March 26th, 2014

// Guest Blog – Injury prevention: Tennis Elbow

Injury prevention: Tennis Elbow

Alicia Bell - Tennis Elbow - Tony Risling

No doubt you have heard of this injury in past while either watching sports or have personally experienced some symptoms of it. Tennis elbow (properly known as Lateral Epicondylitis) is a chronic, nagging pain on the lateral (outer) aspect of the elbow joint often caused by weakness leading to overuse and overexertion of certain movements. Some other signs include pain when gripping an object, pronation and supination while holding an object or by stiffness throughout the forearm and elbow. The reason it was given the common name of tennis elbow was it was a common injury that was popping up in tennis players, with those at higher levels having a greater incidence of the injury. While not a completely debilitating injury, it is commonly a nagging, persistent annoyance for many while it can manifest itself as a very sharp shooting pain very much like other tendonitis type pains.

Rapid extension of the elbow joint coupled with either forceful pronation (turning palm down) or supination (turning palm up) is one of the primary causes of tennis elbow with both direct impacts and overuse also being major contributors to the frequency of the debilitation. Typically there is minimal inflammation from this but is indicated with pain along the radial nerve as micro tears and adhesions in the tendons at the wrist and/or elbow signal pain.

To help prevent the injury from occurring in the first place or to reverse the symptoms of it, one must directly focus on the structures involved. What this requires is properly warming them up to allow greater blood flow and also performing various stretches for the muscles around the elbow and wrist to ensure that there is adequate flexibility in the muscles and tendons and also that the joints themselves are able to move through their full ranges of motion. Some simples ones are wrist circles, wrist extension and stretching out the hand. As well, ensuring that the muscles and joints are “conditioned” enough to handle repetitive use like in tennis/racket sports by gradually increasing their work capacity over time and learning proper mechanics. One population known for this are the older population who take up tennis, doing some general fitness and stretching before and after will help alleviate symptoms.

Also strengthening up specific muscles will immensely cut down the risk for injury. A few of the major points are the supinators and pronators of the arm, excluding the biceps brachii as it is typically already sufficiently strong. I speak of the smaller, supinator muscle, Pronator quadratus and teres. Some simple ways to do this is at a twin pulley station, adjust the pulley height to be at roughly waist height (approximately the same height as the hand when the elbow is bent to 90 deg). From here using either a small straight bar or a rope attachment, perform both pronation and supination of the wrist while keeping the elbow bent to 90 degrees. To  do this, stand beside the pulley with it beside your elbow while you are looking sideways to the pulley, grab the attachment with your furthest hand (if right side is beside pulley, grab with left hand) for supination and closest hand for pronation. From here if you are doing supination start with the palm facing the floor and turn your palm up, in the case of pronation, do this in reverse. This will help strengthen the muscles to be able to handle greater external load demands like striking a ball in with a racket. Performing relatively higher reps, 10-15 reps with a slow eccentric and fast concentric is best while holding a pause at the end of each range.

Another common issue is that people are generally far stronger in elbow flexion movements when the hands are supinated (regular bicep curl) while being pronated (reverse curl) they are significantly weaker. This large imbalance on its own over time can manifest it in the form of tendonitis so as opposed to always doing regular curls, for a time being exclude them completely and focus on reverse grip and neutral (hammer) grip curling movements to bring these muscles all up to par.

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