Tennis Elbow – Tendons and Tension

February 4, 2021

By Josh Guyer, PT, DPT

 

 

 

 

 

 

tennis serve

There is a reason that they call it tennis elbow; it is one of the most common upper extremity injuries that happen when playing the game. Researchers estimate that about half of all recreational tennis players will experience this injury at some point in their life. I can recall training back in high school, enjoying daily practice sessions until the terrible T (tennis elbow) hit, and it hit like a brick wall. Nothing is more aggravating and frustrating than dealing with elbow pain that evolves from training, and it puts a damper on your training regiment. Through all the pain and frustrations that we deal with playing the game, though, know that this condition is treatable if treated the right way! Physical Therapy is one of the best ways to remediate this issue without having to stick a needle in your arm. 

What Is Tennis Elbow?

Tennis elbow is a painful inflammatory condition that occurs on the outer portion of the elbow. This localized site of pain is due to the muscles that attach to this site that are responsible for gripping, turning the arm, and lifting heavier objects. The tendons that attach the muscles to the bone at the elbow are typically irritated more commonly due to overuse or a lack of strength in the muscles responsible for hand and wrist movement. More commonly, this can occur in tennis due to repetitive use of these muscles and potentially technique and grip while swinging a racquet. 

Evaluation Is the Key To Success!

A comprehensive evaluation is necessary to determine that tennis elbow is primarily responsible for your pain, as other conditions may show similar signs and symptoms of tennis elbow. A complete examination of the elbow, hand/wrist, shoulder, neck, and potentially trunk will need to be performed as each part of the body may impact the pain that is occurring at your elbow. A thorough examination will include measures of range of motion, joint mobility, strength, posture, neurological screening, and analysis of mechanics with activity, amongst other potential screening measures. After determining that the primary source of pain is caused by tennis elbow, a complete and personalized plan of care will be designed for you to work towards returning to your activities with improved pain. A comprehensive plan of care may include progressive strengthening exercise, manual therapy to improve soft tissue or joint mobility and pain, modification of activity, and education on appropriate pain management.

How Can Physical Therapy Help?

Progressive strengthening exercise will be essential to help you return to your activity with less pain. Muscles and tendons are designed to be loaded.  It is crucial for success that the appropriate amount of load and progression to build a tolerance to the activity so that you can return to playing. Strengthening should target not only muscles that involve hand and wrist movement but also muscles of the shoulder and trunk. Immediately following injury, ice and gentle stretching can improve acute symptoms. Stretches could include gently pulling the back of your hand towards your elbow with your elbow extended or pulling the hand in the opposite direction towards the elbow. 

biceps curls with blood flow restriction bands

Will Bracing Or Taping Help?

There is some variable evidence to support the use of counterforce bracing and taping to help treat tennis elbow pain and strength with gripping. Counterforce bracing includes applying a brace just past the elbow in an attempt to limit the load that a muscle places on the injured tendon at the elbow. Certain kinds of tape and taping techniques may also help manage painful symptoms at the elbow. There are various kinds of counterforce braces available on the market, so discuss with your Physical Therapist what may be the best option for you to consider for your injury.

A common response to being in pain is fully resting and completely reducing activity level. However, this strategy is often not beneficial as it can lead to other impairments, including secondary stiffness and muscle weakness, which can potentially worsen and prolong symptoms. Instead of thinking complete rest, think relative rest. When an acute injury occurs, such as a grade II sprained ankle, it is not wise to walk long distances on that ankle while the ligaments and structures are healing. However, it is beneficial to work strengthening through the upper body, core, hips, and non-injured leg as well as strategically begin moving the injured ankle to promote healing.  

When someone is in chronic pain, the idea of exercising may not seem overly appealing. However, if you think of “exercising” less in terms of the traditional sense that comes to mind, and more as global, whole body movement, it can become a less daunting task. For some people, the movement may be getting in and out of bed. For others, it may be going on a 10 minute walk every other day. There is no one recipe that fits every person therefore, finding strategies that work best for you is crucial. 

It’s Not Just Tennis Players!

Tennis elbow is certainly not limited to athletes and tennis players! The same elbow pain can originate from other activities involving work and home, including lifting, carrying, and other prolonged activities involving hand and wrist movements. What is unique about treatment in Physical Therapy is that each plan of care is individualized to allow for optimal return to the activity that YOU need to be able to return to.

For a thorough evaluation and individualized treatment, contact us today! We have two physical therapy clinics around Portland to serve you. Contact our Sherwood clinic or our Bethany clinic.

Josh Guyer grew up in Central Oregon and graduated from the University of Portland in 2013. His professional interests extend to tennis and golf with over 10 years of experience in both sports, winning an Oregon high school tennis doubles state championship. He has interests in orthopedics and sports medicine, treating athletes of all ages, prevention and wellness, and post-surgical rehabilitation. Josh has a strong commitment to promoting health and wellness and tailors his care to meet each patient’s needs and goals.

 

 

 

 

 

 

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