Treatment and prevention of tennis elbow

Now that warm weather is here to stay, many Americans are returning to their favorite outdoor sports and starting home projects. Which means, among other things, the annual increase in tennis elbow.

It starts with constant, localized pain on the outside (or inside, if it’s a closely related pain) of the elbow golfer’s elbow), and slowly decays. It can happen to you even if you have never picked up a club or racket. Until 50 percent from tennis players develop it every year, lateral epicondylitis, as experts know, is one of them ruling repetitive stress injuries of the upper body.

Causes vary, but can include prolonged use of a hammer, painting, softball, weight lifting, and even gardening. Or it could be a combination of triggers.

Studies show that people over 40 are the most sensitivesuch as smokers, people who have fatness and those who engage in repetitive motion for at least two hours per day. If you suspect you’re dealing with tennis or golf elbow, there are ways to heal, get back into action, and hopefully keep pain at bay in the future.

What is tennis elbow?

Both tennis elbow and golf elbow are overuse injuries caused by damage to the muscles and tendons that run from the wrist to the elbow. When used too much, and if your shoulder muscles and core don’t have enough strength, the tendon where it attaches to the elbow can develop microscopic tears, causing both pain and inflammation.

The first sign that you might have the condition is pain near the elbow, said Theresa Marko, a doctor of physical therapy in New York City and spokeswoman for the American Physical Therapy Association. You may also feel tightness in your forearm muscles, she said. Sometimes you feel a clicking or sticking sensation, or you can’t fully straighten your elbow.

Pain was Melanie Madden’s first indication that something was wrong two years ago. “I had been playing tennis for about three months when I first noticed it,” said the 45-year-old Boulder, Colo., real estate agent. At the time, I had a new dog and often threw him a ball, practiced yoga, and played golf. I kind of ignored the pain and hoped for the best.

Before long, the pain had woken Miss Madden in the middle of the night, and it hurt to take a cup of coffee.

How do you handle it?

Managing the condition when it starts can shorten the time it takes to overcome the pain. It can be a stubborn injury, said Dr. Marci Goolsby, a sports medicine physician and director of the Center for Women’s Sports Medicine at the Hospital for Special Surgery in New York.

The first line of defense against golf or tennis elbow should be to identify the activities that cause it. If you’ve had a sudden spike in your pickle game, for example, cut back, Dr. Marko said. If you catch it early enough, reducing the time spent on the aggravating injury may be enough. If not, stop it completely until you’ve progressed through the rehab exercises.

This can be tricky because many simple daily activities on the phone, housework such as sweeping, sewing or even washing the dishes can aggravate injuries.

Next, experts recommend using ice and anti-inflammatory painkillers and tennis elbow beltwhich provides compression at the point of pain (though some studies have found that the effect can be psychological). Some experts also suggest a wrist immobilization brace for severe pain because it prevents you from extending your wrist in a way that causes pain in the elbow. You can also try rubbing gently on the forearm, just above the wrist, Dr. Marko said.

However, in most cases, the cause of the problem is a lack of strength in the shoulder area, he said. You can start shoulder and rotator cuff training right away.

One must try shoulder external rotation: lie on your healthy side with a wrapped towel between your upper arm and body. Bend your upper arm at the elbow, lower it towards your stomach and back, repeat 15 times for three sets. You can also add simple ones squeezing the shoulder blades standing or sitting, repeating 15 times three sets. Over time and as you start to feel better, you can add weights or resistance bands.

However, if the elbow hurts, holding the weight is painful, Dr. Marko said. I place an ankle weight around the person’s wrist and ask them to relax their arms while performing the movements of the side-lying exercises.

From there, consider a full house exercise program From the American Academy of Orthopedic Surgeons.

If you’re not making progress, a physical therapist can manually help loosen the joint and develop a personalized strengthening program. They may also exercise your arm to assess your readiness to return to sports or activities.

Some doctors may recommend alternative approaches such as platelet-rich plasma, shock wave therapy, dry needling or a corticosteroid injection, but these are not proven to be effective, as is consuming large amounts of gelatin, despite what friends or social media tell you.

Ms. Madden first dropped tennis from her routine. When that wasn’t enough, she also stopped other strenuous activities like throwing a ball to her dog and yoga. I found someone who specialized in wrists and elbows and saw him twice a week for about six weeks, he said.

As you begin to heal, try testing your elbow with small steps in your sport or activity and let the pain be your guide. At worst, you’ve tried resting for several weeks and working with a physical therapist, you should see an orthopedic specialist, said Dr. Robert Parisien, an orthopedic surgeon at Mount Sinai Health System in New York.

Not to suggest surgery, but to consider other treatments, he said. There is about a 95 percent success rate with a combination of treatments.

Amanda Loudin is a freelance writer covering health and science. His writing has appeared in the Washington Post, Outside, and many others.