Recovering from a tennis elbow
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An architect, 43, who is also a keen tennis player, enjoys socializing at the tennis club on weekends. She plays doubles with friends. A friend at the club suggested she try a different tennis racket to give her ground strokes more power. From the moment she began using the new tennis racket, she could feel the strain on her forearm muscles. It felt like a really good workout initially, but as the weeks rolled by, the mild muscle soreness transformed into a sharp elbow pain.
She still didn’t think much about it, as the elbow would only hurt for the first 5 minutes of the game. The pain would disappear miraculously and she could continue to play without hindrance.
But as the months passed, the pain began lasting longer. She also noticed that her elbow felt tender first thing in the morning. And then it began to hurt at work while she was typing, using the mouse or even texting on her phone.
At this point, she decided to consult a doctor. She explained her story to the general physician, who diagnosed lateral epicondylitis, more commonly known as tennis elbow. He prescribed some pain medication and asked her to apply ice on the elbow, twice a day for 10 minutes. He referred her to a physiotherapist for further treatment and rehabilitation.
The physiotherapist used a number of treatment options, including massage, joint mobilization, neural mobilization, dry needling (similar to acupuncture), ice therapy and strapping. He also gave her a detailed exercise programme to follow at home. After six-eight sessions, the elbow was only marginally better. She didn’t have pain any more, but wasn’t confident enough to return to tennis.
Her physiotherapist asked her to visit her general physician for a review. The doctor referred her to a pain management specialist, who performed an ultrasound. The report revealed an inflamed and swollen tendon on the outside of her elbow. He recommended injecting corticosteroid around the tendon to reduce the pain and inflammation—she agreed to try it. Additionally, the doctor told her to rest for three days and then return to the physiotherapist to complete a strengthening programme. This was extremely important, he said, to ensure that the muscles and tendons in her forearms regained full strength. Failure to do so could result in a pain relapse.
The architect followed up on the exercises diligently. She made a full recovery and returned to playing tennis, and also continued with the exercises once or twice a week to maintain muscle strength.
Here are a few of the exercises that she did during her rehabilitation. If you’re trying these at home, remember to do them in a controlled and rhythmic manner. And do consult a doctor before attempting them.
Radial deviation: Hold the weight vertically, with your thumb facing the ceiling. Bend and flex your wrist as though you are hammering a nail. Begin with one set of 10 repetitions on each wrist, adding an additional set each week.
Wrist extension: Support your forearm on a stable surface like a table or on your knee. Hang your hand sideways or in front. Start by lifting your hand as high as you can, flexing at the wrist and taking care not to lift your forearm off the supporting surface. Use a weight (ranging from 0.5-2kg) that is challenging but does not cause pain at the elbow. Start with one set of 10 repetitions on each hand daily, adding one additional set each week. Keep checking every week if you’re able to lift a slightly heavier weight.
Pro and supination: Rotate the weight so that your palm moves from a downward-facing position to an upward-facing position while you rest your arm on a stable surface for support. Start with one set of 10 repetitions and increase this by one repetition every week.
Self massage: Spend 5-10 minutes every day massaging all the painful spots on the outside of your elbow and down the length of your muscles to the wrist. This massage is crucial to increase circulation in the healing tissues and to relax spasmodic muscles.
Wrist flexion: Follow the same procedure as for wrist extension, but this time turn your palm to face upwards. Begin with one set of 10 repetitions daily and add an additional set each week.
Heath Matthews is head of sports science and medicine at the Sir HN Reliance Foundation Hospital and Research Centre in Mumbai.