Tennis Elbow is currently one of the most diagnosed conditions in the western world. It is extremely common, and can be excruciatingly painful.

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Augustus Sims
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43 Thames Street, St Albans, Christchurch 8013 Phone: (03) 356 1353. Website: philip-bayliss.com Tennis Elbow Tennis Elbow is currently one of the most diagnosed conditions in the western world.

The three most common conditions are "lateral epicondylitis" (tennis elbow), "medial epicondylitis" (golfers elbow), and medial collateral ligament sprain (throwers elbow).

1 43 Thames Street, St Albans, Christchurch 8013 Phone: (03) Website: philip-bayliss.com Tennis Elbow Tennis Elbow is currently one of the most diagnosed conditions in the western world. It is extremely common, and can be excruciatingly painful. There are a number of conditions that affect the elbow area. The three most common conditions are "lateral epicondylitis" (tennis elbow), "medial epicondylitis" (golfers elbow), and medial collateral ligament sprain (throwers elbow). The first two conditions are very similar, however the first effects the outside of the elbow (lateral), and the second effects the inside of the elbow (medial). For the purpose of this newsletter we'll stick with the treatment of lateral epicondylitis, or as it is more commonly known, tennis elbow. Anatomy of the Elbow Before we can understand just what tennis elbow is, it's important to have a general understanding of the structure of the elbow joint, and how the muscles, tendons, ligaments and bones help the elbow joint to function. As you can see from the diagram to the right, there are many muscles and tendons that make up the elbow joint and forearm. The diagram shows the anterior (or

2 front) view of the forearm. The left picture shows the muscles and tendons closest to the surface of the skin, while the picture on the right shows some of the muscles and tendons deeper within the forearm. There are also three bones which make up the elbow joint. They are the "Humerus," the "Ulna" and the "Radius." Now that we can see how the elbow functions, lets look at what exactly tennis elbow is. What is Tennis Elbow? Tennis elbow occurs when there is damage to the muscles, tendons and ligaments around the elbow joint and forearm. Small tears, called micro tears, form in the tendons and muscles which control the movement of the forearm. They cause a restriction of movement, inflammation and pain. These micro tears eventually lead to the formation of scar tissue and calcium deposits. If untreated, this scar tissue and calcium deposits can put so much pressure on the muscles and nerves that they can cut off the blood flow and pinch the nerves responsible for controlling the muscles in the forearm. What Causes Tennis Elbow? By far the most common cause of tennis elbow is overuse. Any action which places a repetitive and prolonged strain on the forearm muscles, coupled with inadequate rest, will tend to strain and overwork those muscles. There are also many other causes, like a direct injury, such as a bump or fall onto the elbow. Poor technique will contribute to the condition, such as using ill-fitted equipment, like tennis racquets, golf clubs, work tools, etc. While poor levels of general fitness and conditioning will also contribute. Signs and Symptoms Pain is the most common and obvious symptom associated with tennis elbow. Pain is most often experienced on the outside of the upper forearm, but can also be experienced anywhere from the elbow joint to the wrist. Weakness, stiffness and a general restriction of movement are also quite common in sufferers of tennis elbow. Even tingling and numbness can be experienced. Exercises Stretching

Gentle stretching exercises including wrist flexion, extension and rotation. The elbow should be extended and not flexed to increase the amount of stretch as required.

Vigorous stretching should be avoided - do not stretch to the point of pain that reproduces your symptoms. Strengthening With the elbow bent and the wrist supported perform the following exercises: 1.

Raise wrist/hand up slowly (concentric contraction), and lower slowly (eccentric contraction). 2. Wrist Flexion. Place 1 lb.

3 Gentle stretching exercises including wrist flexion, extension and rotation. The elbow should be extended and not flexed to increase the amount of stretch as required. These stretches should be held for seconds and repeated 5-10 times, at least twice a day. Vigorous stretching should be avoided - do not stretch to the point of pain that reproduces your symptoms. Strengthening With the elbow bent and the wrist supported perform the following exercises: 1. Wrist Extension. Place 1 lb. weight in hand with palm facing downward (pronated); support forearm at the edge of a table or on your knee so that only your hand can move. Raise wrist/hand up slowly (concentric contraction), and lower slowly (eccentric contraction). 2. Wrist Flexion. Place 1 lb. weight in hand with palm facing upward (supinated); support forearm at the edge of a table or on your knee so that only your hand can move. Bend wrist up slowly (concentric), and then lower slowly (eccentric)(similar to exercise above). 3. Combined Flexion/Extension. Attach one end of a string to a cut broom stick or similar device; attach the other end to a weight. In standing, extend your arms and elbows straight out in front of you. Roll the weight up from the ground by turning

Extensors are worked with the palms facing downward. 4.

Grasp hammer (wrench, or some similar device) in hand

Rotate hand to palm down position, return to start

4 the wrists. Flexors are worked with the palms facing upward. Extensors are worked with the palms facing downward. 4. Forearm Pronation/Supination. Grasp hammer (wrench, or some similar device) in hand with forearm supported. Rotate hand to palm down position, return to start position (hammer perpendicular to floor), rotate to palm up position, repeat. To increase or decrease resistance, by move hand farther away or closer towards the head of the hammer.

5 5. Finger Extension. Place a rubber band around all five finger tips. Spread fingers 25 times, repeat 3 times. If resistance is not enough, add a second rubber band or use a rubber band of greater thickness which will provide more resistance. 6. Ball Squeeze. Place rubber ball or tennis ball in palm of hand, squeeze 25 times, repeat 3 times. If pain is reproduced squeeze a folded sponge or piece of foam. For all of the exercises (except combined flexion\extension) perform 10 repetitions 3-5 times a day. With the combined flexion/extension perform until you feel fatigue. With all exercises use pain as your guide - all exercises should be pain free. When to progress. Begin with a 1 lb. weight and perform 3 sets of 10 repetitions. When this becomes easy, work up to 15 repetitions. Increase the weight only when you can complete 15 repetitions 3 times without difficulty. The axiom "No Pain No Gain" does NOT apply here. After exercising, massage across the area of tenderness with an ice cube for about 5 minutes. You might also try filling a paper cup half-full with water and freeze; peel back a portion of the paper cup to expose the ice. In order to improve muscular strength and endurance, maintain and improve flexibility, and gradually return to prior level of sport or high level activity: continue the stretching and strengthening exercises emphasizing the eccentric contractions of wrist flexion and extension. In this regard, since the eccentric contractions are movements with gravity, do not let the weight drop too quickly; lower the weight in a controlled fashion. With the combined wrist flexion/extension exercise, work on increasing speed when rolling up the string with the attached weight as this will improve endurance. When your symptoms are resolved and have regained full range of motion and strength, you may gradually increase your level of playing activity. An example of one gradual progressive return to tennis is as follows:

Bracing Lateral counter-force bracing is believed to reduce the magnitude of muscle contraction which in turn reduces the degree of muscle tension in the region of muscular attachment.

6 Bracing Lateral counter-force bracing is believed to reduce the magnitude of muscle contraction which in turn reduces the degree of muscle tension in the region of muscular attachment. The counter-force brace is essentially an inelastic cuff that is worn around the proximal (near) forearm (against the forearm extensors for lateral epicondylitis and around the forearm flexors for medial epicondylitis). In theory, the brace constrains full muscle expansion when the muscle contracts, diminishes muscle activity, and therefore the force generated by the muscle. An analogy is the fret on a guitar; when you exert pressure on a different fret along the neck of the guitar, it changes and reduces the tension on the guitar string above where the pressure is exerted. The counter-force brace can be worn beginning in Phase 2 of your rehabilitation program. However, adhere to the following caution: do not become dependent on the counter-force brace and gradually wean yourself off its use during Phase 3. Counterforce bracing is a supplement to, not a replacement for your rehabilitation program. Equipment Modifications Using the wrong tennis racquet may have been a contributing factor to your injury. Guidelines for racquet selection for non-tournament players are provided below. 1. Racquet material - Graphite composites are currently considered the best in terms of torsion and vibration control. 2. Head size - A midsize racquet ( square inches) is preferred. The popular oversized racquets cause problems because they make the arm susceptible to injury due to the increased torque effect of shots hit off-center. 3. String tension - stay at the lower end of the manufacturer's recommendation. While higher string tensions provide improved ball control, it also increases the torque and vibration experienced by the arm. 4. Stringing material - synthetic nylon (re-string every 6 months).

7 5. Grip size - A grip too large or too small lessens control and promotes excessive wrist movement.

PRPLE. Lateral Epicondylitis (Tennis Elbow)

PRPLE. Lateral Epicondylitis (Tennis Elbow) PRPLE Lateral Epicondylitis (Tennis Elbow) What is Tennis Elbow? Chronic lateral epicondylopathy (tennis elbow) is an overuse injury to the tendons/muscles on the outside (lateral) aspect of the elbow.