Know your Injuries – Part 10: Elbow Epicondylitis – Tennis / Golfer’s Elbow
Dr Meenakshi (P. T.) with a Master’s Degree in Sports Physiotherapy is Gāyo Fitness Academy’s (Hon.) Senior National Faculty and Assessor in Sports Medicine, Sports Medical Rehabilitation and Exercise Therapy. Her impressive work experience includes working her Asst. Professorship in Department of Physiotherapy, P.D.M University Bahadurgarh (Haryana) and practice as Sports Physiotherapist in Sports Authority of India National Boxing Academy, Rohtak. She has attended to India’s world-class women’s boxing teams. She is currently attached to SAI, Lucknow.
She can be contacted at firstname.lastname@example.org. Dr Meenakshi will write regularly on exercise and sports injuries management.
Dr Meenakshi presents the early management of Lower Back injuries in Part 10 of her Sports Injury Management Series.
Elbow Epicondylitis – Tennis / Golfer’s Elbow – is inflammation of muscles, tendons, bursa or the periosteum of the bones at the elbow joint. If the inflammation is on the lateral side of the elbow, we call it Lateral Epicondylitis, popularly known as a Tennis Elbow. If the inflammation is on the medial side, Medial Epicondylitis, it is in common parlance a Golfer’s Elbow!
The elbow is a hinge joint between the distal end of the humerus bone in the upper arm and the proximal ends of the radius and ulnar bones in the lower arm. The arm is bent and rotated at the elbow by the biceps brachii muscles in the upper arm. Ligaments located at the front, back, and sides of the elbow help stabilize the joint.
The elbow muscles, tendons and one or both the epicondyles are involved in this injury. Epicondyles are the bony prominences on the lateral and medial sides of the elbow where the muscles of the forearm attach to the bone of the upper arm.
Dr Meenakshi breaks down her explanation in terms of –
- first aid
- basic rehab movements
Signs include –
- pain and tenderness over the epicondyles – with the pain increasing with gripping and /or rotation of the forearm
- weak grip
- pain while twisting the hand and arm as when playing tennis or throwing a ball with a twisting motion, golfing, pushing off while skiing on snow or bench pressing in the weight room.
Partial tear of the tendon and attached covering of the bone may be caused by –
- chronic stress on the tissues that attach the forearm muscles to the elbow region
- sudden stress on the forearm
- wrist snapping or jerking while serving in racquet sports like tennis.
- Incorrect grips
- Using racquets that are too heavy
- Using oversized grips
- Incorrect hitting techniques
Risk increases with –
- Participation in sports that involve forearms – e.g. tennis
- Throwing sports
- Poor conditioning of the elbow and forearm muscles
- Poor nutrition
- History of previous injury – especially premature return to sport after an incomplete rehab program.
Prevention is better than cure! The precautions to be taken are common to all sports and exercise injuries. But it is worth reminding the reader!
- It is essential to engage in a physical conditioning that involves appropriate strength and flexibility building movements prior to playing sports.
- Stretch the relevant muscles as also the tendons prior to physical activity.
- Improve functional movement and dynamic stability of the joints.
- Try to be in shape to play your sport; don’t play your sport to get in shape!
- Hire a good coach who can improve your technique
Follow the P.R.I.C.E. drill –
- Protect the injured part, not allowing any further damage.
- Rest the injured part.
- Apply ice or cold treatment for 15-20 minutes.
- Compression: use of mild to moderate pressure to the injured area with bandages / crepe bandages is advisable.
Current international standards have replaced P.R.I.C.E. with P.O.L.I.C.E.
- P – Protection of injured part
- O/L – Application of Optimal load (local injury factors) / Training load
- I.C.E. – as mentioned earlier (ice + compression+ elevation)
Follow up on First Aid
Return to sporting activity only after complete rest, recovery and rehabilitation.
Use heat therapy as also cryotherapy to manage pain.
Identify and analyze the physical activity that caused the injury in the first place. Make sure you do not repeat it. Focus on proper techniques.
Exercises to prevent injuries and strengthen the hamstrings
Dr Meenakshi (P. T.) recommends these rehab exercises to help recover from Tennis and / or Golfer’s Elbow:
- Wrist active range of motion exercise
- Wrist extensor stretch with elbow extended/ with fist
- Strengthening of Wrist extensors and progression with weight
- Ulnar and radical deviation motion and strengthening exercises.
- Wrist supination and pronation exercises and progression with weight
- Towel twist with wrist extension
- Self tissue mobilization