may vary among physicians.
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