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Player to Player: Coping with Tennis Elbow

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Last week’s question from Todd:
(Please note: There's no need to send additional responses to this question)

"I've reached the age in which I'm experiencing a great deal of pain from tennis elbow, and it's about to end my enjoyment of the game. Can you suggest the forehand grip that is easiest on the ol' arm and elbow? Thanks so much!"

PLAYER RESPONSES:

From Phil, Briarcliff Manor, NY:

I've been plagued by pain in the elbow for decades on and off. I'm convinced that it is a combination of faulty technique, as well as lack of conditioning.

For active tennis elbow, you do need to take a holiday to allow for healing. Playing through it will only prolong the condition. Then do stretching and strengthening exercises with elastic bands, which are the least traumatic. They come in different resistances. Check with a strength and conditioning expert for the right ones to do.

There are two ways you can get tennis elbow due to faulty technique. One is hitting the backhand with the wrist in a weak position. Make sure that you're using a proper grip, with the knuckle of the index finger on the top surface of handle, if one-handed. For the double-handed shot, give enough support to the dominant hand with the opposite hand. Make absolutely certain you do not use a "wristy" shot. The effort must come by taking the racket back and using the core, followed by the shoulder muscles. This must be smooth and not jerky.

The other way I've caused tennis elbow in myself is to check the forward swing of my forehand and not follow through all the way. That causes tremendous strain on the extensor muscles and tendons of the elbow. Make sure to follow through ALL the way around the body. Again, all of the power and control comes from the core muscles and not from "wristing" the shot.

From Harlon M., McDonough, GA:

Without seeing your stroke, my first thought is if you are completely following through with your swing. Tennis elbow is common with people who "punch" their shots and do not release the muscle with a good follow through after they hit the ball. If this is the case, then I suggest holding your non-racket hand by your ear on that side of your head and finish your swing by bringing your racket to that hand and catching it. This will create a long follow through, allowing the forearm muscle to release.

From Coach Poppie, Palm Bay, FL:

Todd, tennis elbow… ouch! The grip is important; however, the contact point is more important. Assuming that you are not suffering from racket shaft harmonics (shaft vibration), your extensor muscles come under extreme stress when constantly hitting late.

As for the grip, eastern forehand for most is an effective grip, since the mass of the hand is behind the racket. The contact point is more out in front (front being toward the net). If your swing is all arm, this can also aggravate the problem. Your swing, whether open or closed stance, is always the last part of the weight transfer. You know, it’s feet, knees, hips, shoulders, and then the arm comes through with the weight transfer.”

Since the continental grip is all extensor muscle on both sides, I would avoid it, except for the serve.

In close, prepare early, transfer your weight and meet the ball out front to lessen the stress on your arm. In the meantime, I also suggest play with rally ball, speedballs or some kind of transition ball to lessen the load.

Good luck.

From Kenny S., Highland Park, IL:

There are a lot of other things, besides the grip, that will give you less pain. The grip should be continental or slight western. Lighter rackets, the little things that you put in the bottom of the racket -- put five of them in there. Use the shortest swing, not taking it back much or going through too hard and long. Stretching, massage, ice and heat when it is not inflamed can all help. So feel good, don't over-use it. I find cell phone use will really hurt that part of the arm, so get a head set.

From Bob K.:

Wrap your hands around some light dumbbells, and start doing reps. You can find the positions in any training book, or if not, I can describe them for a fee.

Start with lighter weights than are usually recommended by body builders, i.e. work three sets up to 20, 20 & 50 reps. Increase weight and drop to 12, 12, 20 reps. Work up to the 20, 20, 50.

Old people (like over 30) try to cure the problem overnight. It does not work that way.

Good luck.

From Ruth R.:

Use a basic eastern forehand grip with just a slight change to the left for the backhand. I am 80 years old, was a top-ranked player and never had any pain in the elbow. They teach too many western grips today, as well as semi-western. The semi can be used way behind the baseline, but western will ruin you.

From Dwyn M., Toronto, ON:

As I look around at all the beautifully aging tennis people wearing their various elbow bands, all I can say is... it's not your grip. You are probably using too much arm, instead of using your legs and body to hit your shots. Combine that with this tendency to think we can still step on the court without proper stretching and warm up/cool down, and we do get hurt.

Warm up, shoulder and arm and wrist stretches and use your legs to get low, and let your body hit the shot. We know it hurts to get down, but it'll keep you playing into your 80s!

From Eric R., Santa Rosa, CA:

Since you asked for a more comfortable forehand grip, Sherlock of Ballingham deduces that your pain occurs mostly on that shot and possibly also your serve. The hardest forehand grip on the elbow is the continental.

Unless you have the timing of a Johnny McEnroe, any late hits can start to erode the joint. Look at your racket as you currently grip it, with the face flat to the perpendicular, like the net. The easiest grip puts the palm of your hitting hand directly behind the contact of the ball. This ensures maximum support for the tendons and ligaments of the elbow.

However, your timing of the swing may actually be the root of your pain. Practice regularly without points involved, just hitting the ball cross court until your weight assists your swing. The hips and shoulders turning into the shot are crucial to avoiding the pain you now experience.

You must hit it early more often, with the largest muscle mass (legs pushing, hips and shoulders rotating). That is more of a cure than just your grip.

From Scott H., Riverside, CA:

A fully inflamed case of tennis elbow needs rest. There is no such thing as playing through tendon inflammation. Once fully rested, consider switching rackets. I have solved inflammation problems simply by finding a racket (stiffer, less stiff, heavier, lighter, etc.) that suits the needs of my body. You may not end up with the same power and pop as you get with your current racket, or you may end up with more. But your body will be happy.

From Frank A., Meza, AZ:

I don't think the problem is the grip, as much as the stroke itself. Have someone look at your technique. You might be bending your elbow during the stroke and pushing the ball. Also check the tension on the strings.

From Joyce S.:

I had it many years ago, and this is what I did:

First, I went to my chiropractor and had my elbow adjusted. Then I didn't play for two weeks. It was adjusted several times, to keep it in.

Second, I had the forearm massaged. The muscle sheath was bumpy, and I massaged it and worked the bumps. They hurt a lot.

Third, I started making a conscious effort to hit the ball way in front. I found I was hitting it beside me or even behind me.

Fourth, I wore a strap on my arm for about six months to help the tendons rest.

Fifth, I worked my arm and wrist at the gym to strengthen it.

Sixth, I use a large grip, so I won't stress the arm with too small and tight a grip on the racket. I see a lot of players using too small a grip on their racket. Most of them complain of elbow pain.

I haven't had a problem for several years. I can use any grip I want.

From Justine J.:

Todd, the best advice I have for you is to move the forearm in a more comfortable way that doesn't mess the shot up, or your arm, for that matter.

From Carole A., Sarasota, FL:

I, too, am suffering from golfer's elbow, which means the tendons underneath the elbow are torn. I play tennis daily but no golf, so this was a mystery. However, I have been working on a topspin forehand, and I found if I keep the racket face slightly closed, it keeps the pressure off that part of the elbow. Also, keeping the left arm out in front tracking the ball helps my right (hitting) arm to extend more, thereby keeping the pressure off the elbow.

From Jim L., Palm Desert, CA:

There are many tennis players in their 80s who do not have tennis elbow, so it's not necessarily an age thing.

Telling you what grip to use without knowing what kind of forehand you have would be like telling you what size shoe to wear knowing nothing about your foot size.

If you hit a big, loopy, topspin forehand, then the semi-western or western grip would be best. If you hit a rather flat forehand, then a semi-western grip or eastern grip would be best. If you hit an underspin forehand, then a continental grip would be best. But even those answers are really vaguely helpful answers.

First, you have to understand the main causes of tennis elbow. If you hit your forehand with a straight arm, you're in trouble. If you hit your serve with a tight grip, that's another great way to develop elbow pain. If you place your thumb up the back side of the racket on your backhand, that's another good route toward elbow pain.

If you constantly grip extremely hard when you hit the ball, that's another way to put those tendons in peril. If you're gripping the racket the whole time you're playing, then you're asking for pain. Between shots, your opposite hand should hold the racket with your index fingers on the strings and the rest of the fingertips on the throat of the racket.

There are a lot of things the opposite hand helps you to do, but the first is the most important one to you. By doing this, you automatically allow your hitting hand to relax between shots. Your hitting hand should be gripping a maximum of maybe 20 percent of the time. The rest of the time, that arm should be on vacation.

Basically, your hitting arm should stay bent throughout the whole shot on your forehand. As I said above, there's no way without seeing how you hit to tell you what grip to use. However, if you also use that opposite hand to set the ANGLE of your racket face, you'll never have to do extra supination or pronation, yet another cause of arm/elbow pain. Simply place your hitting arm and hand in a strong, comfortable, hitting position. Then use your opposite hand to set the angle for whatever shot you want to hit -- perpendicular to the ground or slightly more closed for stronger, topspin groundstrokes or slightly open for an underspin forehand (not nearly as common but still what some people choose to hit).

Then hit your forehand (whatever forehand you normally hit). If the ball is going in consistently, you have the right "grip." What you really have is the right racket face angle. If the ball is going into the net or long, then you already have the perfect tool (your opposite hand) to make any slight corrections that need to be made. This is by far the best way to know what "grip" is best for you. The ball goes in consistently, and you don’t have to put your arm into compromising positions to hit our little yellow two-ounce ball.

Hope this helps, Todd. Add some ice massage (ice cube in a towel), Aleve or comparable anti-inflammatory and rest, if need be, if the injury is already acute. Best of luck.

From Brad W., Alpharetta, GA:

I can't help with grips, but to cure tennis elbow, find a doctor who performs PROLOTHERAPY, a simple "in office procedure that will heal the micro tears which cause the pain in tennis elbow.”

*Please note that any advice given out in this forum should in no way be confused with actual medical advice. Before starting any new exercise regimen or altering your existing one, we strongly urge you to consult with your regular physician.

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