One of the most frustrating problems for the tennis player is tennis
elbow. It is not an exceedingly painful or disabling condition but it can produce enough
discomfort to interfere with enjoyable or competitive playing.
Tennis elbow is caused by stress placed on the muscles of the
forearm. They are attached to the elbow by broad tendons. The muscles bend and straighten
the wrist and turn the forearm. When a ball strikes the racquet, its force is transmitted
along the forearm to the elbow. The tendons at the elbow become inflamed (tendonitis) and
later, scarred.
Ninety percent of people with tennis elbow develop pain at the outer
side of the elbow. This results from stress on the muscles that straighten the wrist. It
occurs as a result of a faulty backhand with abnormal wrist movement. Less commonly, the
pain can be present at the inner side of the elbow due to the forehand or serve. The serve
may produce pain in players who snap their wrists while serving.
In treating mild cases, aspirin can be taken and ice should be
applied after play. Also, a tennis elbow brace may be helpful. This is a snug Velcro strap
worn below the elbow. It is thought to work by limiting muscle expansion and pull at the
elbow. Partially avoiding using a painful stroke, such as the backhand, may also be
needed.
In more severe case complete rest from tennis for a few weeks is
necessary. Rest subdues the inflammation and helps promote healing. During this time,
physico-therapy consisting of whirlpool and ultrasound is useful. In some instances,
anti-inflammatory medication and possibly a cortisone injection may be beneficial.
Prolonged rest or immobilization of the limb is not recommended
because muscle wasting will result. Maintenance of adequate muscular strength is an
important factor in treatment. Graduated stretching and strengthening exercises should be
done after the initial painful phase has ended. Isometrics are initially done with the
elbow and wrist straight.
When there is no pain from a firm handshake, strengthening exercises
are started. A three to five-pound hand weight is used to strengthen the forearm muscles.
A good exercise is done with the forearm flat on a table and the wrist hanging over the
edge; a hand weight is held and the wrist is flexed and extended. The small muscles of the
hand should also be strengthened. This can be done by squeezing a tennis ball or by
spreading the fingers against a thick rubber band.
People with tennis elbow have definite arm weakness, so a formal
exercise program is most important. In recreational players the dominant arm should be
five percent stronger than the non-dominant arm, and in competitive players, the dominant
arm should be 10 percent stronger.
After recovery, routine stretching and strengthening exercises
should be continued.
Technical and equipment modifications are also exceedingly
important. At the top of the list are tennis lessons, which may help alleviate poor
technical habits, such as faulty arm positions during the backhand.
Modifications in equipment are simple enough and most valuable:
Surface.
A fast court such as grass or cement will speed the velocity of the ball and increase
impact force generated toward the elbow. Therefore, playing on slower surfaces such as
clay or Har-Tru is preferable.
Balls.
Heavyweight, dead or wet balls are heavier and therefore produce more force on the
racquet. Fresh, regular duty balls are recommended.
Racquet.
There is no conclusive evidence that one type of racquet is better than another. However,
the lighter, medium-flex, evenly-balanced racquets are probably best. Oversized racquets
are useful for increasing the "sweet spot," thus making the ball less likely to
hit the frame and producing less elbow stress.
Strings.
Stringing patterns do not seem to matter but mild to moderate tension on the strings (52
to 55 pounds) is recommended. Gut is more resilient and slightly better than nylon, but
the cost difference does not really justify the small advantage. Therefore, use 16-gauge
nylon.
Grip.
A correct hand grip size will produce less stress. Most players tend to use a handle that
is too large. The proper size can be determined by measuring the distance between the tip
of the ring finger and the first palm crease.
As a last resort, surgery may be necessary in a patient who is
resistant to treatment. The surgery is relatively simple and frequently effective.
However, most people recover without an operation.
To conclude, tennis elbow can be a difficult problem
but it may be alleviated by thoughtful medical and technical measures.
