Introduction

Tennis elbow, or as some call it, lateral epicondylitis, is a common injury that many people get all over the world.¹ Even though it has "tennis" in its name, not just tennis fans get it; it can hit anyone who plays racket games like squash, racquetball, and badminton.²

The condition is characterised by:³

• Pain and inflammation on the outside of the elbow
• Tenderness and swelling in the affected area
• Weakness and fatigue in the arm and forearm
•  Difficulty performing everyday activities, such as gripping, twisting, and lifting

Tennis elbow can be caused by a variety of factors, including:⁴

• Too much use and repeated stress on the elbow
• Bad form and body moves
• Issues with your gear, like a racket that's too heavy or too light
• Not warming up or cooling down correctly
• Not enough strength and bend in the arm and forearm

This article will discuss how gear and technique can lead to tennis elbow,  and give useful tips on how to prevent and treat the pain. Whether you're a serious athlete or just play for fun, this guide will provide the essential information and tips you need to protect your elbows and improve your performance. 

Anatomy of the elbow joint

Bones⁵

• Humerus: The humerus is the long bone of the upper arm that forms the elbow joint. The distal end of the humerus has two condyles (bony prominences) that articulate with the radius and ulna bones of the forearm
• Radius: The radius is one of the two bones of the forearm that form the elbow joint. The head of the radius bone articulates with the capitellum of the humerus
• Ulna: The ulna is the other bone of the forearm that forms the elbow joint. The olecranon process of the ulna bone forms the bony prominence at the elbow

Joints⁵

• Humeroradial Joint: The humeroradial joint is a synovial hinge joint that connects the capitellum of the humerus to the head of the radius bone
• Humeroulnar Joint: The humeroulnar joint is a synovial hinge joint that connects the trochlea of the humerus to the olecranon process of the ulna bone
• Proximal Radioulnar Joint: The proximal radioulnar joint is a synovial pivot joint that connects the head of the radius bone to the radial notch of the ulna bone

Ligaments⁵

• Medial Collateral Ligament (MCL): The MCL is a ligament that connects the medial epicondyle of the humerus to the medial aspect of the ulna bone
• Lateral Collateral Ligament (LCL): The LCL is a ligament that connects the lateral epicondyle of the humerus to the lateral aspect of the radius bone
• Annular Ligament: The annular ligament is a band that goes around the top of the radius bone and keeps it set in place.

 Tendons⁵

• Extensor Carpi Radialis Brevis (ECRB) Tendon: This tendon links the side bump of the upper arm bone to the start of the second bone of the hand
• Extensor Carpi Radialis Longus (ECRL) Tendon: This tendon joins the same side bump on the upper arm bone to the start of the second bone of the hand

Muscles⁶

• Extensor Carpi Radialis Brevis (ECRB) Muscle: The ECRB muscle starts at the side bump of the upper arm bone and ends at the start of the second bone of the hand
• Extensor Carpi Radialis Longus (ECRL) Muscle: The ECRL muscle is a muscle that originates from the lateral epicondyle of the humerus and inserts into the base of the second metacarpal bone 
• Flexor Carpi Radialis (FCR) Muscle: This FCR muscle starts from the inner side of the elbow bone and ends at the base of the second metacarpal bone in the hand

Biomechanics of the elbow

Movement patterns⁶

• Flexion: The elbow lets you bend by moving the lower arm up to the upper arm
• Extension: The elbow lets you straighten by moving the lower arm down from the upper arm
• Pronation: The elbow lets you turn the lower arm so the handpalm looks down
• Supination: The elbow lets you turn your forearm so your palm faces up

Joint stability⁶

• Valgus Stability: The elbow remains firm when a force tries to push it out
• Varus Stability: The elbow stays strong when a force tries to push it in

Muscle function⁶

• Elbow Flexors: Muscles like the biceps brachii tighten to bend the elbow
• Elbow Extensors: Muscles like the triceps brachii tighten to make the elbow straight

Proprioception and motor control⁶

• Proprioception: This is knowing where your elbow is and how it moves
• Motor Control: It helps to control the movement of the elbow joint

Equipment-related factors that can contribute to tennis elbow

Racket size and weight⁷

• Racket Length: If the racket is too long or too short, it can change how the player swings. This might make the elbow feel more strained
• Racket Weight: If the racket is too heavy or too light, it can change how fast and well the player swings. This can lead to more elbow stress
•  Balance Point: The spot where the racket balances can change how the player swings and can add stress to the elbow

String tension⁷

• String Tension: High string tension can up the shock and shake sent to the elbow, causing more stress and strain
• String Material: The kind of string used can change how much shock and shake reach the elbow

Grip size⁷

• Grip Size: A grip too small or too big can shift how a player swings and bring more strain to the elbow
• Grip Style: The type of grip (like eastern, western, semi-western) can impact how a player swings and the stress on the elbow

Racket balance and swingweight⁸

• Racket Balance:  The balance of the racket can impact how a player swings and the stress on the elbow
• Swingweight: The weight of the racket can change how fast and well a player can hit, making their elbow feel more stressed

Other equipment-related factors⁸

• Racket Frame: How the racket is shaped and sized can change how a player hits and how their elbow feels
• Handle Material: What the handle is made of can change how good the player's hold feels and how they hit
• Vibration Dampeners: Putting no-shake bits on can cut down on the hit feel and shake that goes to the elbow

Technique-related factors that can contribute to tennis elbow

Grip style⁹

• Eastern Grip: This grip might put more strain on the elbow, especially if the player moves their wrist a lot
• Western Grip: This grip can also put more strain on the elbow, mainly if the player turns their forearm a lot
• Semi-Western Grip: This grip is seen as more middle-ground, but can still hurt the elbow if the player uses bad form

Stroke technique⁹

• Forehand: If you hit a forehand wrong, like with too much wrist or arm twist, it can hurt your elbow a lot
• Backhand: Hitting a backhand wrong, by using too much wrist or arm twist, can also hurt your elbow.
• Serve: A bad serve, with too much wrist or arm twist, can make your elbow hurt

Footwork and body positioning⁹

• Shuffling: If you shuffle wrong, it can make your elbow hurt more, especially if you do it badly
• Turning: Turning can make the elbow hurt more, especially if the player uses bad form
• Body Positioning: Bad body position, like standing too close or too far from the ball, can make the elbow hurt more

Racket head speed⁹

• High Racket Head Speed: High speed can make the elbow hurt more, especially if the player uses bad form
• Low Racket Head Speed: Low speed can also make the elbow hurt more, especially if the player uses bad form

Wrist and forearm action⁹

• Wrist Action: High speed can make the elbow hurt more, especially if the player uses bad form
• Forearm Rotation: Low speed can also make the elbow hurt more, especially if the player uses bad form

Other technique-related factors¹⁰

• Poor Swing Mechanics: Poor swings, like using too much arm or shoulder, may make the elbow hurt more
• Inconsistent Technique: Not keeping the same form, like changing grip styles or how you hit, may also make the elbow hurt more

Prevention strategies¹¹

Equipment modifications

• Racket Size and Weight: Picking a racket that is the right size and not too heavy can help ease the stress on your elbow
• String Tension: If you make the string tension lower, it can cut down on the shock and shake that gets to the elbow
• Grip Size: A grip size that feels good can help ease the stress on your elbow

Technique modifications¹²

• Grip Style: A neutral grip style can help ease the stress on your elbow
• Stroke Technique: Using the right way to hit, like using your legs and middle part to make power, can help ease the stress on your elbow
• Footwork and Body Positioning: Using good steps and ways to stand can cut down on elbow pain

 Training and conditioning¹³

• Strengthening Exercises: Making the arm, hand, and top arm areas strong can stop tennis elbow
• Flexibility and Mobility Exercises: Making the elbow, hand, and top arm move and bend well can help prevent tennis elbow
• Cardiovascular Conditioning: Getting your heart fit can cut down the chance of tennis elbow

Warm-up and cool-down¹⁴

• Warm-up Exercises: Performing warm-up exercises, like easy runs and moving stretches, can help prevent tennis elbow
• Cool-down Exercises: Performing cool-down exercises, like holding stretches, can stop tennis elbow

Treatment strategies

Conservative treatment¹⁵

• Rest and Ice: Sitting still and using cold packs can ease the pain and swelling in the elbow
• Stretching and Strengthening Exercises: Doing exercises to stretch and strengthen the elbow can help the elbow move better and get stronger
• Physical Therapy: Doing exercises to stretch and make the elbow stronger can help the elbow move better and get stronger

Medications¹⁶

• Pain Relievers: Using meds like acetaminophen or ibuprofen can cut pain and swelling
• Corticosteroid Injections: Getting shots of corticosteroids can lower swelling and ease pain

Surgical treatment¹⁷

• Arthroscopic Surgery: Small cut work can fix bad bits and cut pain
• Open Surgery: Big cut work can fix bad bits and cut pain

Alternative therapies¹⁸

• Acupuncture: Getting poked with needles can ease pain and swelling
• Massage Therapy:¹⁹ Getting a massage can cut down on pain and swelling
• Platelet-rich Plasma (PRP) Therapy:²⁰ Getting PRP shots can boost healing and lower pain and swelling

Summary

Tennis elbow, or pain on the outer side of the elbow, often affects those who play racket games. It comes from both the gear and how one plays. Knowing how the elbow works and moves is key to stopping and fixing this pain. Changing gear, like picking the right size and weight of a racket, making the strings less tight, and using a grip that feels good, can reduce the stress on the elbow. Also, changing how you play, such as holding the racket in an easy way, using the right way to hit, and moving your feet and body right, can help prevent tennis elbow. Plans to stop and treat it, including conservative management, drugs, surgery, and new ways, must fit what the person needs.

FAQS

What is tennis elbow?

Tennis elbow involves a general injury to the muscles and tendons, commonly seen at the outer portion of the elbow.

What causes tennis elbow?

Tennis elbow is normally associated with repetitive forces on the elbow; these are commonly associated with poor technique in racket sports, overuse, equipment-related issues and poor physical conditioning.

What are the signs of a tennis elbow?

Common symptoms of tennis elbow include discomfort and inflammation in the outer portion of the elbow, tenderness and swelling within the affected region, and weakness and weariness in the arm and forearm.

How is tennis elbow treated?

Treatment of tennis elbow usually includes:

1. Conservative methods such as rest, ice, compression, and elevation (RICE)
2. Physical therapy and bracing
3. Medications like pain relievers and corticosteroid injections
4. Surgery is required in severe cases

Can tennis elbow be prevented?

This condition may be prevented by:

1. Using proper technique
2. Warming up and cooling down properly
3. Adding strengthening and stretching exercises during play
4. Playing with equipment that suits your abilities