What You Need to Know About Tennis Elbow I am not a physician, nor do I have any training in physical therapy or sports medicine. But when I experienced a severe bout of (TE) I researched the condition extensively, and based upon what I learned I formulated a plan of action aimed at getting me back on the court and playing without pain. I am happy to share what worked for me with others who are suffering with this condition. If you have pain on the outside (lateral) aspect of your elbow during and/or after playing tennis, then you have TE. The pain occurs most frequently when hitting a one-handed backand, but can occur with any stroke, including the serve. If you have such pain, stop playing! When you continue to play with the pain, you are increasing the damage being done, and the length of thime you will be forced to stop playing in order for it to heal. It is possible to do so much damage to the extensor tendon that you will require surgery to repair it, or, you will be forced to give up tennis. After you stop playing, and minimizing any other activity that elicits pain in the same location, you begin the first phase of healing and rehabilitation. The goal of this phase is to reduce the acute inflammation by taking ibuprophen and applying ice to the lateral side of the elbow as needed to eliminate the pain. This phase will probably take a week or two, depending on how long you played with pain. As a general rule, you are ready for the next phase in the process when you can shake hands with someone without pain in the elbow. Phase 2 involves stretching and messaging the tendon. The objective of this phase is to increase flexibility of and blood flow to the tendon. With the elbow extended, flex the wrist (fingers with be pointed down) and hold the stretch for 20 to 30 seconds. Repeat this exercise 5 to 10 times, twice-a-day. You can use the palm of your other hand to enhance the stretch but do not stretch to the point of pain. Also stretch the flexors by extending the wrist (fingers pointed up). After stretching, flex the elbow, pinpoint any sites of pain, and with the tip of your forefinger press down very firmly and make small circular motions directly over the point of the pain. This is called a deep friction rub. It will hurt like crazy! But the pain will quickly vanish. The deep friction rub will increase blood flow to the site of injury and promote healing. This phase in the process will probably take another 1 or 2 weeks. When you can flex your elbow after doing the stretching excercises without eliciting pain, you are ready for phase 3. Phase 3 involves weight resistance training every-other-day. The objective of this phase in the rehabilitation process is to increase strength of the forearm extensor muscles. You should continue the stretching exercises performed in phase 2 throughout pehase 3. Exercises are to be performed with dumbbells and include arm curls, reverse arm curls, wrist extension and flexion, and hammer curls. Start with 1 lb. Dumbbells. Perform 3 sets of 10 repititions. When this becomes easy, increase to 15 repititions. Increase the weight only when you can complete 15 repititions 3 times without difficulty or pain. I believe everyone knows how to perform arm curls and reverse arm curls. Wrist extensions are done by holding the dumbbell with the palm of your hand facing down and extending the wrist upward. Hold this position for 2 seconds and then lower the dumbbell slowly. For strengthening the wrist flexors, hold the dumbbell with the palm up and flex the wrist upward. Again, hold for 2 seconds and lower the dumbbell slowly. Hammer curls are very similar to arm curls except the dumbbells are held in a vertical rather than in a horizontal position. Pain when performing any exercise is the “stop” signal. If any exercise causes pain, modify it by decreasing the weight, decreasing the number of repititions, or by reducing the range of motion. Stretch before beginning a weight training session, and on days between training sessions. Phase 3 will require 2 to 3 weeks before you have sufficient strength and flexibility in your elbow and are pain free. You are then ready to resume playing tennis, providing you adopt the strategy outlined below to prevent a recurrence of the condition. Prevention of Tennis Elbow There are 2 major aspects to preventing TE. First, employing proper stroke mechanics on all strokes, and second, using a tennis racquet with “arm friendly” specifications. With regard to hitting the ball properly, there is simply no substitute for one-onone instruction from an experienced tennis instructor. You really should not get back on the court in a competitive situation until you have worked with a teaching professional and you have learned to hit the ball properly with all of your strokes. Otherwise, you will be right back where you started from in no time at all. Essentially, you want to hit the ball using your torso, shoulder, and upper arm as much as possible to take the stress off of your forearm and elbow. You want to hit the ball out front and away from you with a good shoulder turn, racquet preparation, and a stiff wrist. In my opinion, the easiest way to ensure that you hit the ball in a manner that doesn’t injure your arm is to use both a two-handed backhand and forehand. (See my essay entitled, “The Advantages of a Two-handed Forehand in Tennis”.) In terms of racquet specifications, you want a racquet that has a flexible frame (a stiffness rating less than 62). You also want the racquet to be heavy (greater than 11 oz.) but head light, be of normal length (27 inches), have a midsize head (95 – 102 square inches), and have the correct grip size. In addition, a soft string like natural or synthetic gut is easy on the arm, and your racquet should be strung at the low end of the recommended tension range (50 – 52 lbs.) Lastly, it’s always a good idea to stretch your extensor muscles and tendon before playing, wear an elbow brace, and ice your elbow after playing.
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