Australian Open Special: Tennis Elbow in Athletes
The 2018 edition of the Australian Open tennis is nearing its wrap up, with the men's and women's semi finals beginning today. What better way to honour the occasion than by a blog focussing on tennis elbow?
The curious thing is, tennis elbow is absolutely not an injury isolated to tennis players, with only 5% of athletes reporting tennis elbow from tennis! Long term struggles have been documented by various athletes in various sporting codes - cricketing great Sachin Tendulkar is a great example, having struggled for years with tennis elbow:
What Is Tennis Elbow?
Before I get too distracted and start talking about Tendulkar's crazy batting stats, I think it's a good idea for us to understand what tennis elbow even is!
The technical term for tennis elbow is lateral epicondylalgia (can you see why we prefer to just say tennis elbow?). The reason it is called this, is purely down to the anatomy of the elbow:
When looking at the above diagram, don't get too caught up learning about the indivdiual muscles involved. Rather, you can see and appreciate that the muscles above all have a common movement that they are a part of - wrist extension.
Wrist extension (when you move the wrist up towards your elbow), causes all these muscles to shorten, with increased pulling force going through the muscle tendon which attaches into the lateral epicondyle of the humerus bone.
When you begin to consider repetitive sporting movements such as batting in cricket, tennis' forehand and backhand and the golf swing, you can see how continually using these muscles and pulling on the tendon can begin to irritate the elbow.
Most of us have had tennis elbow pain in some form for at least a short period of time - I know personally if I played squash this afternoon I would have quite bad tennis elbow for the next few days - unfortunately for a lot of people this injury can become quite a persistent long term problem.
The Problem Is, There Is More Than One Problem
One of the most difficult things about treating tennis elbow is the variety of causes that the pain may be coming from. On one hand, you have overuse of the muscles causing the tendon to get microscopic tears and start to degenerate. However, studies have also shown that the muscles involved have a decreased blood flow which may be another reason for the problem - they are simply unable to heal as quickly as they need to!
Depending on the main issues that appear to present themselves, this might mean that your physio needs to change their "plan of attack" in order to get this condition to settle down. Among the variety of treatments which have been shown to have a good effect in my experience, it is reasonable to expect soft tissue release (through massage, acupuncture etc), joint mobilisations (freeing up stiff joints in the elbow/wrist may mean the muscles do not have to work as hard), strengthening exercises (these are used with the main goal of repairing and strengthening the tendon which may be torn) as well as stretching of the tight muscles.
Wanting A Quick Fix?
It is not uncommon for people to come in wanting their elbow pain improved quickly - perhaps they have a big competition coming up in a couple of weeks! In this situation, cortisone injections have been shown to be good - in various studies the pain a few weeks after injections was a lot better than before injection.
These studies also found that several months later, the people who got injected were significantly worse off than those who did not get injected and rather tried the normal physio route.
If you watched the above video, you will have noticed Sachin talking about rehab from surgery - this often involves the scraping away of the damaged tendon tissue. This is generally a last resort, and recommended only if 3-6 months of physio treatment has not proven itself to be effective. The rehab process of the surgery is long enough anyway - we can't really refer to that a short term fix!
There is certainly no one-size-fits-all fix for long term tennis elbow pain. The road to recovery is often longer and more frustrating than you might wish it was. However, it is worth noting that with the correct physio management of the problem (and potentially surgical management in the future), you should expect improvement to your pain. If someone like Tendulkar who played over 1600 days of professional cricket can continue to play to a high level, so can you!