Tennis elbow is one of the most common causes of pain in the upper limbs, affecting both active and sedentary populations alike. It’s caused by stress to the tendons that attach to the lateral epicondyle, the bony lump on the outer side of your elbow. Golfer’s elbow is less common and affects the tendons attached to the medial epicondyle, the bony prominence on the inner side of the elbow.
Somewhat confusingly, professional tennis players will rarely develop tennis elbow and, likewise, professional golfers will rarely develop golfer’s elbow. In fact, the names for these conditions should be reversed: tennis players are more susceptible to golfer’s elbow and – you guessed it – golfers are more susceptible to tennis elbow.
This is because, when a tennis player does a forearm swing, they use the muscles and tendon on the inner side of the elbow (putting them at risk of golfer’s elbow from repetitive overuse), while a golf swing uses the muscles and tendons on the outer side of the elbow on the lead arm (putting them at risk of tennis elbow).
However, most of the people who suffer from tennis or golfer’s elbow won’t be athletes at all. The physical conditioning that’s required to be a top athlete reduces the risk of developing these injuries, while the general population can easily find themselves overloaded by repetitive tasks or sudden increases in load.
This means that, despite their sport names, the most common causes for tennis and golfer’s elbow are day to day activities such as repetitive desk work or mobile phone use for tennis elbow or DIY, gardening and weight lifting for golfer’s elbow. People who are sedentary are also at high risk of developing these conditions due to underuse of the affected structures.
One situation where tennis elbow and tennis do occur together is in amateur tennis players, typically caused by poor technique during a backhand swing. During a backhand swing, the wrist should stay in a neutral position, but amateur players will frequently allow their wrist to bend into a flexed position, which – combined with the impact of the ball – can overload the tendons on the outside of the arm.
Both tennis elbow and golfer’s elbow can cause debilitating pain. Even simple actions such as lifting a kettle, slicing bread or opening a jar can become extremely painful, and more difficult activities simply impossible.
But this pain isn’t always where you expect it to be. In lower limb tendinopathies, tendon pain is very well localised and does not spread up or down. However, in upper limb tendinopathies, the close proximity of nerves makes it quite likely that the pain will be more spread out.
This nerve involvement complicates both diagnosis and treatment, as pain has the potential to spread up and down from the actual site of the pathology and can create additional unpleasant symptoms such as tingling and numbness.
Pain is what causes most people to notice they have developed tennis or golfer’s elbow, but a loss of grip strength usually precedes the onset of pain, most noticeable when trying to open a jar or grip a dumbbell.
If you notice a sudden loss of grip strength, especially if it’s in one hand and not the other, you should seek medical advice quickly as you may be able to intervene and resolve the problem sooner and more easily – once a condition becomes painful, its more difficult to treat.
Treatment for tennis elbow and golfer’s elbow involves lifestyle changes to remove the stresses that caused the condition along with very gradual forearm strengthening to toughen up the affected structures and improve grip strength and wrist stability. If you place one hand on your forearm and clench your first, you’ll feel the muscles within tense up – it’s these muscles that we target during rehabilitation.
One forearm-strengthening exercise is to hold a light 0.5-1kg dumbbell with your palm facing down and slowly rotate wrist to bring your hand all the way upwards then all the way downwards, gradually increasing the repetitions and weight over a twelve week period.
But there’s no point strengthening your forearm if you’re going to return to the conditions that caused your tendon problems to begin with, such as a working posture that has your wrists flexed for extended periods or rotating your wrists side to side while you type.
Using ergonomic keyboards, cutting down on smart phone use and sitting at a height that allows you to keep your wrists in a neutral position will significantly reduce your risk of developing tennis or golfer’s elbow.
If you have any questions about tennis or golfer’s elbow, feel free to get in touch with me at david.wynne@westlondonphysio.
Musculoskeletal and Sports Physiotherapist, Research Lead at West London Physiotherapy
For any other questions regarding this topic please do not hesitate to contact West London Physio on 0207 937 1628 or email David at david.wynne@westlondonphysio.