REHABILITATION FOCUS TENNIS ELBOW

AN INTEGRAL APPROACH

By Dr Simon Petrides, MB, BS, DO, Dip.Sp.Med

First described by Runge in 1873 (1) lat- eral epicondylitis affects 40-50% of recre- ational tennis players, mostly over the age of 30. It can be responsible for months or even years taken away from tennis in the vain hope of a cure by rest alone. Unfortunately, rest alone is rarely helpful.

Factors contributing to tennis elbow 1. Age 30+ 2. Frequency of play 3. Force and flexibility of forearm exten- sors ie. grip tightness

4. Unskilled players are more prone (2) 5. Racket factors ie. weight, string ten- sion, grip size and cushioning, head size

6. Older balls 7. Single handed backhand 8. Poor technique.

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Backhand technique This is perhaps the most important aspect to address in ascertaining the cause of lateral epicondylitis and in preventing recurrence.

Faults include: a) Poor body position ready for stroke (ball contact should be out in front)

b) Leading elbow c) Dropped racket head d) Opening up too early - ie. premature trunk rotation

e) Using tennis for fitness conditioning f) Perception of tennis as an upper body sport.

The single handed backhand uses a long fulcrum and consequently increases forces at the elbow. It is also associated with a greater incidence of tennis elbow than the ‘double handed’ backhand (3).

In the ‘one handed topspin backhand

drive’ six body movements/positions should be addressed: 1. Step toward ball 2. Hip turn and transfer of momentum 3. Trunk rotation 4. Upper arm movement about the shoulder

5. Slight forearm movement 6. Hand and racket position.

In tennis elbow sufferers, the co-ordinated sequencing of these movements is often aberrant and results in greater load on the elbow. In unskilled players, the ball strike is more frequently off the ‘sweet spot’ causing more vibration, shock and twisting momentum of the frame in the hand.

Racket vibration Striking off the sweet spot causes a larger amplitude of oscillation and vibration. A stiffer racket will have lower amplitudes of vibration which is why graphite is a popu- lar material for racket manufacture. With