Despite its name, tennis elbow does not occur only in tennis players. Rather, it is due to tendinopathy (chronic tendon changes) of the extensor carpi radialis brevis (ECRB) tendon and it usually occurs due to repetitive elbow and wrist motions. 

Males and females are equally affected by this condition and it is commonly found in persons aged 30 to 50 years of age," Dr Xu added.

What causes tennis elbow?

The name ‘tennis elbow’ arose because it has been a common affliction amongst tennis players. In fact, this is a common sports injury amongst individuals who play racquet sports in general.

This may be due to various reasons, including playing with an improper grip, hitting heavy balls, or playing on hard courts, which require you to exert more strength and strains your elbow tendons.

You might now be thinking - I don’t even play sports. How did I get a sports injury?

Tennis elbow can also happen to anyone who strains their arm in a similar way. There are two main reasons for why you might have gotten tennis elbow:

1. Forceful impact or trauma to your elbow (like when you hit your elbow hard on something), causing injury.

2. Repeated straining of the elbow tendons from other kinds of activities or using tools. Straining happens when you have repeated, forceful use of the forearm and wrist, which causes overuse of the tendon at the elbow.

These factors increase your risk of injuring or straining your elbow tendons:

• Physical activity: Your daily work involves frequent, repetitive motions, like operating equipment (F&B, healthcare, and cleaning), working on equipment (automotive industry, technicians, and engineers), using tools (knives, shears, screwdrivers, scissors), playing instruments, typing, sewing, cleaning, and decorating.

• Age: You are over 40. As time passes, your tendons may degenerate with age and may develop tears.

4 Tips to prevent tennis elbow

1. Strengthen your arms

Strong arms are important to prevent straining your tendons and joints. 

Arm strengthening exercises can strengthen your muscles and improve movement control and maximise the range of motion in your muscles for better flexibility. Your muscles can then adapt more easily to repetitive movements and use. Strong muscles also prevent excessive tension.

To help prevent tennis elbow, you may try the following exercises:

Forearm stretch: Keep your elbow straight, use one hand to bend the wrist such that your palm faces you. Hold for 20 seconds, repeat for 3 sets.

Wrist curls: Hold a light weight in your hand, sit with your forearm resting on a table, and slowly curl your wrist up and down. Perform 10 repetitions for 3 sets.

Forearm rotations: Hold a light weight in your hand, sit with your forearm resting on a table, slowly rotate your hand clockwise and anti-clockwise. Perform 10 repetitions for 3 sets.

Do consult your doctor or physiotherapist about other exercises that may be suitable for you.

2. Practise proper sports technique

Exercising regularly is great for arm strength, but make sure you do it with the right techniques to avoid injuries.

If you play tennis, learn proper playing techniques from a qualified tennis coach.

For other sports where you need to do repeated, forceful hand movements, get sport equipment that’s suited to your arm strength and grip strength. 

An appropriately sized racket grip will reduce excessive stress on your forearms and reduce the chances of suffering from an overuse injury. 

This is essential if you play racquet sports and frequently use a backhanded technique to play.

3. Get lightweight tools and use them properly

If you need to work with heavy tools regularly (e.g. in F&B or engineering), try not to put too much strain on your wrist and elbow while using them. Instead, use your whole arm. This can help spread the weight across your entire arm and lessen the tension on your elbow and forearm.

The choice of tool is also important – avoid using heavy tools as much as possible. Get lightweight, ergonomic tools that reduce the strain on your forearm muscles.

Also, remember to take frequent breaks so you don’t injure your arm.

4. Warm up properly before exercise

Warming up and stretching before playing sports helps your arm muscles adjust faster to repetitive arm movements.

Warm-ups slowly increase blood flow to your muscles. Simple stretches can improve the flexibility of muscles and joints, improving movement patterns. This can better prepare you for any strenuous task that follows, reducing the risk of injury.

Symptoms of tennis elbow

Tennis elbow symptoms include:

• Elbow joint pain and tenderness.

• Forearm pain (you might feel the pain radiating from your elbow down to your forearm).

• Weak grip strength (for example, you might not be able to hold a bottle firmly).

• Pain may initially happen only during the activity (meaning that you only feel pain when using the forearm or gripping and turning things), but it can worsen over time and become constant.

How is tennis elbow diagnosed?

Your doctor will assess your symptoms before making a diagnosis. They might do a physical check (move your arm or press your elbow to check for pain). 

An increasingly common diagnostic tool is a bedside ultrasound examination. This helps the doctor to visualise the structure and health of the tendons. X-rays may be ordered to assess the condition of the underlying bone and joints of the elbow.

You may also need an MRI and nerve studies (different types of scans) to check for other medical conditions which mimic tennis elbow and cause the pain. 

Don’t worry about these for now, your doctor will tell you more about it, if needed.

Tennis elbow treatment 

Treatment for tennis elbow includes physical therapy, tennis elbow exercises, and pain relief techniques.

1. Physical therapy

Physical therapy is a mainstay in the treatment of tennis elbow. During physical therapy, a trained physiotherapist will recommend exercises and stretches to help you build arm muscle strength and flexibility.

Exercises may involve exercise aids like bottles of water and exercise bands. These exercises aim to train strength, control, and flexibility of the forearm muscle and tendons.

2. Ice packs

Ice packs or a cold compress can reduce pain and inflammation. Wrap an ice pack or some ice cubes in a towel and hold it against your elbow for 10 minutes every 3 to 4 hours (around 4 times a day). Repeat this for a few days.

Note: Do not press the ice pack directly on your skin. Always wrap it in a towel first.

3. Wear a brace or splint

A tennis elbow brace can reduce tension on the affected tendon during daily/strenuous activity, thereby facilitating healing and reduction in pain.

How long to wear a tennis elbow brace? About 4 to 6 weeks, or as instructed by your doctor.

4. Painkillers

As tennis elbow can be a disabling condition, painkillers may be required in short courses occasionally to manage discomfort, and to facilitate physiotherapy exercises to be carried out.

For painkillers, you can also buy over-the-counter non-NSAIDS like paracetamol (Panadol).

Do ensure that you take these medications as minimally as possible, and as per labelled instructions. Follow your doctor’s instructions if you need to take prescription painkillers.

5. Activity or equipment modification

If your tennis elbow is due to straining from an activity, your doctor or physiotherapist may check your playing technique, work routine, or equipment to see what’s causing the issue.

They’ll recommend ways to reduce strain or correct your technique to prevent further injury. If your equipment is causing the problem, they may suggest ergonomic alternatives.

• Tennis or other racquet sports: Your racquet should be of the appropriate size to prevent straining from excessive gripping.

• Tools: At work, you may need to wear a tennis elbow strap and switch to using automatic or power tools instead of manual tools.

6. Extracorporeal shockwave therapy

You might undergo extracorporeal shock wave therapy administered by your doctor. It is non-invasive (no surgery needed), relieves pain and promotes natural healing. 

Shockwave therapy can result in immediate short-term reduction in pain and sensitivity by overstimulating pain-transmitting nerve endings. 

Over a longer term of three to six months, shockwave can facilitate improvement of symptoms by facilitating healing of the injured tendon. 

This happens as a result of triggering the body’s repair mechanism through the local release of growth factors.

7. PRP (platelet-rich plasma) injections

Depending on the severity of the condition and treatments attempted previously, your doctor may recommend PRP (platelet-rich plasma) injections.

Your doctor will inject a dose of PRP into the affected area to trigger your body’s natural healing process, facilitating tissue recovery and reducing pain. The effectiveness of PRP is not immediate. It may take up to a few months for full treatment effect.

Tennis elbow happens because of repeated strain over a period. Use proper playing or working techniques when doing sports or using tools, to prevent elbow tendon injury.

Ref: H24

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