Vivian Grisogono

Tennis elbow exercises

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Exercises recommended for tennis elbow?
Q: Maybe you could suggest a rehab exercise for the dreaded tennis elbow for my partner. She thinks she's acquired it from a 'body pump' class- lifting small weights palms down as an extended arm 'raise' routine. I realise it's one of the most persistent problems- I've been very lucky having played squash for 30 years without suffering it. (Your name always occurs in injury situations, I used your Self Help book to great effect during the 'Barrington' era- many thanks!).
MB male, UK

A: Many thanks for your e-mail. I'm very glad my Sports Injuries self-help book has been helpful to you.

Tennis elbow is rather a vague definition: it is usually used as the term for a strain in the common extensor tendon, just above the outer side of the elbow. The most common cause of tennis elbow is gripping, which is of course why it's most commonly associated with racket sports. Most often it's caused by a problem with the racket: the grip might be too large or narrow, the racket might be head-heavy, or the strings might be too tight, for instance. Of course the injury can occur through other causes, such as using a power drill or carrying heavy bags at an awkward angle. Doing lateral arm raises gripping weights can cause the problem, if your partner was gripping too hard, or doing the exercise for too long (which means longer than her arm muscles could cope with).

It's important to realise that elbow pain can be referred from further up the system of joints, from the shoulder region, neck or upper back. Referred pain can create symptoms in the tennis elbow region which feel just like a tendon strain. Sometimes the problem is a combination of a strained common extensor tendon and referred pain. This is especially likely to be the case if the problem affects both elbows. In females it is relatively common for referred symptoms to be complicated or even caused by hormonal changes, especially at the menopause, also after giving birth.

Tennis elbow causes pain in a small spot to the outer side of the elbow, which is usually tender if prodded or even touched lightly. The pain can be reproduced on gripping: one can test this by gripping a narrow object, then a wide object, once with the arm held close to the body and elbow bent to a right angle, and then with the arm stretched straight out in front of the body.

So it's also necessary to check whether the shoulders are fully mobile. One test is to lie on one's back and lift both arms above the head, with the elbows straight. The stiffer the shoulders, the further away the arms will be from the bed or surface one is lying on. One way to check for stiffness in the upper back muscles is for the person to lie prone (on the stomach), while someone presses down the line of muscles and small joints between the spine and the inner edge of the shoulder blade to identify any tightness and tender spots.

Of course it's best to visit a practitioner and have the diagnosis and treatment / recovery process established professionally.

Simple non-invasive self-help measures include ice for the outer edge of the elbow, such as massage with an ice cube for 30 seconds to a minute, repeated a couple of times a day, or more if it is really helpful. To stretch the common extensor tendon and the forearm extensor muscles, you need to hold the affected arm in front of you, elbow slightly bent, fist gently closed and palm down; press the back of the hand downwards, without force and avoiding any pain, so that you can see the tendons on the back of the forearm going into the stretch; hold the position for a count of five, then relax completely. Repeat the stretch two or three times,  as often as possible during the day.

Whether or not the shoulder and upper body are directly involved in the problem, it's wise to include protective exercises for those areas too, to avoid complications. For the upper back, one can lie on the stomach arms by the sides, and lift the head and shoulders a little way upwards (backwards), bracing the shoulders gently back together; hold for a count of two, then lower the body and relax completely. This can be done ten to twenty times, once or twice a day. The shoulders should be kept mobile by lifting and circling them in the air freely about twenty times, once or twice a day. If they do not have full freedom of rotation, one can help that by trying to touch the fingers together behind the back with one arm held above the head, the other reaching up behind the back. This can be done five to ten times each side, as often as possible. If your partner attends a gym, the lats pull-down exercise, done with light weights, is invaluable, doing one to five sets of up to fifteen repetitions.

Obviously all painful movements or activities should be avoided until the problem is fully healed.