Tennis elbow is a condition that plagues many paddle tennis players. In fact, elbow pain in general takes its toll in this sport where there are massive spins played, more shots to hit than an average tennis match, and a stiff racquet that transfers shock and vibration to the arm. Managing and treating the painful area is half the battle and then addressing the big picture of why the injury occurred in the first place is equally important.
If you’ve suffered from tennis elbow you know the pain can range from a nuisance to incapacitating. Generally speaking, no matter where you are on the spectrum you are either trending towards health or spiraling towards increased pain and inactivity. Typically, tennis elbow is considered a “self limiting” condition, which means it resolves itself with activity avoidance within 12 to 18 months – but very few people are willing to give up their sport for a year. So how do you try to expedite the process of getting back on the court? That involves looking beyond just the area of pain.
Tennis elbow, or lateral epicondylitis, is an overuse injury often associated with repetitive motions. As with many injuries, there are often a cascade of events leading to the eventual breakdown of the system and localized injury. External factors, such as sudden increase in play and new equipment, should always be evaluated. However, the biomechanical factors are often as important and less apparent. I always ask patients if they can recall neck or shoulder problems preceding the elbow pain. Our bodies are great at adapting, as they should be, or we would be at the doctor’s office for every ache and pain we ever experienced. Our complex neuromuscular system finds ways to bypass areas of dysfunction to maintain the output that we ask of our bodies. Sometimes these changes go unnoticed or are short-lived memories of a neck strain or shoulder discomfort. Though adaptations can be necessary, they may not be healthy – especially if the adaptation puts excessive stress on areas that cannot support the increased demand. An example of this breakdown in the biomechanics involved in many tennis elbow injuries would be loss of shoulder extension and thoracic spine rotation. In your recovery, it is useful to incorporate strengthening of postural muscles and shoulder stabilizers that often are weak, resulting in excessive burden on the forearm. This will not only help reduce stress to the injured area, it will also help prevent reinjury.
Here are some examples of stretches and strengthening exercises that you can use in your recovery from tennis elbow or add to your training program as a preventative measure to help avoid the injury altogether.
Foam Roller Stretch for chest and shoulder:
1) Lay down on the foam roller so that it is lengthwise and positioned under your spine, with your feet flat on the floor and knees bent. The back of your head should be supported by the foam roller as well as your sacrum.
2) Pull in your stomach so that there is no space between your low back and the foam roller. Maintain this posture while taking deep breaths throughout this stretch.
3) Open arms out to the side with a comfortable bend in the elbows. Ideally the back of your forearms will reach the ground.
Tips: if you find yourself unable to reach the ground with your forearms or the stretch is just too intense in the chest – try using a rolled up a towel instead of a foam roller to start. Stretching should be comfortable so your body can relax and not fight the stretch. You can move your arms up or down in this position (think snow angel) to stretch different fibers within the muscle.
Seated Row for mid-back muscles and shoulder mobility:
1) Sit on the floor with your legs slightly bent out in front. Feet flexed.
2) Loop the band around the soles of your feet, cross it in front of you and hold one end in each hand.
3) Start with your arms straight in front of you, inhale.
4) Exhale as you drive your elbows back and bring your hands beside your abdomen. Squeeze between shoulder blades. Keep shoulders down and back and chest open.
5) Hold for two counts while focusing on squeezing between your shoulder blades. Inhale as you slowly release arms back to starting position.
Tips: This is all about form. Take time to perfect it. Keeping your abdominals braced (think bracing for a hit to the stomach) and back straight throughout this exercise helps avoid arching the back and swaying. Roll your shoulders down and back before you start to make sure you are not engaging the wrong muscles. Extra focus on pinching between the shoulder blades is key – this exercise is targeting your back muscles, not arms!
Open Book Stretch for thoracic mobility:
1) Lay on your side with top knee bent and supported with a foam roller or pillow.
2) Exhale as you slowly take the top arm over to the opposite side of the body opening up the chest and forming a “T” with your arms. Rotate your head to follow your hand with your gaze. Do not move your top leg or rotate your hips.
3) Inhale as your return to starting position slowly.
Seated Thoracic Rotation for mobility:
1) Sit on a chair with your hands behind your head and your elbows in line with your ears. Keep a ball, block, or folded towel between your knees and squeeze lightly.
2) While keeping your back long, on an exhale rotate your trunk to the left. Keep hips square and facing forward.
3) At the end of your range of motion, laterally flex your spine to the right – opening up and stretching your left side. Think of pushing your rib cage up to the ceiling. Take a deep breath here.
4) On your next exhale, straighten back up and continue to rotate a little more. Keep pressing lightly on the ball with your knees to keep hips facing forward and minimize any low back rotation. Repeat 3 cycles on each side.
Tips: Achieving this side stretch means keeping equal weight in both sit bones and focusing on opening from the rib cage, not leaning from the hips. The movement may be small, but it is focused to the muscles around the ribs. Throughout the exercise, the slight squeeze on the ball engages your core and helps keep your hips facing forward.
Seated Upper Trapezius Stretch for relaxation and neck mobility:
1) Sitting up straight, with your feet flat and shoulders back, hold onto the bottom of your chair with your right hand.
2) Turn your head toward the hand that is holding onto the chair.
3) Side flex your head to the left, away from the hand holding the chair.
4) Place your free hand on the top of your head and use it to gently increase the stretch while letting your shoulder completely relax.
5) Breathe deeply and hold for three breaths before repeating on the opposite side.
Looking beyond the area of pain, you can address the biomechanical defects that lead to injury in the first place. Proper management of tennis elbow will involve treating the area of pain with your healthcare professional and addressing the functional aspect of injury to avoid reoccurrence down the road.