By Dana Sullivan
From the September 2003 issue of Tennis Magazine
Tennis elbow, anyone? While you rarely hear the pros complain about it, it's still the scourge of the rec set. Why the disparity? It's simple: The pros have strong and flexible arm muscles and, even more important, excellent technique. "Tennis elbow is especially common in people 40 and up," says Ben Kibler, M.D., a member of the USTA Sports Science Committee and Medical Director of the Lexington Clinic Sports Medicine Center in Lexington, Ky. "But if you have poor stroke mechanics, it can affect you at any age." If you lack arm strength and flexibility, you're also at risk.
First, though, what is tennis elbow? Rather than a malfunction of the elbow joint itself, it's the result of too much stress on the tendons in the forearm and upper arm that connect the muscles to the bones in the elbow. The tendons become inflamed, which causes pain on the outside of the elbow (this is technically called lateral epicondylitis). The pain worsens when you try to lift things palm down, such as when you pick up a jug of milk or even something as light as a cup of coffee. "You also feel pain when you clench or squeeze your fist, gripping your racquet, for example," Kibler says.
In recent years, various alternative treatments-everything from Botox injections to shockwave therapy-have been heralded as miracle cures for tennis elbow. But Kibler says that most of the studies looking at these treatments aren't designed well enough to convince him to abandon the more conservative options. "Most of those treatments are more expensive than physical therapy and only offer short-lived relief," he says. "For long-term results, I suggest a regimen of rest, flexibility and strengthening exercises, and correcting stroke mechanics."
STEP 1: Give your arm a rest and some support. Cut back the number of hours you play for a month or so and work on improving arm strength and flexibility (see Step 2 below). Kibler also recommends wearing a brace on your forearm during flare-ups to support the muscles and tendons near the elbow.
STEP 2: Increase strength and flexibility in your shoulder and forearm muscles, which will help you support the elbow joint. Begin at home with the exercises illustrated below.
STEP 3: Fine-tune your stroke. Tennis elbow is typically caused on the backhand side. If you have a late swing and hit the ball after it has passed the midpoint of your trunk, you're putting too much force on your elbow and the muscles and tendons that surround it. Likewise, if you habitually make contact with the ball when your weight is on your back foot, you end up having to use your arm-rather than your whole trunk-to power the stroke. To correct these problems (we know, easier said than done), concentrate on powering your strokes, especially your backhand, with your legs, trunk, and shoulder, not just your wrist and forearm. Also, using a two-handed backhand will help alleviate some pressure since the force of contact is spread between two arms. One more reason to try a two-handed backhand: It forces you to turn your body, helping to prevent that late swing altogether. If after eight weeks of trying Dr. Kibler's program (aim for three times a week) your arm is still bothering you, it's probably time to have a physician check it out. "Treating tennis elbow with arthroscopic surgery is usually a last resort, but some people won't get relief until the tissue gets cleaned out," he says. If you do need surgery, the good news is that the success rate is 85-95 percent.