How to Minimize or Eliminate Elbow Pain and Prevent the Onset of “Tennis Elbow” or Lateral Epicondylitis

Tennis elbow” or lateral epicondylitis is the most common form of elbow pain experienced by tennis players. “Tennis elbow” is pain that emanates from a bony bump (lateral epicondyle) on the outside of the elbow. The pain of “tennis elbow” occurs primarily where the tendons of your forearm muscles attach to the lateral epicondyle. Pain can also spread into your forearm and wrist. “Tennis Elbow” can usually be traced to overwork (repetitive activity), poor mechanics, poor warm-up prior to play and a lack of fitness conditioning.

Here are 10 recommendations to avoid and/or minimize the pain of “tennis elbow”.

1. Develop an effective fitness conditioning program. Develop and sustain a program that strengthens your supporting muscles particularly your shoulder (which supports the muscles, bones and tendons throughout the arm, hand, and wrist). Exercises that restore the glide and ball and socket functions of the shoulder should be a primary focus for all tennis players (particularly players experiencing “tennis elbow” pain). Since “tennis elbow” is often attributed to an overuse of the wrist extensors and flexors, a preventative conditioning program should also include a focus on strengthening the wrist (specifically the forearm muscles supporting the wrist). A conditioning program to prevent “tennis elbow” should include exercises focusing on wrist extension, flexion, supination and pronation, wrist radial and ulnar deviation, shoulder internal and external rotation at various positioning angles, shoulder abduction and adduction and elbow flexion and extension. A leverage bar (a bar weighted on one end) is an ideal tool for many of the wrist exercises. Other applicable equipment and tool options include free-weights (dumbbells and barbells), kettlebells, resistance bands and even a towel (which can be coiled and then twisted) and an old tennis ball (which can be used to squeeze for grip strength). Cable and plate-loaded machines provide additional pulling and pushing options to strengthen the muscles supporting the elbow and shoulder joints. With all exercises, it’s important to establish and maintain complete range of motion (ROM) and proper technique. Work load demands, intensity, frequency and/or volume should progress incrementally at first in a linear direction and then in an undulating pattern (with days of varying levels of intensity). The program should be comprehensive focusing on the lower as well as upper body preferably with extended kinetic chain exercises, specific to your individual needs and ideally segmented in training blocks as part of an overall periodization schedule and strategy.
2. Warm-up properly prior to play. It’s important to establish a routine to warm-up the muscles prior to play. Dynamic stretching (continuous movement patterns such as arm circles and high kick walks) followed by a graduated length rally progression provides a good option.
3. Choose the right equipment. Use a more flexible or less stiff racquet to relieve pressure on the elbow. Restring your racquet more frequently. Make sure you have new, lively and responsive strings. Use softer multifilament strings (an example is Wilson NXT string) and string your racquet at a lower tension.
4. Check your grip size. Most players undersize their grip size. It takes more hand pressure to support a smaller grip.
5. Move your feet to get in the best and strongest possible position to strike the ball. If you are always playing catch up to get to the ball, you will inevitably hit the ball late, compromising your swing and swing pattern.
6. Hit with a relaxed grip. Use your non-dominant hand to help support the racquet in the ready position. Support your racquet with your thumb and fourth and fifth fingers for the groundstrokes and volleys. Create a gap between the racquet handle and the heel of your hand as you drop your racquet back for the serve. Squeeze your grip only at the point of contact.
7. Avoid excessive rotation of the arm and wrist for the groundstrokes. Keep your elbow down through the hitting zone. Finish with the palm of your hand facing the side fence instead of the ground for the forehand groundstroke (and similarly with your non-dominant hand for the two-handed backhand).
8. Extend your arm fully using a continental grip to hit your serve. The eastern grip on the serve promotes a lower contact with a bent elbow and a dragging down of the elbow after contact. The continental grip promotes a more natural throwing motion and rotation of the hips and shoulders and more extended reach at contact. Hitting with spin (facilitated with use of the continental grip) is also a good way to relieve pressure on the arm.
9. Incorporate all your body components in execution of your strokes. Synchronize your strokes with the rotation of your hips and shoulders. A lack of hip and shoulder rotation or a fault in the kinetic chain leads to muscling or arming the stroke. Over rotation or premature rotation of the hips and shoulders leads to flipping the ball with the arm and wrist. Poor mechanics, particularly as it relates to the hips and shoulders, places undo pressure on the arm, elbow and wrist.
10. As a preventive measure and/or if you start to experience pain or discomfort in your elbow, apply ice and take anti-inflammatory painkillers such as ibuprofen and acetaminophen (as approved by your physician). Applying ice and taking painkillers after play helps to avoid swelling and tissue damage to the elbow.