What is tennis elbow?

Tennis elbow is a medical condition that many who play racquet sports will experience. There has been much written about this condition and as a result, there is reliable as well as unreliable information that can be found online. This post seeks to provide accurate medical information regarding this condition and to dispel some of the myths surrounding it. We’ll also address one of the new approaches for treating tennis elbow.

What is tennis elbow?

Tennis elbow is an inflammation around the bony bump (lateral epicondyle) on the outside of the elbow. That’s why it is also referred to as lateral epicondylitis. It occurs when the tendon that attaches muscles to the bone becomes injured or inflamed.

What causes tennis elbow?

It’s true that playing racquet sports can cause tennis elbow. However, most people get it from other activities. These often involve extending the wrist or rotating the foreman. These include twisting a screwdriver or lifting heavy objects with your palm down. With age, the tissue may inflame more easily.

What are the symptoms of tennis elbow?

The most common symptom of tennis elbow is pain on the outside of the elbow and down the forearm. You may have pain all of the time or only when you lift things. It may hurt to grip things, turn your hand, or swing your arm. The elbow may also swell, get red, or feel warm to the touch. It can be intensified when you play racquet sports, in particular, tennis, and most notably, as a result of poor or improper stroke production.

Understanding your elbow pain

The muscles that allow you to tighten your fingers and rotate your lower arm and wrist are called the extensor muscles. These muscles run from the outside of your elbow to your wrist and fingers. A cordlike fiber called a tendon attaches the extensor muscles to the bone. Overuse or an accident can cause tissue in the tendon to become inflamed or injured.

What symptoms will I have if the tendon is inflamed?

When the tendon is inflamed, moving your elbow is painful. Turning your hand or grasping objects can also be painful. This is why playing tennis while suffering from tennis elbow can be very painful because just before you strike the ball, you naturally squeeze the grip of the racquet and this can be extremely painful.

How is tennis elbow diagnosed?

Your doctor can diagnose tennis elbow from your symptoms and from the look and feel of your elbow. He or she may order an x-ray to be sure the bone is not diseased or fractured. In some cases, other tests may be needed.

How is tennis elbow treated?

Your treatment will depend on how inflamed your tendon is. The goal is to relieve your symptoms and help you regain full use of your arm.

• Rest and medication – Wearing an elbow or wrist splint lets the inflamed tendon rest so it may heal. Using your other hand or changing your grip also helps take the stress off of the tendon. Oral anti-inflammatory medications and heat or ice can relieve pain and reduce swelling
•  Exercise and therapy – Exercises can help to stretch and strengthen the muscles around your elbow gently. Your doctor may give you an exercise program or refer you to a therapist.
• Injections – Your doctor may give you an injection or an anti-inflammatory medication, such as cortisone, to help reduce swelling. You may have more pain at first, but in a few days, your elbow should feel better.
• Surgery – If your symptoms persist for a long time, or are not relieved with treatment, your doctor may recommend surgery.

Lessons from my personal experience

I have had the misfortune of having a severe case of tennis elbow, not from playing tennis, but from a trauma I experienced while at work. While pulling to free the cover from an enclosure, the case broke free and my arm (elbow) shot back into a piece of steel shelving. Yeah, it was just as painful as it sounds. By the time I sat down for dinner that evening I couldn’t raise a glass of water. That experience taught me a lot about tennis elbow and while much of the information above is certainly relevant, I think it’s important to share my first-hand experience with this condition.

There are things that the medical profession just doesn’t emphasize enough in my honest opinion. Back then, the “go-to” treatment doctors used when rest and anti-inflammatory medications failed was an injection of cortisone and after having two injections, my condition was no better. The second injection was quite effective but the bad news is that it only provided temporary relief. Before I knew it my pain had returned and it was time for me to make a decision. My local doctor wanted to do tendon-release surgery and I was just not ready to go under the knife. HERE is just one article on found with a simple online search that addresses surgery for tennis elbow but there are many more out there.

Enter Dr. Robert Nirschl 

In lieu of surgery, I made some basic inquiries and found a doctor relatively close to me in Northern Virginia that sounded promising. Dr. Roberrt Nirschl is one of the most well-respected medical professionals in this field and his research and study of the malady were very impressive. If you’re interested and have the time, you can read about Dr. Nirschl’s studies HERE

How could I possibly get an appointment to see this guy?

After reading everything I could find on Dr. Nirscl I was determined to get an appointment. I was thinking that this would be an exercise in futility but I figured I had nothing to lose and everything to gain by trying so I called his office. As it turned out, good fortune was on my side because the receptionist told me my timing was perfect, she had just hung up the phone with someone who had canceled their appointment for the very next day. She asked if I would like to take that appointment and I happily agreed. The very next day I was off to Arlington Virginia, roughly a 4-hour drive from my home.

Great advice from one of the very best in the business

My visit with Dr. Nirschl was a life-changing event. I was in so much pain that I was ready to try almost anything to get rid of it and honestly, I feel I was very fortunate to spend some time with Dr. Nirschl. He explained everything to me in great detail, gave me a prescription for some anti-inflammatory medication, and a specific exercise regime, and finally, he referred me to a sports medicine clinic in my hometown to begin treatment. The most impressive thing about this visit was that he did not recommend surgery. He told me that if I followed his advice that the likelihood of my tennis elbow healing properly was very good. The prescription of targeted exercises, which would follow after having ultrasound treatments and a specified time frame of the anti-inflammatory medication, was, in his words, the key to healing properly. I couldn’t help but ask “How is this possible? What is the basis for this treatment?” He explained that the process was aimed at removing the inflammation in a natural way while at the same time, strengthening the area around the elbow. After the ultrasound and oral medication, the targeted exercises would move new and fresh blood into the inflamed area and remove the inflammation naturally. I left his office with an exercise band to be used for pronation and supination exercises once my treatment at the sports medicine clinic was complete and I was instructed to use the band daily, especially before playing tennis.

Was Dr. Nirschl right?

You bet he was and to this day, I am forever in his debt however, the path to healing was a long one. A key to the entire treatment was giving up tennis until I was fully healed. At the time, I was playing a lot as well as teaching so this was the biggest challenge of the entire journey. However, I was determined to follow his instructions, and in the end, my diligence along with Dr. Nirschl’s expert advice was the key to a full recovery. It took me approximately 3 months of following his advice and throughout those weeks, I could feel myself getting stronger and I was watching the pain disappear and lessen each week.

What advice should we offer as racquet technicians?

We are on the front lines when it comes to equipment advice for racquet sports and as such, we have a huge responsibility to get it right. Since my own personal experience with Dr. Nirschl many years ago, I have become a source for tennis players in my area who have suffered from tennis elbow. There is a very good reason for this and it basically comes down to offering them the same advice that Dr. Nirscl gave to me. What I have found, however, is the resistance of players to lay the racquet aside is the ultimate challenge for them. Tennis has a very sly way of addicting players to the game and the last thing they want to hear is that in order to heal properly, they have to stop playing while treating their condition. What I can say, however, is that those who have followed my advice have done extremely well and are most appreciative of the effort and advice that I have offered.

Are there new treatments for tennis elbow?

As I mentioned earlier, cortisone shots were rather prevalent back in the day but now there is a new alternative for cortisone. PRP or Platelet Rich Plasma injections offer people with tennis elbow an alternative to cortisone injections. You can follow this link HERE for some very good information from Johns Hopkins Medicine that explains in detail what you need to know about PRP therapy.

Where do we go from here?

From experience, we know that tennis elbow will be an ongoing threat. The best approach we can take as racquet technicians is to stay on top of the most recent developments and treatments available for people with tennis elbow. I had not heard of PRP until a recent visit to an orthopedic surgeon for an unrelated problem with my knee. Having this information in my arsenal gives me yet another option to pass on to players who come to me for advice. Staying constant and always doing our research will prove to be our best chance of offering sound advice when counseling for tennis elbow.

One caveat to this entire article is this. We are not medical professionals and as such, our experience and knowledge only go so far. Once our resources are exhausted it’s our job to make sure we recommend people see their medical professional for further treatment.