Now that warm weather is here to stay, many
Americans are getting back into their favorite outdoor sports and starting home
projects.
Which means, among other things, the annual uptick in tennis
elbow.
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It starts with a persistent, localized pain on the outside
of your elbow (or inside, in the case of the closely related golf elbow), and
slowly gets more debilitating. It can happen to you even if you’ve never picked
up a racket or club.
Although up to 50 percent of tennis players develop it each
year, lateral epicondylitis, as it’s known to experts, is one of the most common
upper-body repetitive stress injuries.
Causes run the gamut but may include using a hammer for
extended periods of time, painting, softball, weightlifting, and even
gardening. Or it could be a combination of triggers.
Research shows that people older than 40 are most
susceptible, as are smokers, people with obesity and those who engage in
repetitive motion for at least two hours a day. If you suspect that you’re
dealing with tennis or golf elbow, there are ways to heal, return to activity
and hopefully keep the pain at bay in the future.
What is tennis elbow?
Both tennis and golf elbow are overuse injuries that stem
from damage to the muscles and tendons running from the wrist to the elbow. If
used too much, and if you do not have enough strength in your shoulder muscles
and core, microscopic tears can develop in the tendon where it attaches to the
elbow, causing both pain and inflammation.
The first sign that you might have the condition is pain
near the elbow, said Theresa Marko, a doctor of physical therapy based in New
York City and a spokesperson for the American Physical Therapy Association.
“You might also feel a tightness in your forearm muscles,” she said. “Sometimes
you’ll feel a clicking or a ‘catching’ sensation, or you can’t straighten your
elbow entirely.”
Pain was Melanie Madden’s first indication that something
was amiss two years ago. “I had been playing tennis for about three months when
I first noticed it,” said the 45-year-old real estate agent from Boulder,
Colorado.
“At the time, I had a
new dog and was frequently throwing the ball for him, practicing yoga and
playing some golf. I kind of ignored the pain and hoped for the best.”
Before long, the pain was waking up Madden in the middle of
the night, and it hurt to pick up a cup of coffee.
How do you treat it?Managing the condition when it starts can shorten the time
it takes to overcome the pain. “It can be a stubborn injury,” said Dr. Marci
Goolsby, a sports medicine physician and director of the Women’s Sports
Medicine Center at the Hospital for Special Surgery in New York.
The first lines of defense against golf or tennis elbow
should be to identify the activities causing it. “If you’ve had a sudden
increase in your pickleball play, for instance, scale back,” Marko said. If you
catch it early enough, reducing the time spent on the aggravating injury may be
enough. If not, stop it altogether until you’ve made progress with rehab
exercises.
This can be tricky because many simple daily activities —
time on a phone, household chores such as sweeping, sewing or even washing
dishes — can aggravate the injury.
Next, experts recommend icing and anti-inflammatories and
wearing a “tennis elbow” strap, which provides compression at the point of pain
(although some studies have found that the effect may be psychological).
Some experts also suggest a wrist-immobilization brace for
severe pain, as it prevents you from extending your wrist in the manner that
causes pain at the elbow. You can also try to gently massage on the top of the
forearm, with hand facing down, 2 to 3 centimeters below the elbow, Marko said.
Work those shouldersIn most cases, the root of the problem, however, is a lack
of strength in your shoulder area, she said. “Right away, you can start doing
some shoulder and rotator-cuff exercises.”
One to try is shoulder external rotation: Lie on your
unaffected side, with a rolled-up towel resting between your upper arm and your
torso. Bending your top arm at the elbow, lower it toward your stomach and back
again, repeating 15 times for three sets.
You can also add in simple shoulder-blade squeezes while
standing or sitting, repeating 15 times for three sets. With time and as you
start to feel better, you can include weights or resistance bands.
“However, if the elbow is hurting, gripping a weight will be
painful,” Marko said. “What I do is place an ankle weight around a person’s
wrist and have them relax their hand as they perform the movements of the side-lying
exercises.”
From there, consider a full home-exercise program from the
American Academy of Orthopedic Surgeons.
If you’re not making progress, a physical therapist can
manually help loosen the joint and develop a personalized strengthening program.
They can also put your arm through motions to assess your readiness to return
to your sport or activity.
As you begin to heal, try testing your elbow in small
increments of your sport or activity, letting pain be your guide. In worst-case
scenarios — you’ve tried resting for several weeks and working with a physical
therapist — it’s worth a visit to an orthopedic specialist, said Dr. Robert
Parisien, an orthopedic surgeon at Mount Sinai Health System in New York City.
“Not because we’ll suggest surgery, but to consider other
treatments,” he said. “There’s about a 95 percent success rate with a
combination of treatments.”
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