TENNIS ELBOW – HOW TO PREVENT IT AND WHAT TO DO IF YOU START TO FEEL MILD ELBOW PAIN
The Washington Post Health section did a story last year about steroid injections and tennis elbow. http://www.washingtonpost.com/national/health-science. It mentioned a recent study stating that steroid injections were not effective in treating tennis elbow vs. Physical Therapy. In my experience tennis elbow can become a chronic problem very quickly and nag you for long time until you finally have to stop playing due to the pain. My best advice is to do some simple steps to prevent it.
Below is a brief overview of Tennis Elbow and some simple strategies to prevent it, or to treat it if you have it.
So what is Tennis Elbow? Lateral Epicondylitis is medical term aka inflammation of the lateral epicondyle of the ulnar or tendonitis of the wrist extensor muscles. The painful spot is the near the elbow joint.
THE BEST WAY TO FIX YOUR TENNIS ELBOW IS TO AVOID GETTING IT IN THE FIRST PLACE!
How to prevent it!
The two closest joints to the elbow are the wrist and the Shoulder. That’s where we must start. Most treatments attack the wrist extensor muscles. They are usually weak and must be strengthened to prevent Tennis Elbow from recurring. Additionally the shoulder and or hip complex on the hitting side may also be weak.
Let me explain how the hip is connected to the elbow. All movements of body parts and of the whole body both conscious and unconscious are three dimensional. These three directions of movement are
This is especially true during sports and increased force generations. Let’s look at what happens when you hit a tennis ball. As the ball approaches and you get ready to hit a forehand, depending on the type of shot you are hitting you square your body to the approaching ball and if you are right handed you right rotate your body during the back swing. Notice I did not say you right rotate your trunk. Multiple joints are being rotated to allow for R trunk rotation during the back swing. One key to creating force will be your ability for your left hip to internally rotate and your right hip to simultaneously externally rotate allowing your trunk to turn right while you retract your scapular as you bring your arm back for that forehand shot. Just before you make contact with the ball the opposite must occur as you generate force in the direction of the ball. Once contact is made your body must then create forces to slow down the rotation. If you did not create force in the opposite direction to slow down you would end up spinning around like a top and be unable to get ready for your next shot. The point I am trying to emphasize is the lower body and core are vital in creating force for you shot and for your follow through. If any weakness is present in either the hip, trunk, or lower body muscles that are assisting in slowing the body down after a shot extra stress can be placed on the forearm muscles. I can’t stress enough how important for elbow and shoulder health to have strong core, hips, and lower leg muscles.
Performing eccentric contractions are the best way to increase a person’s ability to slow the body down during the follow through in sports. What is an eccentric contraction? Eccentric Contractions: The simple definition is a muscle that is actively lengthening. Eccentric contractions are vital in your wrist strengthening exercises. The average player hits the ball 100-200 times per tennis set. Our elbow must have adequate strength to absorb this contact repeatedly throughout the match. The ability to absorb this force is our eccentric strength. The common sense approach would be to perform eccentric contractions to help prevent and rehab from tennis elbow.
Below are my two favorite exercises for tennis elbow. They should both be performed EVERYDAY. In addition to being done during your injury recovery they should be done to prevent the trauma from occurring in the first place.
The first exercise is done using a Thera Band flex bar. It can purchased from Paul or online by clicking the http://www.optp.com/Thera-Band-FlexBar/?FROM_CART=TRUE#.U0SKK_ldXTo The yellow or red bar will be adequate for most tennis players. This eccentric exercise should be done up to 3 sets per day and for 15 repetitions. If you can complete 1 set of 15 pain free then you can advance to a second set of 15 and the same for the third set. No more than 3 sets should be done per day. The exercise is shown below.
The instructions for using the Thera Flex Bar are listed below since the instructions above are difficult to read.
Step 1. Grasp FlexBar® exerciser in front of you with the injured side and extend your wrist.
Step 2. Grasp the upper end of the bar with your other hand facing away from you
Step 3. Twist the bar with the top hand as you stabilize with the bottom hand
Step 4. Hold both wrists steady as you extend both elbows in front of you. The wrist on your injured side should be extended and the other wrist flexed.
Step 5. Slowly release the bar with your injured side while maintaining tension with the uninjured side.
You can watch the movement at the following https://www.youtube.com/watch?v=gsKGbqA9aNo
Repeat 10-15 times up to 3 times a day. Begin with the red FlexBar and progress to the next color when you can easily perform 3 sets of 15. Use ice or Biofreeze for any soreness.
The second exercise for your wrist muscles is a straight arm wrist extension. This exercise should be performed at a minimum of 1 time per day every day.
Start by kneeling to the side or a workout bench, chair or the corner of a table with your elbow as straight as possible. With your palm facing the floor and using a 1 pound weight in your effected side slowly lower the weight down as far as it will go. It is vital that you do this extremely slow and move through a complete range of motion. The downward movement should take a minimum of 4 seconds. When you have fully lowered your hand towards the floor (flexion) the wrist, pause and then slowly move it towards the ceiling (extension).
Repeat this movement until you not able to perform it with good form or you reach 25 repetitions. Good form means moving slow and controlled without any elbow bending.
If you have tennis elbow then it must be treated. Below will help you navigate the beginning stages of tennis elbow.
Treatment for Tennis Elbow, either acute or at the chronic stage is RICE (Rest, Ice, Compression, and Elevation). Resting and inflamed tendon is vital to returning it to a properly functioning muscle/tendon. Ice is the best way to reduce inflammation and should be done immediately after stressing a muscle or tendon. Ice should be applied for a minimum of 20 minutes and can be done multiple times per day. When the elbow pain has subsided to a level which is not painful during normal daily activities then you can start strengthening the forearm muscles.
Use the exercises described above and you can definitely prevent and once the initial irritation subsides performed them daily will keep you pain free and happy.
Next month I will go over my favorite core/hip exercises for hip rotation which will help prevent shoulder and wrist injuries.