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Living with and Preventing Tennis Elbow

Whether or not you are a tennis player, if you have tennis elbow you know too well how bothersome and painful it can be. It needn't be though; there are various things you can do to manage your tennis elbow and prevent chronic reoccurrence.

Follow the R.I.C.E. Method

• Rest: The first step to recovery is to prevent chronic inflammation and further elbow injury and tissue damage. Resting from tennis or activities that are triggering your tennis elbow is necessary when symptoms first appear up until they have virtually disappeared, however long that takes.
• Ice: Ice packs are good for reducing inflammation and associated pain. Apply ice packs to the forearm, elbow or area that is injured and painful for 10 minutes three times a day.
• Compression: Compressing the injured area with an elastic bandage can help keep swelling down.
• Elevation: Elevating the elbow above heart level whenever you get a chance will reduce swelling and oedema.

Tennis Elbow Supports

Wearing elbow supports, such as splints, straps, bands or braces when you are using the affected arm can help to prevent further injury. Most elbow supports are placed around four fingers down the forearm and work by limiting muscle contraction, which in turn reduces stress on injured muscles, tendons and tissue. However, these methods alone are most often not sufficient unless you combine them with natural anti-inflammatory supplements (see nutritional supplements below).

Nutritional Supplements

Nutritional supplements, such as chondroitin, glucosamine, methylsulfonylmethane (MSM), ginger root and omega-3 fish oils have scientifically documented effects on tennis elbow. Due to today's diet and global pollution, ninety percent of people do not have sufficient amounts of natural anti-inflammatory and antioxidant nutrients in their bodies. These nutrients are vital in the natural healing process of our body and if they are lacking, what started out as a simple case of tennis elbow, can turn chronic, which means more inflammation and pain. In chronic cases, tennis elbow can take years to heal, if it heals at all.

Tennis Modifications

If you are a regular, amateur tennis player, various factors could be triggering your tennis elbow including:

• Tennis technique: You may not realise it, but perhaps your strokes, particularly backhand are causing tennis elbow. If you hit the ball incorrectly and flex your wrist a lot rather than keep it firm, you are likely to stress the tendons and muscles of your forearm. Switching to a two-handed backhand or consulting a tennis instructor about ways to improve your technique and place less stress on your tendons and muscles can help.
• Choice of tennis racquet: The tennis racquet you use can have an impact on arm injuries. Graphite-composite racquets or those made from titanium are recommended over other materials because they are more flexible so transfer less shock and vibration to the arm and shoulder. Mid-sized racquet heads (85-100 square inches) are better in the sense that they offer more stability and less torque - the force that makes the hand bend back and then forward when the ball impacts with the racquet. String tension is another factor you need to be aware of. Many people like high tension strings because they have more control of the ball; however, high tension strings increase shock and vibration to the arm and shoulder. Lower string tension is recommended. Finally, the right grip size for you is vital to minimise wrist movements during play. The easiest way to know the correct grip size is, with your playing hand, hold your racquet in a forehand grip - your palm is placed against the same level as the string face). If you can place the index finger of your other hand in the space between your ring finger and your palm, you have the correct grip size. A small grip size would mean your index finger doesn't fit in the space between your ring finger and your palm and a grip size that is too big would mean there is too much space between your ring finger and palm. A grip that is too small or too big can lead to tennis elbow.

Lifestyle modifications

What if you have tennis elbow but don't play tennis? It is likely that another recreational or occupational activity (painting, plumbing, raking and weaving) is contributing to your injury. It is important that you try not to overuse your arm by repeating the same movements. One thing you can do, if possible, is to alternate hands during these activities. Wearing an elbow support like a brace, strap or band during activities in which you repetitively use your arm will also help to reduce stress on tendons and muscles. Just as important is to do warm-up, stretching and strengthening exercises for your arm (see below).

Exercises for treating and preventing tennis elbow (WebMD)

Warm-up exercises:

1. Place your hand, palm up on a hard surface, such as a table. Touch your thumb to your little finger; thumb to ring finger; thumb to middle finger; thumb to index finger. Repeat sequence at least 10 times.
2. Put your forearm on your thigh with your palm up. Clench your hand into a fist and make slow circles with your hand. Repeat at least 10 times.

Stretching exercises:

1. Place your palms together in front of your chest just below your chin in prayer position. Gently lower hands toward your waist until you feel a stretch in your forearms. Hold for 20 seconds and repeat sequence four times.
2. Place the backs of your hands together in front of your waist with forearms parallel to the floor in a reverse prayer position. Gently raise hands towards the chin and bend the elbows until you feel a stretch in your forearms. The back of your hands should stay together throughout. Hold for 20 seconds and repeat sequence four times.
3. Extend your arm in front of you with your palm up. With your other hand, slowly bend your wrist, pointing your hand toward the floor until you feel a stretch in your forearm. Hold for 20 seconds and repeat sequence four times.
4. Repeat exercise above, but this time with your palm down.

Strengthening exercises:

1. Squeeze a tennis ball or a rolled-up sock in your hand (palm up) and hold for three seconds. Repeat 20 times and gradually increase set over weeks.
2. Place forearm (palm up) on a table with your hand hanging over the edge. Hold a dumbbell - or anything else you might have handy such as a bottle of water - (0.5 kg - 1 kg). Gently raise and lower the dumbbell keeping your forearm on the table and palm up.Repeat 20 times and gradually increase set over weeks.
3. Repeat exercise above with palm facing down.

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