Now that the warmer weather season is in full swing, so are the golfers and the tennis enthusiasts (pardon the pun.) Most will enjoy the sunshine and the game without a problem (except, perhaps, for their scores), but others may develop a consistent pain in their elbow commonly known as “tennis elbow” or in medical terms: elbow tendonitis or epicondylitis. While it can be very uncomfortable, it is temporary and can be managed or prevented altogether.
What is Elbow Tendonitis?
Elbow tendonitis is an inflammation of the tendons that attach the forearm muscle to the bony surface of the elbow. These tendons move the wrist up and down. This condition can occur in anyone who uses frequent forearm motion such as those racquet players and golfers, but also carpenters and construction workers.
The inflammation can take many forms and may include a sense of heat, pain, redness and swelling. The pain occurs at or around the elbow with flexion or extension of the wrist or rotation of the forearm.
What causes Elbow Tendonitis?
Often, the cause is over-use or repetitive use of the muscles in functional or occupational activities such as tennis, golf and carpentry. Poor body mechanics or positioning can also be a cause, especially improper techniques or use of inappropriate equipment in sports activities. For example, an incorrect tennis backhand or an incorrect grip size can result in lateral humeral epicondylitis, known as “tennis elbow,” which affects the outside or medial side of your elbow and involves the extensor tendon.
Golfers can experience a slightly different form of tendonitis called “golfer’s elbow” or medial epicondylitis, which affects the inside or medial side of the elbow and involves the flexor tendon.
How long does tendonitis last, and what can I do?
Usually, the inflammation cycle lasts about 4-6 weeks. Proper resting, protection and specific management may be required to prevent a prolonged course of healing. Specifically, you should do the following:
- Rest. Temporarily, you may have to stop playing tennis or golf or performing activities that may have caused your condition. It is very important not to aggravate the condition by continuing activity, especially if you experience pain. If you do need to continue the activity, take frequent rest breaks.
- Ice. Ice your elbow three times a day for 20-30 minutes each time in the early painful stage, and then for 15 minutes after active use of your arm. Protect your skin by putting a towel between your elbow and the ice pack. Alternatively, try to ice massage the painful area. Fill a paper cup ¾ full with water and freeze. Using the frozen ice from the cup, massage the area for up to 5 minutes, 3 times a day or after activities.
- Protection. Try using a “tennis elbow armband” when exercising or using your arm. It should be placed about an inch below the elbow crease and comfortably tightened to distribute the force of muscle contractions around the muscle of the forearm.
- Exercise. Wrist extensor and wrist flexion stretching are important exercises to do. Keeping the elbow straight, grasp your hand and slowly bend wrist down (for wrist extensor) then up (for wrist flexor) until a stretch is felt. Hold 30 seconds, then relax. Repeat 5 times. Do 3 sessions per day.
When should I call my doctor?
If your symptoms do not begin to subside or become worse within 5-7 days, consult your primary care provider.
The cliché about an ounce of prevention definitely holds true for elbow tendonitis. Below are some tips that may help you avoid a painful injury and, in the case of a favorite sport, maximize your time in the game:
- The warm up. Always warm up carefully before you play or perform any activity that involves a repetitive or weight-bearing motion for your hand or arm. Very slowly, “shadow” all of the motions you use in your sports. In tennis, do ground strokes against the wall and practice the motion of serving. Rallying is not a substitute for warming up. Stretching and strengthening exercises will help prevent injury.
- The Racquet. Use a lighter weight racquet and move your hand a bit on the grip. Reduce your string tension. Grip size can also be an important factor. If possible, discuss equipment options with your local pro.
- The stroke. In tennis, the backhand, the serve, or the overhead smash may be equally damaging to your elbow if they are not done well. The two-handed backhand tends to be easier on your elbow. Avoid the shots that aggravate the problem. Reduce wrist motion to a minimum. Lessons can help to alter your strokes.
- The game. When you go back to your sport or activities, take it easy. In tennis, rally at first only for short period of time, avoiding problem shots. Play less time each day or play doubles. Avoid playing competitive games until your elbow is healed. In golf, start with only putting and pitch shots. Slowly work up from a few holes to a complete game.
Wen-chih Shih PT, MS joined Harvard Vanguard Medical Associates’ Burlington practice in 2005. Five years ago, she took on added responsibility as the north region physical therapy supervisor, managing the Burlington, Chelmsford and Peabody sites. Just recently, she became manager of physical therapy at Harvard Vanguard Medical Associates and has relocated her practice to Chelmsford. Wen-chih has been instrumental in leading the effort in the north region to provide preventive medicine tips for patients, especially for sports injury topics. Her interests include sports/orthopedic injury, preventive medicine, and enjoying family life with her husband and two children.