TENNIS ELBOW
by: Dr. Darrell M. Schreyer, D.C.

Now that summer is here and we tend to play outside more often, a lot of new injuries present themselves to many of us. One of the most common and most painful of these conditions is "tennis elbow", otherwise known as lateral epicondylitis. This is an overuse injury caused by repeated and forceful elbow extension combined with sharp twisting of the wrist. The term "tennis elbow" is a misnomer. Even though it is estimated to occur in 30% of all tennis players, it is much more common in golfers, and also seen frequently in baseball pitchers, badminton players, and manual laborers.

The symptoms of "tennis elbow" include pain over the outside of the elbow that can continue down the forearm. Pain can become very sharp with exertion, but otherwise remains dull, aching and constant. The grip strength of the individual will become weakened and squeezing objects with the fingers is often painful. A point of local tenderness can be felt 1/2" to 1" below the bony protuberance on the outside of the back of the elbow, this is called the lateral epicondyle. This is the area in which the forearm flexors and extensors all attach to the elbow joint. Along with this tenderness, other clinical signs can be heat and swelling in the area of injury.

In tennis, improper technique, poor or no warm up, and a racquet that is inappropriate for the level of play are contributing factors to this injury. In baseball, pitchers who begin throwing curve balls at too early an age are especially vulnerable. In manual laborers, such as carpenters and electricians, "tennis elbow" is caused by constant twisting and extension of the wrist and elbow produced while using tools such as a hammer or screwdriver.

As a Doctor of Chiropractic and also trained in physical therapy, I would approach the treatment of "tennis elbow" conservatively. An examination of the elbow is performed to determine the correct diagnosis. X-rays are produced and analyzed if there is the possibility of the ligament that joins the muscle to bone may be starting to become bone itself. If the bones that make up the elbow joint where found to be functioning improperly, the bones would be moved back to the correct position by a Chiropractic "adjustment". This misalignment is detected and treated in approximately 40% of cases seen.

If there are no bio mechanical problems with the bones of the elbow joint, the ligaments and muscles are treated next. Management can include slings, rest, ice, or a brace worn just below the elbow, depending on the severity of the injury. Physical therapy can include therapeutic ultrasound, diathermy, and transverse friction massage across the painful area. The medical approach usually includes anti-inflammatory agents, pain controlling drugs, and even casting or surgery if the problem progresses far enough.

The serious athlete or the weekend warrior all want to return to their activity as soon as possible. The most frustrating part of "tennis elbow" is that a return to activity immediately upon loss of pain invites recurrence. This usually starts the healing phase over again from the beginning, frustrating both patient and doctor. However, proper treatment and rest can restore the elbow to pain free activity.

For anyone who has any of the signs or symptoms discussed here, it is best to seek out advice from a trainer, a tennis or golf instructor, or a professionally trained sports physician. Have them determine if you have this problem and what the best way to resolve it would be. Discover and treat the problem early, when the pain just starts, and the healing time will be much quicker.