What is tennis elbow?
Tennis elbow, also known as lateral epicondylitis, is a condition where the outer part of the elbow becomes painful and tender. It is caused by overuse of the muscles and tendons that extend the wrist and fingers. Repeated contraction of the forearm muscles leads to small tears in the tendons that attach the muscles to the bony bump on the outside of the elbow called the lateral epicondyle. This results in pain and inflammation around the lateral epicondyle.
Tennis elbow gets its name because it is commonly associated with playing tennis. However, any activity that involves repetitive motions of the wrist and arm such as painting, raking, and typing can also lead to tennis elbow. Even though it is commonly called tennis elbow, less than 5% of cases are actually related to playing tennis!
Symptoms of tennis elbow
The main symptom of tennis elbow is pain and tenderness focused on the lateral epicondyle. The pain may radiate down the forearm. Pain generally increases with activity and improves with rest. Other symptoms include:
– Pain when lifting or gripping objects
– Weakened grip strength
– Stiffness and achiness in the elbow
– Difficulty fully extending the elbow
– Numbness or tingling in the forearm and hand
The pain often starts out mild but can worsen over weeks to months without proper rest and treatment. Activities that require repeated twisting motions of the forearm such as opening jars or turning doorknobs may be especially painful.
What causes tennis elbow?
The exact cause of tennis elbow is not always clear, but it is thought to occur due to repetitive microtrauma or overuse of the forearm extensor muscles that control the movements of the wrist and fingers. Activities that involve repetitive gripping or wrist extension movements over time can lead to gradual wear and tear of the tendons, resulting in injury and inflammation.
Risk factors for developing tennis elbow include:
– Age between 35-55 years old
– Sports involving repetitive wrist motions – tennis, golf, racket sports
– Manual labor jobs – plumbing, painting, carpentry
– Poor technique when performing motions that strain the forearm
– Jobs that require a tight grip – gardening tools, scissors
– Obesity
– Smoking
– Alignment issues of the elbow joint
When should I see a doctor for tennis elbow?
You should see a doctor if:
– Pain and tenderness persists for more than 2 weeks
– Pain worsens or causes significant discomfort during daily activities
– Home treatment and rest does not improve symptoms
– Elbow pain and weakness affects your ability to work
A doctor can do a physical exam and confirm the diagnosis of tennis elbow. They may order imaging tests like x-rays or an MRI to rule out other causes of elbow pain like arthritis or nerve problems. Getting an accurate diagnosis is important to guide appropriate treatment.
How is tennis elbow treated?
Treatment focuses on relieving pain and inflammation while resting the affected tendons to allow healing. This may include:
– Activity modification – avoiding aggravating activities that strain the elbow.
– Rest and ice – take frequent breaks from repetitive tasks and apply ice packs to help manage pain and swelling.
– Non-steroidal anti-inflammatory medication (NSAIDs) like ibuprofen help relieve pain.
– Elbow strap – wearing a counterforce brace or strap just below the elbow helps reduce strain on the tendons.
– Physical therapy – gentle stretches and strengthening exercises can help improve flexibility and endurance in the forearm muscles.
– Platelet-rich plasma (PRP) injections – injecting concentrated platelets can speed healing.
– Shockwave therapy – uses sound waves to promote healing of injured tendons.
– Surgery – in severe, chronic cases surgery may be needed to repair damaged tendons.
The mainstay of treatment is activity modification to rest the elbow along with ice, non-steroidal anti-inflammatory medication, bracing, and physical therapy. Most cases resolve with conservative treatment but recovery can take several weeks to months.
How much rest should you give tennis elbow?
Resting the elbow is crucial to allow the injured tendons to heal. The amount of rest needed will vary depending on severity. Here are some general guidelines:
– Take a complete break from any activities that aggravate symptoms for 2-3 weeks. This includes any repetitive gripping, wrist extension/flexion, lifting, pushing, and forearm twisting motions.
– After 2-3 weeks of complete rest, you can start light activity as tolerated. If pain flares up, go back to resting. Light activity may include gentle range of motion exercises.
– Avoid any forceful activity involving the elbow for at least 4-6 weeks. Even if pain improves, the tendons are still healing. Resume forceful activity too soon and you risk re-injury.
– Controlled, gradual return to normal activities after 6 weeks if there is no longer any pain with day-to-day use of the elbow. Start light and gradually increase intensity over 2-3 weeks until back to full activity.
– Adjust activity level based on symptoms. More rest may be needed if pain resumes. Increase activity levels only if you can do so pain-free.
– Tougher tendon injuries may require longer rest periods, from 6-12 weeks. Follow your doctor or physical therapist’s advice on when to advance activity.
The key is to rest until you can use the elbow fully without pain before resuming strenuous repetitive tasks. A full recovery from tennis elbow can take 3-6 months. Rushing back to activity too soon often leads to recurrent problems. Patience and allowing adequate rest for tissue healing are vital.
How can I prevent tennis elbow from recurring?
Here are some tips to help prevent tennis elbow from recurring once you have recovered:
– Warm up properly before physical activity using gentle stretches for the forearm muscle group.
– Use proper technique and body mechanics when performing repetitive gripping motions. Avoid bending the wrist fully back. Keep the wrist in a neutral position as much as possible.
– Take frequent breaks when repeating tasks to give your forearms a rest.
– Use an elbow strap or brace during activities that aggravate tennis elbow.
– Strengthen the forearm muscles with exercise like wrist curls and reverse wrist curls.
– Stretch the forearms gently after activity.
– Use tools with larger, cushioned handles that do not require tight grasping.
– Maintain a healthy weight to avoid excess strain on the elbow.
– Have a sports medicine specialist evaluate your technique if tennis elbow was caused by a sport. They can identify flaws and correct them.
– Consider occupational therapy to learn ways to protect your elbow during daily tasks.
– Avoid smoking and activities that irritate the elbow until fully recovered.
With proper rest, activity modification, and technique adjustments, most people recover fully from tennis elbow. Implementing preventive techniques can help avoid reinjury once you have returned to normal activity.
When can I return to sports after tennis elbow?
Returning to sports after tennis elbow requires patience. Resuming intense sports too soon often leads to repeat injury. Here are some general guidelines on when you can safely return to sports:
– After resting completely for 2-3 weeks, you can start with very light activity like walking, swimming or stationary cycling. Avoid any impact or repeated gripping.
– At 4-6 weeks, if you have no pain with daily activities, you can begin doing light strength training. Start with lower weight and higher repetition sets.
– At 6-8 weeks, if using the elbow fully no longer causes any pain, you can start tennis or golf practice in small doses. Only do 10-15 minutes at a time. Stop if pain returns.
– After 8-12 weeks, if you can swing fully and hit balls pain-free for 30-60 minutes, you can consider returning to full sports participation. Advance slowly.
– Build up sports activity gradually over 4-6 weeks once you return fully. Go 50% intensity for 1-2 weeks, then 75% for 2 weeks, before 100%.
– Wear an elbow brace or strap during activity for several months after returning to sport for protection.
– Stop immediately if elbow pain comes back and consult your doctor. You may need more rest or therapy.
– Work closely with your doctor, therapist or trainer when planning return to sport timelines.
The takeaway is to advance very gradually through each phase of recovery without overdoing activity. Giving your elbow adequate rest and slowly ramping up intensity again is key to preventing reinjury. Returning too soon or pushing too hard is the main reason tennis elbow recurs.
Conclusion
Tennis elbow is a common overuse injury that requires adequate rest to heal properly. A complete break from any aggravating activities for 2-3 weeks is recommended initially. After that, light activity can be resumed gradually if pain-free. At least 4-6 weeks of rest from forceful repetitive motions is needed before starting therapy and building back strength. Most people recover fully within 6-12 weeks with a controlled return to activity, but recurrence is common if elbow strain happens too soon. Being patient and allowing tendons sufficient time to heal completely is the best way to avoid chronic tennis elbow problems.