Tennis elbow in the making - how to stop it before it gets worse

A week ago I finished painting a fence with a power sprayer.

Then I played tennis almost every day (some of it was just practicing serve or tutoring my family).

Then, two days ago I started feeling it in my elbow. Not extremely painful but uncomfortable.

I got me that elbow brace last night, took two ibuprofens, and I have been putting cold pads on the upper forearm three, four times a day.

This morning it feels better. No pain. Very light pain when I rotate wrist. Slightly more, but still slight when I bend wrist downwards.

My questions (asking your non-binding advice):

1.What else should I be doing to “nip this in the bud”?
2. Is my current regimen OK
3. Do I wear this brace at all times or just when I play?
4. How long should I stay away from playing?
 

shamaho

Professional
theraband flexbar, deep tissue massage and ice, plus no tennis for now

you can google all of the above
Yup! that's it!

BTW re the Ice... don't just put ice cold packs.... dip your entire forearm up to and including your elbow in a bucket full of Iced water...
 

WildVolley

Legend
Why is everyone advocating icing?

I won't claim to constantly follow the literature, but from what I've seen, the only proven benefit of icing is pain management and studies showing the quick icing (within 15 minutes) of an acute sprain may have some benefit.

I still haven't seen any studies demonstrating increased healing due to icing. Since icing is a hassle, I'd only reccomend it if you find it reduces pain. Otherwise, I'd stick to exercises that have some evidence, such as doing eccentric exercises with the theraband flexbar, etc.
 

HouTex

Rookie
Why is everyone advocating icing?

I won't claim to constantly follow the literature, but from what I've seen, the only proven benefit of icing is pain management and studies showing the quick icing (within 15 minutes) of an acute sprain may have some benefit.

I still haven't seen any studies demonstrating increased healing due to icing. Since icing is a hassle, I'd only reccomend it if you find it reduces pain. Otherwise, I'd stick to exercises that have some evidence, such as doing eccentric exercises with the theraband flexbar, etc.

My thoughts as well. I iced my TE for months with no perceived benefit. Heat, however, seemed to help. Above all, stop playing until the pain goes away or you could get way worse and then be out of tennis for a couple of years. That happened to me.
 

pats300zx1

New User
I have tried ice and heat for my TE and GE and heat seems to make things worse. The heat just seems to inflame the lateral epicondile. For me ice seems to calm things down. If anybody has any suggestions I am all for it. TE and GE are the most frustrating injury I have ever dealt with. I have been battling TE in my dom arm for over 1.5 years. I have rested, done PT, and no matter what I do it just keeps coming back. I have had my form looked at my teaching pros and they say all looks good. I have switched to the Wilson Clash and multi strings. My former racquet was a Babolat PD with Silinco Hyper G which just crushed my arm.

I literally rehab'd for 2 months during the COVID pandemic exercising everyday and my arm felt perfect... went to hit and it came right back. I am seeing my ortho this week and am seriously considering PRP. I also now have GE in my non-dom arm. Just shoot me....
 
Is it Tennis Elbow or Golfer's Elbow? Neither is nice, but Golfer's Elbow is a lot easier to deal with.

In both cases, REST is the first port of call. Lay off the hitting for a week. Certainly look into using the appropriate Theraband Flexbar and exercises. Both will do you a world of good and you will come back better and stronger than ever.

Might also be a good opportunity to review your equipment configuration (Racquet, Strings, tensions etc.) and make sure they are still optimum for your game. That said, a review of your stroke technique (especially FH and Serve) might be in order. Perhaps a couple of private lessons just to fine tune a few things.
 

pats300zx1

New User
Is it Tennis Elbow or Golfer's Elbow? Neither is nice, but Golfer's Elbow is a lot easier to deal with.

In both cases, REST is the first port of call. Lay off the hitting for a week. Certainly look into using the appropriate Theraband Flexbar and exercises. Both will do you a world of good and you will come back better and stronger than ever.

Might also be a good opportunity to review your equipment configuration (Racquet, Strings, tensions etc.) and make sure they are still optimum for your game. That said, a review of your stroke technique (especially FH and Serve) might be in order. Perhaps a couple of private lessons just to fine tune a few things.

TE in my dom arm and GE in my non dom.

Have both Therabands and used them for 2 months with no playing to rehab which greatly helped. Strokes have been reviewed and are in order and I have switched to a Clash with only multi strings at lower tension. Seeing my ortho tomorrow to discuss options.
 

HouTex

Rookie
When I finally came back to tennis I found that the old Prince EXO3 strung with Wilson NXT multi was the best arm friendly racquet that I liked. The Volkl Classic V1 was a close second. Just a few hits with my old Wilson Hyper pro staff 6.1 would cause discomfort. Even perfectly solid hits caused vibration that would cause pain in my elbow. The racquet/string combination matters. I haven’t tried them but I hear that some of the newer Volkls are arm friendly.
 

LocNetMonster

Professional
I had really, really, really bad TE about a year after I started playing (which eventually led me to stringing and learning about racquet modification) from playing with really stiff poly (I shouldn't have been back then) for too long and strung too tight. I had the trifecta for TE and got it bad. My suggestion is first take two weeks off to heal and second, modify your stick(s). You want to look at two things: Your grip and the racquet weight. In my own personal experience and those I've recommended this to their arem issue goes away in a month. You need to bump the racquet weight up to at least another ounce bare minimum, 1.5 would be ideal. Since my case years ago, when I stop hitting with anything under 12oz, I haven't had a problem since. Next, I suggest you add at least one overgrip, ideally two. Without seeing you hit, I would bet your racquet grip is too small, you are grasping the racquet too tight or a combination of both. I was skeptical when my coach suggested this to me a decade ago, but it made a difference. I say try these two things and you will be happy camper in no time.
 

pats300zx1

New User
I had really, really, really bad TE about a year after I started playing (which eventually led me to stringing and learning about racquet modification) from playing with really stiff poly (I shouldn't have been back then) for too long and strung too tight. I had the trifecta for TE and got it bad. My suggestion is first take two weeks off to heal and second, modify your stick(s). You want to look at two things: Your grip and the racquet weight. In my own personal experience and those I've recommended this to their arem issue goes away in a month. You need to bump the racquet weight up to at least another ounce bare minimum, 1.5 would be ideal. Since my case years ago, when I stop hitting with anything under 12oz, I haven't had a problem since. Next, I suggest you add at least one overgrip, ideally two. Without seeing you hit, I would bet your racquet grip is too small, you are grasping the racquet too tight or a combination of both. I was skeptical when my coach suggested this to me a decade ago, but it made a difference. I say try these two things and you will be happy camper in no time.

Thanks for the advice. I am currently using a 4 3/8 grip and always wondered if this could be causing my issues as I could be gripping the racquet tighter in my swings. I guess I could try bumping it up to 4 1/2. Good advice on the racquet weight. I might try adding some lead tape. Where would you suggest I start putting it?
 

LocNetMonster

Professional
Thanks for the advice. I am currently using a 4 3/8 grip and always wondered if this could be causing my issues as I could be gripping the racquet tighter in my swings. I guess I could try bumping it up to 4 1/2.

Start with one overgrip and play for ten days and then add another, play for ten days. You might try one more and then back down if it seems like too much.


Good advice on the racquet weight. I might try adding some lead tape. Where would you suggest I start putting it?

What worked for me was adding weight from 8 to 10 and 2 to 4 on the inside of the hoop. Whatever I added to the hoop I multiplied it by x 1.5 to gradually increase the headlight balance as the overall weight increases. You may want it more or less headlight depending on you swing mechanics. You will have to play around with it until you feel like you can generate the same RHS.
 

LoanStar

Rookie
I developed really bad TE/GE last year experimenting with poly strings and hitting with a younger, hard-hitting human backboard. I finally got over it continuing to play. Not sure which had the most impact but here’s what I did...
1. Arm-friendly racquet (I play with a DR98)
2. NO POLY...first tried multi, then gut (that really helped) and now I’m trying syn gut
2. Reduced frequency and duration of playing for a few months
3. Regular heat (I used a heating pad) and stretching at ortho’s recommendation. He said no ice (In order to get circulation thru the area) and to stop therabar until pain goes away (his opinion is the therabar strengthens when the initial goal should be to quiet down all the soft tissue in the area)
4. Arm band (I use the IT band).
 

Gyswandir

Semi-Pro
Why is everyone advocating icing?

I won't claim to constantly follow the literature, but from what I've seen, the only proven benefit of icing is pain management and studies showing the quick icing (within 15 minutes) of an acute sprain may have some benefit.

I still haven't seen any studies demonstrating increased healing due to icing. Since icing is a hassle, I'd only reccomend it if you find it reduces pain. Otherwise, I'd stick to exercises that have some evidence, such as doing eccentric exercises with the theraband flexbar, etc.
As per my physio, who first introduced me to icing, the point is to do it right after the rehab exercise. What it does is promote blood flow into the area. The ice constricts the blood vessels and helps numb any pain, then, after removal, the vessels expand and the body tries to send more blood to the cold affected area (a sort of pump effect). This helps in promoting tendon healing, as they are challenged by limited blood flow to begin with
 

WildVolley

Legend
As per my physio, who first introduced me to icing, the point is to do it right after the rehab exercise. What it does is promote blood flow into the area. The ice constricts the blood vessels and helps numb any pain, then, after removal, the vessels expand and the body tries to send more blood to the cold affected area (a sort of pump effect). This helps in promoting tendon healing, as they are challenged by limited blood flow to begin with

This has been discussed here in the past. One of the physicians who posts here denied the very argument your physio made.

I became aware of the controversy when the guy behind the RICE acronym admitted that it wasn't based on evidence, but just something he made up.

When I did some online searches, the only positive evidence for icing was if done very quickly after an acute injury like an ankle sprain.

If you want more blood flow in a joint, the way to do it is by exercise and movement. The icing, as you stated, restricts blood flow to the area.
 

yossarian

Professional
This has been discussed here in the past. One of the physicians who posts here denied the very argument your physio made.

I became aware of the controversy when the guy behind the RICE acronym admitted that it wasn't based on evidence, but just something he made up.

When I did some online searches, the only positive evidence for icing was if done very quickly after an acute injury like an ankle sprain.

If you want more blood flow in a joint, the way to do it is by exercise and movement. The icing, as you stated, restricts blood flow to the area.

thing is a lot of the evidence on thermo and cryotherapy really is **** and no one really knows what's going on. like you said it's best used as an analgesic rather than thinking that it's going to contribute to some healing effect. an ice massage over the common extensor tendon may be a good way to do this with LET
 

Shroud

G.O.A.T.
This has been discussed here in the past. One of the physicians who posts here denied the very argument your physio made.

I became aware of the controversy when the guy behind the RICE acronym admitted that it wasn't based on evidence, but just something he made up.

When I did some online searches, the only positive evidence for icing was if done very quickly after an acute injury like an ankle sprain.

If you want more blood flow in a joint, the way to do it is by exercise and movement. The icing, as you stated, restricts blood flow to the area.
Agree with this 100%. Ice never worked for me and made things worse. Keeping the blood flowing through heat and wearing thigh wraps to keep it warm at night was the ticket.

Also my setup gives people TE just reading about it, but IMHO the handle I have really helps, and is a reaction to the TE and GE I had. I don't worry about TE or GE now and outside of some stretches, I don't do a thing to keep the arm healthy because my handle protects me. My 2 cents is that the forearm muscles get tight and over worked and pull on the tendons. For me at least the big a s s handle makes gripping hard unnecessary.

Anyhow here is a timely vid if you want to get a larger handle.

 

Tennease

Legend
I play every morning and I don't have any elbow nor any other muscle problems. I use heavy racquets and soft strings.

When I started playing tennis many years ago I used a light racquet and it gave me wrist problems. After switching to heavy racquets and soft strings I have no muscle problems since.
 
Regarding the Ice discussion ...

Application of ice can decrease the speed of nerve conduction from the pertinent body location. This can reduce pain from tissue near the surface. The person is then able to perform beneficial exercises and mobilise the affected area and this will help to reduce swelling of the affected area.

Basically, application of ice can indirectly facilitate the reduction of swelling, but not for the reasons that most think.
 
because my handle protects me.

Imho, at the first sign of any elbow pain, immediately stop playing and add at least one, preferably two overgrips to the handle. Then proceed to hit and see what happens. If the pain immediately disappears, that is an indication that the grip is too small. If the pain diminishes but is still apparent, add another overgrip and observe the result.

Alternatively, and this is much more difficult for many to achieve, try to release the grip pressure during the actual impact of the racquet with the ball. Focus on getting into a rhythm during the serve, and every shot in a rally. As you go into your swing pattern focus on releasing the grip pressure just prior to hitting the ball. In the early stages, you risk the racquet flying out of your hand - not really a problem on soft surfaces, grass, clay, synthetic. But once you get the hang of it, you might find it feels a lot more comfortable. There could be an added benefit of additional racquet head speed too.
 

Tennease

Legend
Imho, at the first sign of any elbow pain, immediately stop playing and add at least one, preferably two overgrips to the handle. Then proceed to hit and see what happens. If the pain immediately disappears, that is an indication that the grip is too small. If the pain diminishes but is still apparent, add another overgrip and observe the result.

Alternatively, and this is much more difficult for many to achieve, try to release the grip pressure during the actual impact of the racquet with the ball. Focus on getting into a rhythm during the serve, and every shot in a rally. As you go into your swing pattern focus on releasing the grip pressure just prior to hitting the ball. In the early stages, you risk the racquet flying out of your hand - not really a problem on soft surfaces, grass, clay, synthetic. But once you get the hang of it, you might find it feels a lot more comfortable. There could be an added benefit of additional racquet head speed too.
I agree with this. I try to always be fluid and relaxed when hitting the ball and I don't grip the handle too tight.
 
I think I found a partial cause of my TE in the making: I practiced lots of slice serves, probably 80-160 a day, every day, and my follow through might have been too much to the right side.
In terms of healing, I got a TE air pad brace and it helps a lot. No play for a week so far, and ibuprofen and massages.
Tried tests playing a little bit and found that flat and spin forehand are good, flat backhand too, but slices, specially slice serves aggravate it.
 

gvsbdisco

Semi-Pro
I have tried ice and heat for my TE and GE and heat seems to make things worse. The heat just seems to inflame the lateral epicondile. For me ice seems to calm things down. If anybody has any suggestions I am all for it. TE and GE are the most frustrating injury I have ever dealt with. I have been battling TE in my dom arm for over 1.5 years. I have rested, done PT, and no matter what I do it just keeps coming back. I have had my form looked at my teaching pros and they say all looks good. I have switched to the Wilson Clash and multi strings. My former racquet was a Babolat PD with Silinco Hyper G which just crushed my arm.

I literally rehab'd for 2 months during the COVID pandemic exercising everyday and my arm felt perfect... went to hit and it came right back. I am seeing my ortho this week and am seriously considering PRP. I also now have GE in my non-dom arm. Just shoot me....
If you are getting it in both arms the root cause might be your neck.
 

WilPro

Semi-Pro
I play every morning and I don't have any elbow nor any other muscle problems. I use heavy racquets and soft strings.

When I started playing tennis many years ago I used a light racquet and it gave me wrist problems. After switching to heavy racquets and soft strings I have no muscle problems since.

One more guy who confirms my theory. Weight is helping.

Also I went down from a 4 1/2 grip to 4 1/4. And in my case the problems was how I did that wrist lag. I found out that in my case poor technique was also the cause. Although at first I didn't like to admit it. It was true.
 

undecided

Semi-Pro
One more guy who confirms my theory. Weight is helping.

Also I went down from a 4 1/2 grip to 4 1/4. And in my case the problems was how I did that wrist lag. I found out that in my case poor technique was also the cause. Although at first I didn't like to admit it. It was true.
I wouldn't be so sure. I went to a heavy racquet (my racquet was already 12.1 oz, I added some lead to bring it up to 12.9) to avoid TE and ended up with rotator cuff tear. I mean it's anecdotal, it can definitely be bad technique or something totally unrelated but it coincided with that change.
 

Dartagnan64

G.O.A.T.
Most tennis elbow is caused my incorrect form. Hence why the pros rarely get it. Fix your form and the forearm will heal.

Actually most TE is caused by repetitively using the arm, followed by age. Then you can start looking at individual sports.
But if you solely focus on tennis-associated TE/GE risk factors, in order of importance:
1) Age
2) Frequency of play
3) Form
4) Equipment

2 and 4 are the most modifiable risks. 3 is minimally modifiable. 1 is immutable.
 

WilPro

Semi-Pro
Actually most TE is caused by repetitively using the arm, followed by age. Then you can start looking at individual sports.
But if you solely focus on tennis-associated TE/GE risk factors, in order of importance:
1) Age
2) Frequency of play
3) Form
4) Equipment

2 and 4 are the most modifiable risks. 3 is minimally modifiable. 1 is immutable.

Did you verify your assumptions?

I think ALL of the above are 100% false. It's 100% technique.
 

WilPro

Semi-Pro
Most people's problem is the wrist lag.

Because of bad wrist lag, they get tennis elbow, golfers elbow, low power, they need bigger racquet head, softer string and so on.

It's just the damn wrist lag. Do it correctly and all your tennis will be great, you can play smaller head racquets, you can play stiffer and higher spin potential strings. You cand o anything, just learn the proper wrist lag.
 
It's 100% technique.

If only your were right. Unfortunately you are not!

Genetics play a very important part in the susceptibility of the human body to develop all sorts of ailments. Tennis elbow is actually called lateral epicondylitis. I know quite a few people who suffer from that condition and they have rarely, if ever, picked up and used a tennis racquet. So technique is not a factor.

Lateral epicondylitis is an over-use related condition. It can also be termed a repetitive strain injury. People who have a 100% perfect tennis stroke technique can still end up with lateral epicondylitis if they have a genetic disposition for it simply by hitting a lot of tennis balls. (And this is also related to age. Older players have usually hit more balls than younger ones. Human bodies "wear out" over time. Cell regeneration becomes less efficient. etc. etc.)
 

WilPro

Semi-Pro
If only your were right. Unfortunately you are not!

Genetics play a very important part in the susceptibility of the human body to develop all sorts of ailments. Tennis elbow is actually called lateral epicondylitis. I know quite a few people who suffer from that condition and they have rarely, if ever, picked up and used a tennis racquet. So technique is not a factor.

Lateral epicondylitis is an over-use related condition. It can also be termed a repetitive strain injury. People who have a 100% perfect tennis stroke technique can still end up with lateral epicondylitis if they have a genetic disposition for it simply by hitting a lot of tennis balls. (And this is also related to age. Older players have usually hit more balls than younger ones. Human bodies "wear out" over time. Cell regeneration becomes less efficient. etc. etc.)

I guess it is due to racism. Everything in Murica is not someone's fault. It's always someone or something else that caused it.

If you are black the whites are guilty for whatever goes wrong in your life, if you're a woman then it's the men. If none of this apply then it is genetics. But none of what you do is a cause. You should do whatever and however and you should be fine.

Some people play games, overuse PC, or do other stuff. Whatever you do that puts a tendon at high stress would cause problems. What's so hard to understand?

It's genetics, sure thing, or white people, or democrats, or Donald Trump. Maybe you would get healthy if you destroy some historical statue or ban a masterpiece movie. Then they spread this kind of thinking all over the world, or wherever they can. And people buy it like gold.

The normal way of doing it is to look for ways to improve and get better results, But it's way easier to blame everything for your faults.
 

LocNetMonster

Professional
I guess it is due to racism. Everything in Murica is not someone's fault. It's always someone or something else that caused it.

If you are black the whites are guilty for whatever goes wrong in your life, if you're a woman then it's the men. If none of this apply then it is genetics. But none of what you do is a cause. You should do whatever and however and you should be fine.

Some people play games, overuse PC, or do other stuff. Whatever you do that puts a tendon at high stress would cause problems. What's so hard to understand?

It's genetics, sure thing, or white people, or democrats, or Donald Trump. Maybe you would get healthy if you destroy some historical statue or ban a masterpiece movie. Then they spread this kind of thinking all over the world, or wherever they can. And people buy it like gold.

The normal way of doing it is to look for ways to improve and get better results, But it's way easier to blame everything for your faults.

So who do you blame for your ever so subtle prejudices?
 

undecided

Semi-Pro
One thing that no one has mentioned is medications. It's proven that certain antibiotics cause tendon ruptures even years later. I think that maybe the cause of mine as the tendon injuries started after a course of cipro.
In addition, I get very worried when people tell other people to do exercises for TE/GE without first saying wait till it's pain free. Doing curls and flexbars and what not while your tendon is achy is basically prolonging the issue. Wait for the inflammation to subside and then slowly start those exercises. Tendons respond very slowly to force stimuli. Like, really slow.
 

yossarian

Professional
One thing that no one has mentioned is medications. It's proven that certain antibiotics cause tendon ruptures even years later. I think that maybe the cause of mine as the tendon injuries started after a course of cipro.
In addition, I get very worried when people tell other people to do exercises for TE/GE without first saying wait till it's pain free. Doing curls and flexbars and what not while your tendon is achy is basically prolonging the issue. Wait for the inflammation to subside and then slowly start those exercises. Tendons respond very slowly to force stimuli. Like, really slow.

if the tissue is really irritable at rest then yes, you shouldn’t really load it. But eccentric exercise to improve tendinopathy is often supposed to be somewhat painful
 
The normal way of doing it is to look for ways to improve and get better results, But it's way easier to blame everything for your faults.
A person's genetics is not their "fault".

Changing a technique does not change genetics or genetic dispositions to certain medical conditions.
 
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Most tennis elbow is caused my incorrect form. Hence why the pros rarely get it. Fix your form and the forearm will heal.

yep, man................it's the core/real issue. all the other stuff like rkts/strings/braces/physios/etcetc simply scratching the surface barely even get under the skin. but.............if u can't 'reform', hardest thing to do if u pkup the wrong form 1st place, scratching the surface in all different ways might be the only option. sadly speakingo_Oo_Oo_Oo_Oo_Oo_Oo_Oo_Oo_Oo_Oo_Oo_O...................................
 
wrong form 1st place

Really?

Rod Laver, Tony Roche, Bjorn Borg, Venus Williams, Andy Murray, Juan Martin del Potro, Nick Kyrgios and Novak Djokovic have all been diagnosed with Tennis Elbow.

I guess they all got it because their stroke technique was poor. :rolleyes::eek::-D

Playing tennis, the correct stroke technique may delay the onset of tennis elbow in players who have a genetic disposition for it ... but if they continue to play to the point of over-use, they will eventually get it.
 
.........
Rod Laver, Tony Roche, Bjorn Borg, Venus Williams, Andy Murray, Juan Martin del Potro, Nick Kyrgios and Novak Djokovic have all been diagnosed with Tennis Elbow.
...................

they're top pros n in order to stay at the very top for yrs w/ the fame + $$$lams they had to deal w/ the extremely bad 'form' forced by opponents, ie saving all sorts of awkward shots. the cost of a arm or leg was inevitable even they're working so hard day in day out to prepare/condition themselves. their occasional/enforced 'bad form' accumulation could be 000,000s x more than those bad forming every shot from milxmil once/twice wknd-ers 3.0ers or 3.5ers etcetc............every now n then heard of ppl comparing themselves w/ top atp-ers but..........tbh, man only thing comparable is injuries, lololololololol:-D:-D:-D:-D:-D:-D:-D:-D:-D:-D:-D.....................
 
OK. Cheers!

yep man, dat's all abt my 'tennis'........cheers or cheerful n feel sososo fkn good man. absolutely addictive n nothing else can be anywhere near as substitute. i mean fh/bh topspin only.............volleys/serves/slices/etcetcetc not addictive at all:-D:-D:-D:-D:-D:-D:-D:-D:-D:-D:-D:-D:-D:-D...................................
 
I got a cheap strap from CVS with an air pocket, and it is pretty helpful, but it looks like it might unravel soon (air pocket is slipping out).

Does anyone have a good TE brace/strap to recommend?

I've seen victory bands, and elbow sleeves, and regular braces with gel pads, so I was wondering what is the "best bang for the buck"?
 

PhxRacket

Hall of Fame
I got a cheap strap from CVS with an air pocket, and it is pretty helpful, but it looks like it might unravel soon (air pocket is slipping out).

Does anyone have a good TE brace/strap to recommend?

I've seen victory bands, and elbow sleeves, and regular braces with gel pads, so I was wondering what is the "best bang for the buck"?
Band It.
 
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