Tennis Elbow Causes and Prevention

Tennis Elbow most commonly occurs at the junction where the tendon of the 'extensor carpi radialis brevis' muscle inserts into the lateral epicondyle of the humerus (bony bit on the outside of the elbow near the “funny bone”).

In this area there are a large number of pain receptors making this region particularly tender to touch.

The most common cause of Tennis Elbow is overuse of the muscles (also called “repetitive strain”) caused by repeated extension or bending back of the wrist against resistance. Gripping or turning objects like a manual screwdriver, lifting heavy weights during strength training or repeatedly performing occupational activities such as a builder laying a number of bricks are all common causes of tennis elbow.

As the name suggest, these injuries do sometimes occur whilst playing tennis and the cause is often a technical issue. The main contributing factor is poor back-hand technique because during this particular shot, large forces are transmitted through the muscles and tendons of the forearm and this is made worse if the wrist is bent when striking the ball causing an overload of the muscles in the area followed by the onset of pain.

Other possible factors that are related specifically to tennis with this particular injury are gripping the racquet too tightly (if the handle is too small) and having the strings of the racquet too tight. In both of these situations the consequence is that the forearm muscles are overworked which increases the load on the tendon and its attachment to the elbow.

Professional tennis players don't usually get Tennis Elbow because they bodies have been conditioned to the demands of the sport and their technique is good. We look at some top tips to help amateur tennis players avoid tennis elbow injuries.

Use Correct Technique

Tennis balls can make contact with a racket at over 80 miles per hour. Much of this impact and energy may be focused directly on the attachment of the forearm muscles to the bony bit on the outside of the elbow. Massive forces result on such a small area causing injury.

Poor technique in a backhand tennis stroke is a common cause of Tennis elbow. It is important that the wrist is not bent when hitting the ball. This factor combined with a very 'wristy' backhand (often used to increase topspin) may increase risk of injury.

A firm wrist will mean that the energy of a high speed ball will be dispersed throughout the arm and not focused on the lateral epicondyle of the elbow.

The wrist needs to be straight and firm when striking the ball. A brace can help disperse the forces of the forearm, especially useful during the return to full fitness phase of rehabilitation.

Equipment and Facilities

  • String tension - If the tension in the strings is to high, this will lead to greater forces being imparted into the arm.
  • Grip size - The distance from the mid-line of the hand to the tip of the middle finger should be equal to the circumference of the racket handle.
  • Good footwork to get into the correct position to play the ball is important.
  • Court surface is important - fast surfaces such as grass or concrete will cause the ball to bounce off and hit the racket at more speed than other surfaces.
  • Hitting wet and heavy balls will also increase the forces at the elbow.

Return to Fitness Gradually

  • It is important that the return to full fitness is a gradual step by step process. Any attempt to rush rehabilitation may simply result in making the injury worse.
  • Ensure you can comfortably do the strengthening exercises before starting on the racket work.
  • Continue to stretch and strengthen the elbow long after your return to fitness. It should be an integral part of training. Do not become complacent.