PATIENT ADVICE Rehabilitation of tennis elbow

What is it? Tennis elbow (lateral epicondylitis) is an inflammation of the outer elbow where the tendon attaches to the bone. It is caused by the repetitive movements and the gripping actions common in tennis hence the term ‘tennis’ elbow however it may also occur in other sports requiring gripping actions.

Factors contributing to tennis elbow: Age 30+ Frequency of play Force and flexibility of forearm extensors ie. tightness of grip Unskilled players are more prone Racket factors ie. weight, string tension, grip size and cushioning, head size Older balls Single handed backhand Poor technique

Prevention There are modifications you can make to your tennis equipment to help reduce the chance of your tennis elbow injury recurring. Using the initials of Britain’s top tennis player to help you remember these changes.

Try a lighter racket Increase grip size Maybe use string vibration dampers

Have the string tension reduced Ensure larger racket head size Newer balls to play with More flexible shaft needed Allow balls to dry out if you have played in wet weather New, softer grip material

When you think you have tennis elbow: 1. Do not return to the activity responsible until you have sought medical advice.

2. Ice the elbow using a bag of peas or ice pack wrapped in a damp towel. Apply the ice over the affected area for five min- utes. Repeat every 15 minutes if possible.

3. Take a full dose of anti-inflammatory medication such as Nurofen available from your chemist. Take for one week then as required (provided you have no allergies or gastric irritation from these type of pills).

4. Attend your nearest sports injury clinic for further early treat- ment. You will be asked to do regular stretching exercises (see below) and it may be worthwhile obtaining a wrist/forearm splint to help rest the inflamed tendon.

5. Physiotherapy/osteopathy/chiropractic can all help in the first instance.

6. Injections should be considered if you have already undergone a full course of treatment to no avail. In this instance you are more likely to obtain a longer lasting result from injection.

7. Surgery can be carried out under local injection (subcutaneous tenotomy) with a 95% success rate and no deficiency in grip strength. (Scar almost invisible).

Rehabilitation Correct faulty technique Correct shoulder movements Pilates approach to trunkal stability Maintain muscle strength around the shoulder (rotator cuff) Strength exercises for forearm Start specific resistance work

Exercises Specific stretching and strengthening exercises can help but seek medical advice before attempting them.

Stretching Exercise one 1. Hold affected wrist as shown 2. Bend the wrist until you feel a stretch in the forearm

3. Hold for 5-10 seconds 4. Do 10 repetitions twice a day

Exercise two 1. Hold affected wrist, as shown

2. Bend the wrist until you feel a stretch 3. Hold for 5-10 seconds

4. Do 10 repetitions twice a day

Strengthening Exercise one 1. Squeeze a squash ball, hold for three seconds and release

2. Do this 20 times per day. 3. This exercise must be done with the back of the hand in align- ment with the forearm

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for special- ist medical advice in each individual case. To the extent permissable by law, the publisher, editors and contributors accept no liability for any loss, injury or damage howsoever incurred (including negli- gence) as a consequence, whether directly or indirectly, of the use of any person of the contents of this article.

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