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Coping with Tennis Elbow

Q. I've battled with chronic tennis elbow for the last couple of years. I've tried cortisone, physical therapy, arm braces, bands, creams, pills -- you name it! Is there anyone out there that has survived this and kept playing tennis? Is taking a few months off going to help? I love the sport and would be heart broken to permanently give it up. On the other hand, I feel like I'm making things worse by playing, plus I don't want to let my teammates down by not playing my best.

From Enno P. of Flushing, NY

The only way you’re going to permanently fix that tennis elbow is to take a lesson to correct the mechanical deficiencies that are contributing to the problem. As much as professional tennis players may become injured due to the incredible stress put on their body at the pro level, the one injury you rarely hear affecting them is tennis elbow. Why? Because their strokes are fundamentally sounds. I suspect you probably have a one handed backhand and you’re jabbing at the ball. Doing this just one time puts enormous stress on the joint and will lead to tendonitis. Continuing to do so will eventually result in a full tear. For now it may be beneficial to take a rubber band and wrap it around your fingers, flex your fingers back and forth as many times as you can during the day. This may eventually bring some relief.

From Michael D. of Powder Springs, GA

I don't normally do things like this but tennis elbow is something I wouldn't wish on my worst enemy. I am a tennis player but didn't get mine from tennis. I'm in construction and developed it swinging a hammer. I moved to Atlanta from the Boston area (Upton) 4-1/2 years ago and resurrected my love for tennis. I took a year off from doing everything with my arm when I moved south after having five cortisone shots in my elbow in 2-1/2 years. When I discovered that tennis is huge down here (eight lighted courts in our neighborhood) I went to a tennis shop that a co-worker recommended to me. I explained right up front how scared I was to pick up a tennis racquet after what I had been through. The owner of the shop went over to the wall of racquets, picked one out and handed me a ProKennex 5G. In the beginning I was very conscientious about icing my elbow and shoulder after I played. Today, four years later I play 125-150 times a year. I wear a tennis elbow arm band, but don't really need to ice anymore after I play, and I still use the ProKennex 5G. I have a friend in the neighborhood with the same tennis elbow problem who bought the ProKennex 5G on my recommendation and his problem is gone also. Racquet manufacturers phase racquet models out, but ProKennex knows it has a loyal following when it comes to this racquet. If you don't believe me, go to Tennis Warehouse and read the feed back on this racquet. I'm a 50 year old 4.0 player, and because of this racquet I will continue to play three times per week and never think twice about it. Take some time off, let the cortisone heal your elbow and buy this racquet. Take heart, it will get better.

From Vincent Buscemi PT, Director of Physical and Occupational Therapy, Winchester Hospital/ Orthopaedics Plus

Your problem is a common one. Given your history, you likely have tendon damage. It is still possible to play tennis and heal your injury, but you need a long-term plan to manage, heal and exercise your elbow in order to TREND your injury towards recovery. It is a balance of all the factors which include strokes, racquet, strength and injury management. If you do not achieve that, you will trend your injury in the wrong direction. You do not live too far from me. If you would like, call me and I will offer my services (no charge) to point you in the right direction. I have been practicing in Winchester for 20 years and have been treating tennis players since. If you know anyone from Winchester that plays tennis, it is likely they may know of me. All for the love of the game and when it comes to tennis, I can't resist a challenge on or off the court (although I am much more successful off the court).

From Phil K. of Houston, TX

I was like you, Mary, trying just about everything for my tennis elbow -- other than switching racket hands. I was extremely skeptical when I heard mention of using acupuncture for tennis elbow treatment. I did a lot of reading on the subject, but could not see how little needles could ever have any positive effect of eliminating elbow pain. I contacted several acupuncturists in this area, and selected one that had claimed prior successes with tennis elbow treatment. I was treated five times, and felt absolutely no improvement. On the sixth visit, I was prepared to tell the acupuncturist that it was not working for me and it would be my last visit. However, before I could tell her that, she told ME that it would her last treatment of me -- as this would be the one that did the trick. Mysteriously, as I left her office, I could sense that I had no elbow pain -- no problems in opening the car door, shifting gears, steering the car, etc. I came home to hit a few balls off the backboard and, well, no pain! That was three years ago, and I have not had a twinge of pain in my tennis elbow since. So, Mary, give it try -- it's not expensive, not painful, and it might be your best solution. Good luck!

From Rob L. of Scituate, MA

Like you I have been constantly battling tennis elbow for about 3 years now. I've been through two rounds of physical therapy, one cortisone shot, lots of stretches and numerous ointments. Sadly, I have not found a cure-all for this problem -- but you should not lose hope as there are still options for you to pursue. Try these tips which have helped me greatly: First, take two weeks off from tennis. Then, find a 2 lb. runner's dumbbell that has a built-in handle. Sit in front of the TV with your arm resting on the armrest of a sofa or chair and your hand dangling over the edge - supported at the wrist. Place the handle of the dumbbell over your finger tips just below where your fingers meet your knuckles. With your palm facing down, slowly lift the dumbbell with your fingers to full vertical extension and return to rest equally slowly. Perform three sets of 25 reps each day.

Strengthening the forearm helps to take pressure off the elbow. In addition, you may want to pursue acupuncture or acupressure. Finally, take a lesson and have the pro focus on your technique, paying particular attention to the backhand -- they may find a weakness in your form that can be corrected with the result being less shocking to your arm. I hope something in there is helpful. Make sure you look me up when you are ready to hit again. I work down the street from you in Woods Hole!

From Karen D. of Seattle, WA

I struggled with tennis elbow for over a year (I am 46) and I did not want to stop playing or take any time off. I asked a tennis coach if he had any advice and he said as a last resort to string my racquet looser. I did and I have not had a problem since. I have no idea how tightly it was strung previously, nor the type of strings, but the pro shop seemed to understand what I was telling them and it completely cured it. You may want to try that.

From Daniel

I think you should take a rest and go to a relaxing place such as Hawaii for a week or two.

From Stephanie of Rockford, IL

I too suffered from chronic elbow pain and used the straps. I had x-rays taken that confirmed tendonitis. I didn't quit. I iced and took ibuprofen after using that arm, even after vacuuming. I used a movie camera to evaluate my contact point and follow through and noticed my shoulder wasn't completely parallel with the net and my follow through was “wristy” (not through the ball, like swinging a baseball bat). Concentrate on making contact with the ball in the middle of your racquet head and have plenty of warm-up time before a match. This change required me to do weights with my wrists. I have a great one-handed backhand with no pain if I take my time, warm-up, turn my shoulder and strengthen my forearm. I don't need a strap but ice when I over do it. Good Luck.

From Bob C.

Everyone is different, and what works for one person does not work for another. I suddenly got tennis elbow. My professional said I was hitting the ball too late and that I can cure that with always (and he means always) getting my racquet back early. If I am not able to get the racquet back, I don't hit at the ball and accept a lost point. So, I went to my physical therapist and he said I should ice my elbow often and repeatedly. I needed to be careful not to give my elbow frost bite. I am still getting over the tennis elbow, but my progress is such that I now feel just a slight twinge.

From Laura D. of New Canaan, CT

I suffered from tennis elbow for a season. I actually hurt my arm carrying something heavy and as soon as I hit my next ball, the pain was terrible. It lasted from October until June. I took a few months off, bought a copper bracelet with magnets and when I started again in September the problem was gone. It seemed like the addition of the bracelet in August did the trick. I still wear the cushion on my arm from time to time as the backhands can cause a slight recurrence.

From J M.

I am going through the same thing. I've been to the doctor for the Cortisone shot and used CT Cream that I found on a tennis site. It seems to help. One thing that I know is working is a regimen of exercises that strength that forehand muscle. Squeezing tennis balls are helping as well.

From Paul B. of Shrewsbury, MA

I have played tennis many times in Falmouth, a really great town on Cape Cod! If your tennis elbow is that serious, first you MUST REST. Now that it’s winter season, maybe take 60 days off. Along with some basic Advil or Motrin, this will reduce the inflammation. Now, time for an equipment check-up. Is the frame you’re using too stiff? Heavy? Grip too small? Talk to a pro and show him your racquet. Lastly, string tension is critical. Try stringing 5-7 lbs. LOWER. Let the strings absorb the shock, not your arm. Also, try a lighter gauge string, maybe 17g. Tennis elbow can be very stubborn, but it will fade. Remember this: RICE: Rest, Ice, Compression and Elevation. It works for many overuse injuries. Just think of all the Tennis Magazine's you'll catch up on when resting.

From Clément D. of Norcross, GA

I am 64 years old and went through periods of tennis elbow a number of times in my life. I tried everything, but the only successful method has been to stop completely playing tennis for at least 6 months. Whenever I resumed playing, I can usually play for 8 to 12 years without any problems. When the problem arises, I repeat the cycle. The secret is to stay away from the racket for at least 6 months. It is like trying to quit smoking. If you go back too early, you have to start all over again. Hey, it worked for me over a 45 year period so far, and I am still enjoying singles tennis. Most of my longtime tennis friends have given up tennis for golf due to knee, shoulder and tennis elbow problems.

From John G. of Lake Ariel, PA

My experiences with tennis elbow occur when I go back to not hitting the ball far enough in front, especially on my serve. As long as I'm keeping the ball out in front, I find I have no problems with tennis elbow or any other arm problems. Have a friend or a pro check your stroke to see where you are contacting the ball.

From Kevin F.

You mentioned several treatments for your elbow, but no equipment changes. I have read that more flexible and heavier rackets reduce stress on the elbow. Thinner rackets (the width of the head where the strings go through) are reportedly more flexible and reduce stress and vibration transmitted to the elbow. Also, a slightly heavier racket--like the old Prince Graphite Classic that is slightly "head heavy"--reportedly deliver less stress to the elbow. Give one a try. You might also consider building up the arm and shoulder muscles to help handle the heavier racket and reduce the need for the lighter, stiffer ones. I did switch to an old Prince Graphite for a few weeks and it did seem to help, but the pain didn't go away entirely. Now I mostly use my light, stiff racket again and I still have pain but it is tolerable and does not keep me from playing.

From Minh Q. of NC

Thirty years ago when I started to compete, I had my first incident. I had a one-handed backhand and a continental grip, and I attacked the ball a little too far out. When I changed my grip to a semi-eastern grip and let the ball come closer, it solved my problem. Two years later, as I was moving up to the pro level, I found myself with a lot of difficulties in handling their fast and heavy balls, and my elbow started to hurt badly. Through a conversation with one of the top national players, I've learned that I didn't hold my grip strong enough. You need to squeeze the grip as strong as you can before you hit the ball and relax after you follow through with your shot. Take a minute or two to squeeze the grip and toss the racquet to warm-up your hand and fingers. Most importantly, during the first 5-10 minutes, center the ball well (this will also help you further in the game) to avoid any vibration. Once you get used to these steps, it will become natural, and will help you to get a better feel for the ball. Within four weeks my elbow pain disappeared and my game got much better.

From Barbara J.

The only way to recover from serious tennis elbow is to take time off. I had to stop playing for eight months. During that time I used my left arm for the many other things we do every day that further aggravate tennis elbow, and had physical therapy. If you try to play too soon (which I did) it will return with a vengeance. When I was able to play again with NO pain, I always used an elastic active support (still do) that I got with a prescription from my physical therapists, and I always ice my arm after playing. When I first returned to play, I made certain that I rested my arm one day before I played again. I've managed to play with no pain for several years. It takes patience but it's worth it long term.

From Howard of FL

I went through a bout with tennis elbow, first with the right arm, then with the left. Each occurrence took about a year-and-a-half to recover from, but I never stopped playing. I got through it using physical therapy, lots of ice, a change of racquets and stringing as low as 35#. One more thing--take lessons so that you learn to hit the ball earlier. Stroke mechanics is a big factor.

From Joe G. of Richmond, VA

My tennis elbow appeared to be related to hyperextension of the elbow, something that can happen when you carry a suitcase, heavy grocery bags, etc. with your arm extended. I purchased an elbow brace online that uses a combination of metal hinged plates on the sides and crossed straps to prevent over-straightening my arm and overextending my elbow. It’s not pretty, but it has really done the job for me. By the way, I am also now careful to keep my elbow bent when carrying items that might cause me to hyperextend that precious elbow.

From Christoph C. of Ben Lomond, CA

I've seen great benefits from massage. Massaging the forearm greatly relieves the stress and tension that develops with tennis elbow. Some physicians agree that the elbow is not the problem, but the muscles that are attached to the elbow are. Give it a try and don't forget to drink plenty of water after your massage. This will help eliminate the toxins released from the massage. Good luck!

From Linda S. of Springfield, MO

I had severe tennis elbow about four years ago. I had two rounds of physical therapy, three cortisone injections, wore an arm brace, but nothing was helping. After about six months, I finally quit playing for a few months and when I came back, I took some lessons on hitting the ball out in front and changed to a racquet that was easier on my arm. It finally did go away and I now play 4-5 times a week with no elbow pain, and I haven't worn a brace or needed to ice for several years now. Taking a couple months off now may help you overcome the inflammation so that you can be able to play pain free in the future. I am! Good luck.

From Bee of Hermosa Beach, CA

Seven months completely tennis free (that was just as painful as the tennis elbow) and I'm now back to playing. The three "R's" seem to be the best way to recover: Rest, rest, rest. Take a break and come back when the pain is gone.

From Suzanne C.

I survived tennis elbow six years ago. I had not played tennis as an adult until 2000, and during my first year I was a 2.5 player. I could hardly turn the steering wheel of my car without pain. Here’s what I did: 1) Took 3 months off from tennis. 2) My doctor prescribed a heavy anti-inflammatory drug (Celebrex) and physical therapy. 3) I changed my strokes. Once my arm pain settled, I spent time on stroke production. I also worked with a tennis pro to adjust my strokes. We changed my backhand from a one handed to a two handed. I also adjusted my forehand so I was not hitting it late. 4) Proactive pain management: I wear an elbow brace and ice my elbow after I play. I continue to three to four times a week, and am now a 3.5 player. When my elbow starts hurting, I continue to ice it and cut back on my tennis.

From Mike O. of Portsmouth, VA

I’m currently suffering as well and have been going to the chiropractor to receive ultrasound treatment. I’ve only received three so far, but it does seem to help. The chiropractor suggests 10 to 12 treatments spaced two times a week. I’ve tried everything also except quitting for several months, which I think is the only real chance for a cure. I’ve been suffering for about nine months and seem to have helped it very little. My club pro suggested increasing my grip size, so I’m going to try that as well. Hope these help us both!

From David

I too have "tried everything" including surgery. Nothing worked until I took a three year hiatus. My elbow will still get sore if I play more that twice a week, but is greatly mitigated with ice immediately after playing. I find ice to be more effective that those re-freezable sleeves, as you can apply pressure and penetrate the tendon more effectively. In addition, I use two racquets with 1/8" difference in size to vary the "repetition" impact. And most significantly, I switched to two hands, which has been enormously beneficial.

From Dr. Ralph Bysiek, chiropractor

Along with adjusting the forearm, I also use a tissue stripping technique (A.R.T. or Graston work) with patients with lateral epicondylitis. Ask some chiropractors in your area what soft tissue techniques they use and their experience with tennis injuries.

From Jenene S.

Taking time off is really one of the few things that helped me. Just like any other injury, you have to let it heal. I did the cortisone shots, too, but after three rounds I didn't like what the cortisone was doing to my arm! Switching to a less stiff racquet also helped. Oh....and no housework, dishes, etc either...anything that will aggravate the arm. (Now there is some real USEFUL advice!) Good Luck!

From David K. of Flushing, NY

I finally started dealing with tennis elbow a few years ago when I couldn't pick up a glass of water; until then I just iced it after playing. I tried everything and finally even had surgery. Between the surgery and just not being able to play for several months it got better. I've kept up the exercises, switched to a two-handed backhand, and only play every other week at most. Last week I realized after playing that my arm didn't hurt at all. I'm getting ready to join a league again. It's been nine months since the surgery.

From Nancy P. of Albuquerque, NM

I cured my chronic tennis elbow with 1500 mg a day of Bromelain, plus lots and lots of stretching. Bromelain is a food supplement found in health food stores. It's a digestive aid and natural anti-inflammatory made from pineapple.

From Mark S. of Lincoln, NE

I am a 47 year old player who began working on the two-hand backhand four years ago because of tennis elbow. The timing is completely different, so that has been the hardest adjustment. My tendency is to reach for the ball and take it out in front like a single-handed forehand rather then wait until it is in the power zone. What helped me the most in the beginning was to get on a wall at a pretty close distance and just hit 100's of two-hand backhands (starting at a very slow pace). I also did a lot of backhand, forehand, backhand, forehand stuff on the wall to get used to the feel of gripping the two-hand backhand. It took a couple of years but I use the two-handed for about 75% of my backhand shots now. I still go to the single for hard to reach stuff, approach shots to the net, change of tempo shots and volleying, and I’m enjoying the game much more because tennis elbow is a thing of the past.

From Dave W. of Sewell, NJ

I had to take about six months off two years ago to let my tennis elbow (lateral epicondylitis) heal and stop hurting. Then I started with exercises (rubber bands, wrist raises with progressively heavier weights, etc) and took a few lessons to improve form. The biggest plus for me was a new racquet. A pro at the club suggested the Head Protector and it has worked for me -- no more elbow pain! I gave up a lot of "feel" but I can still play. Demo one and see if it will help you. Good luck!

From Jack of Chicago

1) Try a different racquet and string tension. 2) You probably have something wrong with your strokes that are putting too much stress on your arm. Go to a good pro to get it corrected. I had to try out several pros before I found one that offered good advice. 3) Switch to a two-handed forehand or backhand. 4) Lift weights starting with very light weights. Be sure to exercise both the muscles affected and its opposing muscle. 5) Last option: switch hitting arms. I knew a woman who was right handed, had very bad tennis elbow and taught herself to play left handed.

From Unknown

I assume your grip is the right size. There is a template on the Wilson web site you can download to double check. Also, use a thin, super-soft over grip--my favorite is Babolat VS original (others may last longer, but they give me callused thumb/forefinger). You must have heard this before, but use a racquet with lots of flex (a rating of 66 or lower and a beam width of 22 mm or less). Make sure it is balanced at least five points head light (8 to 10 points head light is easy on the elbow), and has as much heft as you can handle. My current racquet is 13.4 ounces, has a flex of 66 and is five points head light. And if you hate the sounds of all that, at least switch to honest-to-goodness, natural gut, 17 gauge strings. If you have been using synthetic strings, string natural gut four to six pounds higher because it has more elasticity. Lastly, use a Babolat RVS damper. It dampens both the string and racquet head vibration.

From Dan Dwyer at Point Set Indoor Racquet Club, Long Island, NY

I have been a teaching pro for 50 years and have seen many cases of tennis elbow. I suffered with it many years ago myself and chose a radical but very effective treatment. The doctor put my arm in a cast for four weeks. He told me I could do anything I was able to do in the cast. After one week I went back for a check up. He asked what I’d been doing, and I told him I was still teaching tennis with the cast on. He then enlarged the cast from the tips of my fingers to the top of my arm which totally immobilized it. Four weeks later, I returned to have the cast removed. I then immediately played tennis, pain free and have not had a problem since. Since I don't know anyone who cured their tennis elbow in less than four weeks, the treatment in retrospect was not so radical. I believe that almost all arm injuries are caused by basic flaws in the players’ strokes. The following are critical to eliminating the potential threats that most often cause tennis elbow.

• Look at the ball with intensity beyond belief. See it hitting your strings, feel the contact and elongate that contact as much as possible.

• Turn your shoulders as much as possible in preparing your backswing.

• Hit the ball as far in front of you as possible. This guarantees that the head of the racquet comes through first, generates maximum speed in the racquet head, and guarantees that your body weight is behind the ball. All of these things will reduce the stress that must affect your wrist, elbow or shoulder.

• Make sure the ball, racquet and body weight are all going in the same direction.

• Hold the racquet loosely (I know most people will disagree with this). If you hit the center of the racquet, it is impossible for the racquet to turn in your hand and if you hit the ball late (primary cause of tennis elbow) you will absorb less shock.

• If you have no problem taking aspirin, taking one before playing helps prevent inflammation, but certainly get the advice of your physician before doing this.

• Where the exact point of the pain is will tell you whether it is your forehand or backhand that is causing the problem. The outside of the elbow is usually caused by the backhand while the inside is usually caused by the forehand and/or service.

• Make sure that you avoid any stress to the elbow in your day-to-day activities, such as opening jars, turning door knobs, shaking hands (politicians suffer from tennis elbow regularly) holding a pen or pencil tightly. In general anything that causes you to stretch the inflamed tendon is going to exacerbate the problem.

• Playing with a loosely strung racquet, preferably strung with gut will also help immeasurably.

I hope this helps. You definitely do not have to give up playing for any extended period of time. Remember this is the "sport of a lifetime."

From Rich of Belmont, CA

I use to suffer from tennis elbow too! I would play through it but at times it was almost too much to bear. I used creams, bands and everything else I could find. I have not had the problem now for several years, due in part to several factors. I used to string my racquet (Fischer Vacuum Pro 90) at 70 lbs. using synthetic strings. A few years ago I switched to the Fischer Pro Tour FT 98, lowered my string tension to 56 lbs. and started using real gut strings. I'm positive this combination has been a lot easier on my arm. Maybe you can find a better combination of string type, tension and possibly a more flexible (softer) racquet. I also do a few arm exercises several times a week, which only takes a few minutes and I can do it while walking my dog. You can probably find a few good exercises in a tennis publication or from a physical therapist. I also improved (lengthened) my follow-through on ground strokes, which allows more time for the deceleration of the racquet. I hope this might help you.

From Carol S. of Belton, TX

I had a very bad case of tennis elbow too, and ended up having surgery on my elbow. After rehabilitation, I was able to start playing tennis again. So, you might look into having surgery done on your elbow. I have not looked back on mine, and am so glad I had it done.

From Karen P. of Marietta, GA

REST and Anti-inflammatories were the key for me. You’re just going to have to say no to tennis for a few weeks. I fought tennis elbow for two years, then was finally able to stop it by doing several things. First, to get rid of the pain, I put my arm in a sling for two weeks and took Ibuprofen (800 mg) 2-3 times per day. With a full time job working in computers, and three kids, plus tennis several times a week, I was just using the arm constantly. By putting it in the sling, it forced me to take it easy and the Ibuprofen took care of the inflammation. I took another week off tennis after the sling came off and sure enough, by the end of the third week, NO MORE PAIN! Now, on the rare occasion that I feel an ache, I take the Ibuprofen and I say NO to tennis until it subsides (which usually only takes a couple of days). In addition to this, I loosened the strings on my racquet (now at 53, but back then I think I went down from 62 to 58), and I put a big vibration dampener on my racquet (one that stretches across all of the strings). It's been five years since the last bout and I play tennis more than ever. I never want to go through that again!

From Fran M.

I struggled with tennis elbow off and on for several years. The only thing that finally resolved my issue was total rest from tennis for a whole summer. When I returned I took lessons and looked at stoke issues that led to injury (for me this was hitting late and using too much wrist). When my elbow stopped hurting, I began strengthening exercises. I also string my racquets 5# below suggested range.

Q. "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!"

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.”

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