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Tennis Elbow

Q. What tennis elbow brace is the best? There are so many to choose from. Has your organization done any surveys or studies to see which brace has the best result?

A. In my experience, most tennis elbow braces are similar in how they perform. The best brace to get is the one that you feel comfortable in and the one that you will wear.

Q. I'm one week into a 6-8 week self-imposed lay-off from tennis in an effort to heal my tennis elbow. Any advice? I'm a 53 year old small-framed 3.0 player and play doubles 5-6 times a week on hard court surfaces with a Prince O3 Red racquet (4 & 1/2 grip size). Thanks!

A. First, I would recommend that you see a physician to make sure that what you are experiencing is actually “tennis elbow”. Here are some things you can do to help tennis elbow:

1. Wrist stretches: With the arm held straight and using the other hand to help with the stretch, push the hand in to extension so the back of the hand moves closer to your forearm. Apply pressure until you feel a slight stretch in the muscles. Hold for 20-30 seconds. Then flex the wrist and apply pressure with the other hand until you feel a slight stretch. Again hold for 20-30 seconds and perform each stretch 2-3 times a day.

2. Grip strengthening exercises: Squeezing a tennis ball or grabbing handfuls of sand or rice in a bucket will help build strength to prevent this from happening again.

3. Icing, and ibuprofen: These will help control inflammation and help with any pain. ALWAYS speak with your physician before taking medication, even ibuprofen.

4. Technique: Work with your teaching pro on technique to make sure that poor technique isn’t the cause of your injury.

Q. My 15 year old tennis player is recovering from a bout of medial epicondylitis due to overuse. He's getting conflicting advice from his trainer and the physical therapist as to whether to ice the tendon after play and strength training sessions. Do you have any thoughts?

A. Though the use of ice has played a prominent role in the treatment of sports injuries, some confusion still exists regarding when to use it and how effective it is. Ice promotes constriction of blood vessels. Therefore, it is extremely helpful in reducing bleeding and swelling that may occur in the first 24-48 hours following an injury. It also has an anesthetic effect, reducing local pain when adequate cooling is achieved. In a player recovering from medial epicondylitis, if pain and/or swelling occurs following playing or exercises, ice applied for 15-20 minutes may be beneficial.

Q. I am a left-handed player & recently injured my RIGHT elbow. The pain is on the outside area. It hurts when I'm hitting my handed back hand. Now my backhand is so messed up & unreliable because I think about the injury all the time. They say it's the beginning of carpal tunnel - any advise? I don't think I could handle a one handed back hand. I'm pushing the ball long now!!

A. This is not carpal tunnel syndrome - that is down at the wrist and is on the palmar side of the forearm/ wrist. This problem you describe is likely due to overuse- either too much play, poor mechanics so that the arm is late coming through the hitting zone, even with a 2 handed grip, weak right shoulder muscles or weak elbow muscles.

Treatment for this type of pain typically consists of modification of play to a point that you do not feel any pain and possibly modifying your stroke mechanics.

Review your technique with a pro and start a strength and conditioning program to improve shoulder and elbow strength. If those measures don't work, consultation with a sports medicine doctor may be necessary.

Q. What treatment to you recommend for tennis elbow? And what exercises to you recommend to speed up the healing process? And lastly what can be done to prevent future tennis elbow? Thank you!

A. The same type of exercises as were discussed in the previous questions are just as appropriate for helping to prevent tennis elbow. There are no treatments or exercises with a scientifically proven advantage in promoting healing. Prevention is based on good technique, from the ground to the wrist, good flexibility in the shoulder, and strength of the shoulder and elbow.

Q. What is tennis elbow? Also, are there any exercises for the arm you would recommend to help prevent it?

A. Tennis elbow, also known as lateral epicondylitis, is an inflammation of the wrist extensor tendons where they attach on the outer side of the elbow. Tennis elbow is one of the more common injuries in tennis, and it is estimated that over 50% of all tennis players will encounter it at some point in their tennis careers.

Tennis elbow is an overuse injury that is characterized by pain on the outer part of the elbow, particularly when hitting backhands and/or after play. (This is different from “golfer’s elbow”, or medial epicondylitis – an inflammation of the wrist flexor tendons where they attach on the inside of the elbow.

Tennis players can also experience golfer’s elbow, although less frequently.) The treatment for tennis elbow, if caught early, is icing, limiting activity that causes pain, and stretching and strengthening of the forearm muscles. If not caught early, treatment may require more aggressive methods like a corticosteroid injection or prolonged rest.

Tennis elbow prevention is based on developing sound technique and building strength and flexibility in the muscles of the forearm. In terms of technique, one of things to focus on is your wrist position at the point of ball contact. The hand and wrist should be in line with the forearm, and not flexed or extended, to allow the muscles to best handle the forces that are generated. We recommend meeting with a teaching pro to evaluate your technique if tennis elbow is a problem.

As for strength and conditioning, you should try to strengthen and stretch the wrist flexors and wrist extensors regularly. Information is available on the USTA Player Development website under Strength and Conditioning/ Injuries and Tennis Technique on how to do this.

Select the “Prevention of Elbow and Shoulder Injuries” or the “Prevention of Wrist Injuries” links to learn about exercises to prevent tennis elbow. One other exercise, not included on the website, is to improve grip strength by squeezing a low pressure tennis ball or racquetball.

Another important piece of anecdotal information is that we tend to see elbow injuries increase when players switch equipment – either rackets or string. For this reason, we recommend players take some time to do some pre-hab strengthening and flexibility training for the forearm muscles starting several weeks before making that equipment change.

Q. I'm sure this question has been posed hundreds of times but I have developed what my doctor describes as tennis elbow. The pain eminates from the top of my elbow. It seems to come from the bone or in close proximity. I have been through three weeks of physical therapy consisting of stretches and small weight exercises. It hurts worse. Some people tell me to rest it completely, some say light exercise. Any advice?

A. Mary Jo Campbell: David, thanks for your question, it is a great one! As I read your letter I was reminded of another player who having been treated for his shoulder injury with complete rest noticed that his tennis elbow of 2 years disappeared!! There is something to be said for listening to your body, and pain is definitely a message that you should heed.

Rest alone will not guarantee that the lateral epicondylitis will not return. It is sometimes caused by an acute or sudden injury but more often it is related to repetitive stresses and overuse of the wrist extensor muscles. There are several factors to consider for total treatment of this condition:

1) Check your stroke mechanics. Seek help from a certified professional to find the flaw in your mechanics and to ensure that you have the proper sized racket. Increasing the size of the racket head can increase the size of the ‘sweet spot’ and hence, decrease the amount of vibration. Tight strings and even the playing surface can also contribute as stressors.

2) Strengthen the surrounding shoulder and forearm musculature while you are healing and it will help to prevent a recurrence. If pain persists during exercise, total rest is advised.

3) If symptoms persist, seek medical attention. You may need to consider more aggressive treatment than the above conservative modes. Non-steroidal, anti- inflammatory medicines or even cortisone injections may be indicated.

Below are some of my favorite shoulder and wrist exercises that may help to prevent this overuse injury. Thanks for your question, David and good luck!

Wrist Roller-Wrist Flexion and Extension. (Angela Kulikov is a junior player who trains at the USTA Carson Training Facility)

Ulnar Deviation

Neutral Position

Neutral Position (Sloane Stephens is a top junior player)

Wrist Pronation

Wrist Supination

Radial Deviation

90/90 Ball Drops

Release and Catch to load the rotator cuff muscles eccentrically

'Stick 'em Ups' - Starting Position

Ending Position - Scapular Retraction and Depression

All exercises can be performed three times per week. Two-three sets of 15-20 repetitions, very light weight.

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