Many of you have been very busy with activities such as golf, tennis, rock climbing, and biking. All these activities require a lot of gripping and sustained wrist positions. Hobbies and occupations such as gardening (pulling those persistent weeds!), carpentry and mechanics also put considerable stress on the wrist and elbow muscles. If you do too much of any of these activities, you may end up with pain somewhere in the elbow, forearm or wrist. In this article we will discuss “Tennis Elbow”.

On the outside of the elbow, there is a prominent bump of bone. The muscles which stabilize and extend the wrist, pull the fingers back and make our grip strong, all attach to this bump. If these muscles pull too forcefully or too frequently at the elbow, a tendinosis can develop. The common name given to pain at the outer aspect of the elbow is “Tennis Elbow”. In tennis the most common way to develop this is from an improper backhand stroke. In my practice, I see a large number of patients with pain at the outside of their elbow. Some are tennis players, but most develop it from work activities or other sports.

How do I know if I have Tennis Elbow?
Pain felt at the outside point of the elbow is the most noticeable sign. The pain is produced when you grip or squeeze something. It is also felt with lifting, especially when your arm is held out straight in front of you. Pulling a jug of milk out of the fridge or lifting up a coffee pot are common activities which patients report as being painful. A quick test you can do on yourself is:

1. Straighten your elbow out in front of you, away from your body;
2. Turn your palm so it faces down to the floor;
3. Extend your wrist, hand and fingers back towards you…keep the elbow straight;
4. Take the other hand and try to push the middle finger (on the painful arm) forwards, towards the floor; and,
5. Push back against this pressure with your middle finger.

If this causes pain at the outside of the elbow you probably have “Tennis Elbow”. The pain is also reproduced if you try to squeeze/grip in the above position.

What do I do now?
Treatment in the initial stages consists of ice to the outside of the elbow. This should be done for 15 minutes, at least 3 times per day or after any activity that has caused you more pain. You should try to avoid any sport or activity that requires you to grip or use your wrist and finger muscles repetitively. If you can’t avoid these movements, try to do them with your elbow bent to 90° and your palm turned facing up instead of facing down. This position causes you to use different muscles and might be less painful. You can purchase a brace to wear around your forearm that may decrease your pain during activities. These are usually called “Tennis Elbow straps” and they can be found at most pharmacies or medical supply stores.

There is a simple stretch that can be very helpful in treatment of Tennis Elbow.

1. Straighten your elbow out in front of you, away from your body
2. Turn your palm so it faces down to the floor
3. Drop your wrist and fingers down towards the floor
4. Take the other hand and slowly pull the wrist and fingers towards your body, keeping your elbow straight

This stretch should produce a mild pulling sensation across the top of the wrist and forearm. Don’t pull so hard that you get sharp pain at the wrist or elbow. Hold this stretch for 10-30 seconds and repeat it twice. This stretch can be done at least three times per day. It is also helpful to do during or after any activity that uses your wrist and elbow a lot or produces the pain at the outside of the elbow.

What do I do if the pain doesn’t go away?
Tennis elbow can be very persistent. If it doesn’t settle down in a week after resting, icing and stretching as I have outlined above, you should visit a physiotherapist. They will assess your wrist, elbow, shoulder and neck to see if there are any other factors leading to the elbow pain. The most common causes of persistent “Tennis Elbow” are:

• Problems in your neck that are referring pain to the elbow or making the muscles weak;
• Problems with the nerves which run down the arm past the elbow
• Tightness in the joints at the elbow or wrist.

These problems require specialized “manual therapy” treatment to correct them. The therapist will also use things like Ultrasound, LASER, electrical current, massage and stretching techniques. The key thing that helps to resolve “Tennis Elbow” is a series of specific, graduated strengthening exercises. Without these exercises, pain at the elbow can continue for years or come back repeatedly. If you are diligent with your exercise program you can “elbow” yourself back into all your favorite activities including pulling weeds!