Don’t play around with a tennis elbow, here is how to treat it

NEW YORK – Tennis elbow starts with a persistent, localised pain on the outside of your elbow (or inside, in the case of the closely related golf elbow), and slowly gets more debilitating.

It can happen to you even if you have never picked up a racket or club. Although up to half of tennis players develop it each year, lateral epicondylitis, as it is known to experts, is one of the most common upper-body repetitive stress injuries.

Causes run the gamut, but may include using a hammer for extended periods of time, painting, softball, weightlifting and even gardening. Or it could be a combination of triggers.

Research shows that people older than 40 are most susceptible, as are smokers, people with obesity and those who engage in repetitive motion for at least two hours a day. If you suspect that you are dealing with tennis or golf elbow, there are ways to heal, return to activity and, hopefully, keep the pain at bay.

What is tennis elbow?

Both tennis and golf elbow are overuse injuries that stem from damage to the muscles and tendons running from the wrist to the elbow. If used too much, and if you do not have enough strength in your shoulder muscles and core, microscopic tears can develop in the tendon, where it attaches to the elbow, causing pain and inflammation.

The first sign that you might have the condition is pain near the elbow, said doctor of physical therapy Theresa Marko, who is based in New York City and is the spokeswoman for the American Physical Therapy Association.

“You might also feel a tightness in your forearm muscles,” she added. “Sometimes, you’ll feel a clicking or a ‘catching’ sensation, or you can’t straighten your elbow entirely.”

Pain was Ms Melanie Madden’s first indication that something was amiss two years ago.

“I had been playing tennis for about three months when I first noticed it,” said the 45-year-old real estate agent from Boulder, Colorado. “At the time, I had a new dog and was frequently throwing the ball for him, practising yoga and playing golf. I ignored the pain and hoped for the best.”

Before long, the pain was waking up Ms Madden in the middle of the night, and it hurt to pick up a cup of coffee.

How do you treat it?

Managing the condition when it starts can shorten the time it takes to overcome the pain. “It can be a stubborn injury,” said Dr Marci Goolsby, a sports medicine physician and director of the Women’s Sports Medicine Center at the Hospital for Special Surgery in New York.

The first lines of defence against golf or tennis elbow should be to identify the activities causing it.

“If you’ve had a sudden increase in your pickleball play, for instance, scale back,” Dr Marko said. If you catch it early enough, reducing the time spent on the aggravating injury may be enough. If not, stop it altogether until you have made progress with rehabilitation exercises.

This can be tricky because many simple daily activities – time on a phone, household chores such as sweeping, sewing or even washing dishes – can aggravate the injury.

Next, experts recommend icing and anti-inflammatories and wearing a “tennis elbow” strap, which provides compression at the point of pain (although some studies have found that the effect may be psychological).

Some experts also suggest a wrist-immobilisation brace for severe pain, as it prevents you from extending your wrist in the manner that causes pain at the elbow. You can also try to gently massage on the top of the forearm, with hand facing down, 2 to 5cm below the elbow, Dr Marko said.

In most cases, the root of the problem, however, is a lack of strength in your shoulder area, she said. “Right away, you can start doing some shoulder and rotator-cuff exercises.”

One to try is shoulder external rotation: Lie on your unaffected side, with a rolled-up towel resting between your upper arm and your torso. Bending your top arm at the elbow, lower it towards your stomach and back again, repeating 15 times for three sets.

You can also add simple shoulder-blade squeezes while standing or sitting, repeating 15 times for three sets.

With time and as you start to feel better, you can include weights or resistance bands.

“However, if the elbow is hurting, gripping a weight will be painful,” Dr Marko said. “What I do is place an ankle weight around a person’s wrist and have him or her relax the hand as he or she performs the movements of the side-lying exercises.”

From there, consider a full home-exercise programme from the American Academy of Orthopaedic Surgeons.

If you are not making progress, physical therapists can manually help loosen the joint and develop a personalised strengthening programme. They can also put your arm through motions to assess your readiness to return to your sport or activity.

As you begin to heal, try testing your elbow in small increments of your sport or activity, letting pain be your guide.

In worst-case scenarios – you have tried resting for several weeks and working with a physical therapist – it is worth a visit to an orthopaedic specialist, said Dr Robert Parisien, an orthopaedic surgeon at Mount Sinai Health System in New York City.

“Not because we’ll suggest surgery, but to consider other treatments,” he said. “There’s about a 95 per cent success rate with a combination of treatments.” NYTIMES