Why is my tennis elbow not getting better?
Why is my tennis elbow not getting better ?
Tennis Elbow, is a condition that affects the outside of the elbow and is one of the most common causes of longstanding elbow pain. It is an overuse injury of the tendons that attach to one of the bones that make up the elbow joint. The main tendon involved in tennis elbow, the extensor carpi radialis brevis (ECRB), this helps with wrist extension.
Tennis Elbow it is not limited to just tennis players, it also affects manual workers such as painters and people who perform repetitive tasks but it has been reported that around 50% of tennis players will experience at least one episode of tennis elbow in their career. Recovery is often slow, although most cases resolve within a few months.
The more common medical name of lateral epicondylitis is being replaced with the term Common Extensor tendinopathy. [expand] It is no longer thought to be a purely inflammatory condition but is as a result of tendon degeneration - a degenerate tendon can become painful when overused. Understanding why your tendon is being overused is a good first step to recovery. In tennis there are a number of factors to consider, here are a selection that can lead to overuse injuries of the tendon as it adapts to different demands
Technique - playing with your elbow higher than your wrist on backhand
Playing with a different racket
Altering string tension
Playing with heavier tennis balls than usual
Incorrect grip size
Playing a lot more that usual
Having identified training error may not be sufficient to eliminate your symptoms and return to playing, here are other reasons your elbow still hurts when you play.
1. Is it tennis elbow?
Having the correct diagnosis is key to ensure you are following the correct treatment path. The main differential diagnoses for tennis elbow are nerve entrapment, arthritis, or it can be coming from the neck. A good way to examine the elbow is with diagnostic ultrasound [expand]: radiocapitellar joint OA, PIN, neck
2. I have rested it but each time I return to play it hurts
Tendons do not respond well to rest. Rest, which avoids the movements that aggravate the tendon are effective at reducing pain in the short term but when it comes to returning to tennis the tolerance of the tendon will have reduced, making it less able to deal with the demands of tennis. It is certainly beneficial to rest from aggravating activities for a time but this is when specific exercises need to be done [expand]
3 I have been stretching it and it’s the same or even getting worse
As with rest, stretching can be beneficial in the short term, improving the muscles’ flexibility and trigger points but as with rest this does nothing to improve the tolerance of the tendon, in some cases stretching the tendon will actually increase the compression of the tendon at the irritation point and worsen the pain. As mentioned above, tendons need to be strengthened, this is achieved by heavy slow, loading of the tendon and muscles involved. In addition it is also important to make sure higher up the arm is strong and moving well too…[expansion with example strengthening exercises]
4. I’ve been doing trying all this and I still cant play tennis
If you have been steadily loading up, moderating activities, and still feel you are not making the progress you expect. Sometime a little bit more time is needed. When it comes to tendons, healing is a slow thing. 3 months is the minimum amount of time to effect change, there are often other factors involved that can delay healing. 90% of cases resolve within 12 months. So rehabilitation requires a concerted effort or tendon loading alongside moderation of activities. It is not essential to be 100% pain free before returning to tennis but it is important to keep the pain at a very low, manageable level. If you have done all this and feel you have reached a plateau there are adjuncts that can escalate the treatment such as focussed Shockwave PRP injections and Ultrasound guided injections.