Dr. William N. Levine on treating tennis elbow
It’s an injury tennis players dread. But what does it actually mean when you’re diagnosed with “tennis elbow”? Dr. William N. Levine, Chief of Orthopedics at NewYork-Presbyterian/Columbia and Chair of the Department of Orthopedic Surgery at Columbia, is uniquely qualified to answer that question. In addition to regularly treating patients for the injury, he has a deep understanding of the sport itself, having previously played competitively and serving as a tennis coach in his early 20s. We spoke with Dr. Levine about what tennis elbow is and the various measures players can take to prevent getting sidelined by it.
You specialize in treating patients with tennis elbow. Can you explain what is going on in the body when a player receives this diagnosis?
DR. LEVINE: Tennis elbow is the colloquial term. The technical term in medicine is called lateral epicondylitis. The lateral condyle is the bump on the side of your elbow, and it is an attachment site for the muscles and tendons that extend from your wrist. When there is repetitive overuse, when that part of the body is seeing too much stress, it leads to some microtearing on the lateral side of the elbow. There are some theories that inflammation is involved. But when you analyze the tissue under a microscope, you don’t see many inflamed cells. So the injury is probably more degenerative than inflammatory. That kind of makes sense, since anti-inflammatory medicines aren’t that successful in eliminating pain caused by tennis elbow.
What would you say are the successful treatments then?
DR. LEVINE: Stretching exercises, counter-traction, tennis elbow braces and physical therapy are the mainstay treatments. The good news is that tennis elbow is almost never an operative problem. I tell my patients that if you go to an American Academy of Orthopedic Surgeons meeting, which is around 15,000 orthopedic surgeons in a conference room, and you say, "Please raise your hand if you've had lateral epicondylitis," 15,000 hands go up in the air. And, then you say, "Please keep your hand raised if you've had surgery for your lateral epicondylitis,” 15,000 hands will go down. So orthopedic surgeons, who know the best, rarely recommend surgery even for themselves for tennis elbow, since it is so successfully treated with non-operative measures.
Are there any preventative measures players can take?
DR. LEVINE: Yes, and they relate to stretching and strengthening of the tendons in the forearm. Also it’s very important to make sure that your racquet is properly sized. Many tennis shops can help you determine just what grip size is right for you. But the most important point is really stretching and strengthening, which is at the heart of any preventative programming to prevent common injuries in tennis.
You know a lot about the sport, and not just because some of your patients are players. Before becoming a surgeon, you were a competitive player in high school and later on, a coach. When did you first begin playing?
DR. LEVINE: I grew up in Fargo, North Dakota, and here was a park about a three-and-a-half mile bike ride from my home. I was roughly 10 or 11 when I first picked up a racquet, and I completely fell in love with the sport. In the summers there were no summer camps so I would just ride my bike down to the park and be on the courts from eight in the morning until six at night. I was living on the tennis court. Then I started to play tournaments, traveling the Midwest circuit, competing against much better players than I was and learning life lessons. I made the varsity team at my high school as a freshman, which was rare. I was also named captain my senior year. That year, our team finished runners-up at the state finals, and I won the state doubles championships.
How did you get into teaching the sport?
DR. LEVINE: I went to Stanford for college where clearly I was not going to be able to continue at a competitive level, though I met the legendary coach Dick Gould and ended up becoming a team manager. Then my junior year, I got a job as a high school tennis coach at [nearby] Los Altos High School. The team hadn't won a match the year before, and they lost only one match the year that I took over, which was fantastic. To see the success of these young men that I had the opportunity to teach was very gratifying. That was kind of my first foray into teaching and mentorship, which has been very instrumental in my career in orthopedics now.
Clearly tennis has played a major role in your life. What do you love about the game?
DR. LEVINE: It’s not about being the biggest, the strongest, the fastest. There’s so much strategy involved. There’s the whole mental element, which I think appeals to my scientific side as a doctor and surgeon. And it’s a sport you can play for life, which is so appealing. Especially when you’re thinking about health, it can be hard to figure out how to fit exercise into your busy schedule. So, if you can go hit tennis balls for an hour, run all over the court and get the blood flowing, get the endorphins going through your body, there's something really valuable about that...I can [also] directly tie [who I am as an educator] back to my first days in tennis. I think that if you have an inclination toward teaching, there's probably nothing more gratifying than being able to see the fruits of your labor, seeing the young kid understand what it means to hit a topspin forehand, or what it means to slice a backhand. When you see that light bulb go on, there's no amount of money in the world that substitutes for that feeling. It's really incredible when I think about how much tennis has influenced my passion for teaching and education, and that's what I've spent my life and career doing, mentoring students at Columbia and from around the country.