Tennis elbow, or Lateral Epicondylitis, is an overuse injury affecting the tendons that connect the forearm muscles to the outside of the elbow. In tennis, this injury typically arises from the repetitive strain of gripping the racket and extending the wrist, particularly during the backhand stroke or when hitting the ball off-center. This stress causes microscopic tears and degeneration in the tendon, most often the Extensor Carpi Radialis Brevis (ECRB) tendon, leading to pain and a weakened grip. Although named for the sport, managing this injury is a direct challenge for players seeking to stay on the court.
Assessing Pain: The Decision to Play or Rest
The decision to continue playing tennis depends on the severity of the pain experienced, though professional medical advice should always be sought for a definitive diagnosis. If the pain is mild, presenting as a general ache that appears only during play but quickly disappears afterward, it may be possible to continue with significant modifications. This mild discomfort suggests the tendon is irritated but not acutely damaged, allowing for play while focusing on technique and equipment changes to minimize further strain. Ignoring mild pain, however, risks progressing the injury.
Moderate pain signals a more significant issue, manifesting as discomfort during simple daily activities like gripping a coffee cup, or sharp, lingering pain during and after a tennis session. Playing through this level of pain is discouraged because it can transform an acute, manageable problem into a chronic condition. At this stage, a period of rest or greatly reduced activity is recommended to prevent the micro-tears from worsening.
Severe pain involves constant discomfort, an inability to grip objects, or pain that disrupts sleep. This requires the immediate cessation of all tennis and a prompt consultation with a physical therapist or physician. Continuing to play with severe symptoms guarantees further damage to the tendon structure, significantly prolonging recovery time.
Adjusting Your Game: Equipment and Technique Modifications
Players with mild symptoms who wish to continue must implement specific equipment changes designed to reduce the shock and vibration transmitted to the elbow. Increasing the grip size on the racket is an effective modification, as a larger grip encourages the wrist muscles to relax, reducing the required forearm muscle activation. Switching to a racket with a lower stiffness rating, meaning a more flexible frame, can also help dampen impact shock.
Equipment Modifications
Reducing impact further involves optimizing the string setup. Lowering the string tension creates a larger sweet spot and allows the string bed to absorb more energy upon contact. Using softer strings, such as natural gut or a multifilament synthetic, rather than stiff polyester, is also beneficial for shock absorption. These changes collectively lessen the load on the ECRB tendon with every ball strike.
Technique Adjustments
Technique adjustments are equally important for minimizing stress on the injured tendon. Players should avoid excessive wrist snap or flick at the point of contact, as this movement overloads the strained extensor muscles. Instead, focus on generating power through proper body rotation and a longer, more complete follow-through. Adopting a two-handed backhand, if possible, is highly effective, as the non-dominant arm absorbs a substantial amount of the impact force.
Prioritizing slice shots over heavy topspin on the backhand can also reduce strain, as the slice technique naturally involves less wrist extension at impact. Supportive gear like a counterforce brace or strap can be worn just below the elbow to provide temporary relief. This device works by compressing the forearm muscles, redirecting the forces away from the painful tendon insertion point.
Treatment and Rehabilitation Protocols
When playing is not an option, a structured rehabilitation program is necessary for tendon repair. Initial management often involves the RICE principle: Rest from the aggravating activity and applying Ice to the lateral elbow to manage inflammation. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may be used temporarily to alleviate pain, but they do not address the underlying tendon degeneration.
The cornerstone of long-term recovery is a physical therapy program centered on eccentric exercises. These exercises involve strengthening the muscle while it is lengthening under load. For example, the slow, controlled lowering phase of a wrist extension exercise stimulates the tendon to remodel and build strength. These movements are effective for promoting collagen synthesis within the degenerated tendon tissue.
Stretching the forearm extensor muscles is also important for restoring flexibility and reducing chronic tension in the muscle-tendon unit. Consistent adherence to these protocols helps ensure the repaired tendon can tolerate the high loads of tennis activity. For persistent cases, a healthcare provider might consider corticosteroid injections, though these are typically viewed as a short-term solution for pain relief.