Avoid an Injury



What is this injury? 

Tennis elbow—the medical name is lateral epicondylitis—is irritation of the tendon (connective tissue attaching muscle to bone) that attaches the muscles of the forearm to the outside of the elbow, followed by inflammation, swelling, and pain. Typically, the pain results in a reduction of the range of elbow motion. About half of the world’s tennis players suffer tennis elbow at one time or another, but you don’t have to play tennis to get tennis elbow (in fact, tennis players account for only about five percent of total incidence). Many people develop the condition from repeated movements involving the elbow or wrist. The injury occurs more often in people between the ages of 40 and 60 years, even when these individuals have been involved in the same provoking activity for many years.

How does the injury occur?

Although direct impact to the elbow may cause tennis elbow, the most common cause is overuse, often magnified by poor technique and mechanics of movement. Sometimes tennis elbow may be precipitated by poorly balanced or too heavy instruments used to perform a skill. Awkward and heavy tennis racquets or other clumsy, perhaps needlessly heavy, instruments (hammers, wrenches) can cause the problem.

What are the symptoms?

The primary symptom is pain at the outer side of the affected elbow. Its presence might be increased upon mild pressure to that area. The pain increases with any activity requiring hand-gripping movements and is often aggravated by lifting with the forearms. Sometimes the pain radiates down the arm, perhaps all the way to the wrist. Weakness of the muscles of the forearm is also a feature, sometimes resulting in an inability to firmly grasp even light objects.

How is the injury diagnosed?

Health care professionals will take a detailed history of the injury, including whether an identifiable incident can be associated with first appearance of pain, which conditions or activities cause or intensify the pain, and if the condition has happened in the past. The patient may be asked to perform certain movements of the shoulder and forearm, such as lifting or swinging, and to report sensations of pain or weakness.

The range of motion of the wrist and elbow may be checked, as well as the strength of the muscles of the forearm. To check for forearm strength, grip strength may be assessed. Exact location of the pain needs to be determined, usually through manual manipulation (movement of the forearm by the health provider) or palpating of (pressing on) the elbow. In some cases, x-rays of the elbow may be obtained, but are generally unnecessary.

How is the injury treated?

Performing the activity most associated with appearance of elbow pain should be discontinued for two to six weeks. Application of ice packs or ice massage is often effective, as are alternate hot and cold applications: cold applied for 20 minutes, followed by heat for 20 minutes. Alternate hot and cold applications may be done for about 30 minutes per session and repeated twice daily. Nonsteroidal drugs such as aspirin or ibuprofen may reduce inflammation, swelling, and pain. Exercises to stretch and strengthen the muscles of the forearm are critical to recovery and to help prevent reinjury (see below). Sometimes injections of an anti-inflammatory drug might be helpful. Rarely, surgical intervention is required in cases that resist traditional treatment.

How long will the effects of the injury last?

Duration of effects vary significantly. Unless surgical intervention is required, symptoms may diminish within seven to 10 days and disappear in two or three weeks. Grip strength can return to normal in about the same time period. However, some stubborn cases requiring injection or surgical intervention may show symptoms that persist for months. Finally, recurrence of tennis elbow is common. It may take months for a recovery in which all symptoms vanish forever and there is a return to full activity.

When can I return to my sport or activity?

Some may be ready for full participation in two weeks, others not for two months or more. Of course, time for return to activity is much longer if surgery is necessary. A too early return may cause recurrence—not unusual even with a long rest. In the case of an injury due clearly to overuse, returning to the activity that caused the injury should be governed by pain. If skills of the activity create significant pain in the affected area, further rehabilitation is indicated.

How can I prevent the injury?

Tennis elbow frequently recurs. To help prevent recurrence, maintain strength and flexibility of forearm muscles (see exercises below). Be sure to warm up forearm muscles before performing the activity that originally caused the injury. When lifting, do so with palms facing the body. Participation in the activity that originally caused the injury may have to be temporarily curtailed or, in the worst case, discontinued.

For prevention of recurring tennis elbow it’s worthwhile to have a knowledgeable coach or biomechanist watch and evaluate activity. In many instances, persistent or recurring tennis elbow is traced to faulty mechanics of motion and performance.

Anyone just beginning an activity with potential to create tennis elbow through overuse should be sure to increase intensity and duration of participation gradually. This is especially important for beginners older than 40.

Rehabilitation?

The exercises below stretch the muscles of the forearm and upper arm. These exercises should be done at least once and preferably twice daily. Along with their rehabilitative purposes, they can be done to help prevent recurrence of tennis elbow.

Wrist flexor stretch: Extend affected arm forward with palm up and elbow straight. Place fingers and palm of opposite hand across palm and fingers of the extended hand and draw back with it until stretch is felt in the forearm. Hold this position for three to five seconds, then relax for three to five seconds. Perform this exercise 10 times.

Wrist extensor stretch: Extend affected arm forward with palm down, elbow straight, and fingers slightly curled. Grasp the affected side hand with other hand and draw affected side hand down until stretch is felt in the forearm. Hold this position from three to five seconds, then relax for three to five seconds. Perform this exercise 10 times.

Pronation/Supination stretch: Extend affected arm forward in a hand-shaking position with palm facing up. Slowly rotate the hand from a palm-up position to a palm-down position. Hold for three to five seconds and then rotate back. Perform this exercise 10 times. Once strength training is necessary, use a can of food to act as the weight while rotating the hand and wrist.

Tricep stretch: Stand erect with feet at about shoulder width. Raise injured arm at the shoulder with elbow bent and place the forearm behind the head. Grasp the injured elbow with opposite hand and draw it toward the centre of the body until stretch is felt. Hold this position for three to five seconds, and then relax for three to five seconds. Perform this exercise 10 times.

Bicep stretch: Stand erect with arms raised to shoulder height and palms up. Press arms backward until stretch is felt. Hold this position for three to five seconds, and then relax for three to five seconds. Perform this exercise 10 times. The bicep is stretched by this exercise as well as the muscles of the shoulder and upper chest.

The exercises below help develop strength of the muscles of the forearm and upper arm. To maintain symmetry of the arms in terms of strength and appearance, perform these strength exercises with the uninjured arm as well as the injured arm.

Wrist extension: Sit in a chair with forearm resting on the end of a table, palm down. Grasp a lightweight dumbbell and raise the weight up as high as possible while maintaining contact with the table top. Hold this position for three to five seconds. Relax for three to five seconds. Repeat this exercise five to ten times. Substitute a heavier dumbbell as strength increases.

Arm curls: Either standing or sitting, grasp a two- to four-pound dumbbell in one hand. With palm up, flex elbow and draw the dumbbell up to the same side shoulder while maintaining erect posture. Do not bend at the waist or swing the dumbbell. Lower dumbbell slowly and with control to the starting position. Repeat this exercise 10 times. Use a heavier dumbbell as strength increases.

Perform more of the same stretching exercises using weights, starting at a low weight and gradually moving up as the injury improves.
 

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