RICE/Prevention

The pain felt from tennis elbow, like most injuries, occurs from inflammation. Use the RICE method if you feel your elbow hurting. The ‘R stands for rest. Stop repeating the causing movement until the pain subsides. If an individual event causes the pain, apply ice (the ‘I’) as quickly as possible. The ‘C’ stands for compression. Wrap the elbow immediately after an injury, and if the movement must later be repeated, it is crucial to wrap before-hand. Elevate (the E) the elbow equal to or above the heart when resting.

The RICE method is useful after an injury occurs. The best health measure is to prevent the injury from happening n the first place. Here are some examples of how to prevent tennis elbow from occurring.

• Use the larger muscle groups (upper arms, shoulders, back and chest) for movement. The larger muscle groups are naturally stronger than the wrists and can withstand more stress.
• Use a two-handed backhand when playing racquet sports
• Keep wrists locked during weight lifting movements
• Do not perform the same strength training routine with the same exercises for more than 12 weeks at a time.
• The forearms are a muscle just like the hamstrings, so they should be stretched before and after activity, remembering never to stretch a ‘cold’ muscle and performing a very light warm-up beforehand. A good forearm stretch is to clasp the hands in front of your face with palms together and fingers locked. Rotate the hands from the wrists clockwise, counter-clockwise, forward and back, and left to right, trying to use a large range of motion.

Rehabilitation/Available Treatments

Simple prevention techniques can eliminate tennis elbow if performed consistently for six months. If preventative measures are not enough and tennis elbow lingers, doctors may prescribe orthotics, corticosteroids and exercises. A more natural approach taken by many is Active Release Technique and/or acupuncture, along with the strengthening and stretching exercises. After preventative and healing measures are taken, rehabilitation exercises are the next step in treating tennis elbow. The goal is to strengthen the forearm and wrist muscles. Exercises include the wrist extension, flexion, pronation/supination, finger extension and ball squeeze. Each exercise should be consist of 3 sets of 10 to 15 repetitions and completed 3 times per week. The wrist extension, flexion, and pronation/supination are performed in a seated position. For the wrist extension, place a relatively light weight in the hand. Place the elbow on the thigh. The wrist should be on the knee and the hand is hanging off /over the knee. The palm should be facing the floor. Gently bend the wrist, raising the knuckles towards the ceiling.

The wrist flexion is the exact opposite of the extension. Instead of having the knuckles towards the ceiling, place the hand with the palm facing the ceiling. Now lift the palm toward the ceiling, bending only at the wrist. The wrist pronation/supination is completed in the same seated position with the hand hanging off the knee. This time, hold a wrench or hammer in the hand. Hold the hammer completely vertical. Now rotate the wrist so the hammer is parallel to the floor to the left. Rotate the wrist again until the hammer is parallel to the floor to the right.

The finger extension is performed with a rubber band. Spread the band around all five fingers. Spread the fingers as far apart as possible. The ball squeeze is the opposite of the finger extension. Place a tennis ball in the hand and squeeze it as hard as possible.

The next tennis elbow treatment is orthotics. Orthotics are braces or straps to be worn on the arm just below the elbow or over the elbow itself. When the orthotics are worn during exercise, the compression helps increase comfort while performing possibly aggravating movements. Wearing the orthotics after activity can help reduce inflammation. The majority of the orthotics are made of nylon or neoprene. Some may even have pads to further protect the elbow.

The second-to-last treatment option is corticosteroids. Corticosteroids are a topical cream or an injection of a special type of inflammation reducing steroid. The idea is to reduce inflammation (pain, swelling, burning and redness). Injections have been found to be more beneficial than topical creams. Corticosteroids work by helping prevent inflammation. Before taking, ask your doctor about the numerous side effects of short-term and long-term use of corticosteroids.

Only 5 to 10% of tennis elbow cases require surgery. A surgical procedure should always be the last possible solution and performed only if the injury is seriously hindering lifestyle. The surgeon treating tennis elbow, in most cases, cuts the tendon to release pressure and removes damaged tissue within the tendon itself. In some cases, tennis elbow is caused by tears in the tendon. The surgeon can then sew the tears together. The cost for not losing any tissue is a longer recovery period, including extra long immobilization time. Again, ART is in the vast majority of cases a much better choice of treatment.

If you think you may be dealing with a case of tennis elbow, or you want to avoid it, talk to your tennis pro or a personal trainer at the club, and they can help with both preventive and rehabilitation strategies.