Tennis elbow (Lateral Epicondylitis) is a painful condition affecting the tendons on the outer side of the elbow joint. It arises from the repetitive stress and overuse of the forearm muscles, specifically the extensor carpi radialis brevis (ECRB) tendon. Activities involving repeated gripping, twisting, or wrist extension exacerbate the micro-tears and degenerative changes in this tendon, making tennis players susceptible. Continuing to play requires a careful assessment of the injury’s severity and the potential for long-term harm.
Assessing the Risk of Continued Play
The decision to play depends on the intensity and character of the pain. Sharp, shooting, or acute pain indicates active tendon damage and requires immediate cessation of the activity. Ignoring this risks turning a manageable issue into a chronic degenerative condition (tendinosis), which is significantly harder to resolve.
If discomfort is mild, manageable, and does not progress during or immediately after hitting balls, cautious, modified play might be considered. A practical “pain threshold test” involves monitoring the pain level 24 hours following a session. If the pain is noticeably worse the next morning, the activity level was too high, and play should be reduced or stopped. Continuing to load a compromised tendon delays healing and leads to a longer recovery. Avoid any activity that causes a significant spike in pain above a level two or three on a ten-point scale.
Equipment and Technique Adjustments for the Court
Players continuing with modified play should focus on equipment changes that minimize shock transmission and reduce forearm load. Increasing the grip size is effective, as it prevents over-squeezing the handle and reduces muscle tension. A grip that is too small forces the hand to work harder, directly straining the extensor tendons.
Lowering the string tension increases the ball’s dwell time, providing a larger sweet spot and absorbing more impact shock. Using a softer, more flexible racket frame also helps dissipate vibrations. These adjustments lessen the sudden jolt the forearm muscles must counteract upon impact.
Technique adjustments are equally important for reducing elbow strain. Players should generate power from the body’s larger muscle groups—the legs, core, and shoulder—utilizing a connected “kinetic chain” to drive the swing. This prevents over-reliance on the smaller muscles of the wrist and forearm for shot velocity. Adopting a two-handed backhand is often recommended, as the non-dominant arm absorbs significant impact energy, reducing stress on the injured elbow.
Comprehensive Treatment and Rehabilitation
True recovery necessitates a dedicated rehabilitation protocol beyond modifying play. Relative rest is the foundation of treatment, requiring a temporary reduction in all aggravating activities, including non-tennis tasks like lifting or forceful gripping. This initial phase allows the micro-trauma in the ECRB tendon to begin healing without constant re-injury.
Physical therapy, focusing on eccentric exercises, is the gold standard for long-term recovery. These exercises involve lengthening the muscle while under tension, stimulating the tendon to adapt and rebuild its structure. A standard regimen involves the slow, controlled lowering of a light weight, such as a one-to-three-pound dumbbell, with the wrist in extension.
Supportive measures, such as wearing a counterforce forearm brace, provide temporary relief by compressing the forearm muscles below the elbow, lessening tension on the tendon attachment point. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may briefly manage acute pain, but this should be discussed with a healthcare professional. A full return to regular tennis should only occur once daily activities are consistently pain-free and strengthening protocols are complete, ensuring the tendon can handle the game’s loads.