Posted on July 02, 2015 by Jenny Cromack

Tennis Rehab
As Wimbledon season is here I anticipate the rising numbers of people getting themselves down to their local tennis court. Why not keep yourself ‘niggle’ and injury free, or manage any current injuries you may carrying? The most common injury associated with tennis is the aptly named ‘tennis elbow’.
What is Tennis Elbow?
Tennis elbow concerns the muscles of the forearm that extend the wrist and fingers. These muscles and the associated tendons can become damaged causing pain, tenderness, and stiffness. The muscles all attach at one point on the outside of the elbow, known as the lateral epicondyle. This is often the point of tenderness people will feel when they touch it.

Initially in acute tennis elbow the muscles and tissues experience micro-damage which cause inflammation hence the potential swelling, redness, pain and stiffness.

The issue with tennis elbow is that if it isn’t treated properly, or any contributing factors aren’t addressed, it can become chronic and degenerative. This is highly uncomfortable and frustrating for those who suffer from it.

In chronic tennis elbow there is no inflammation, the symptoms are experienced through pain related chemicals, restrictions in blood flow, and scar tissue formation. One of the reasons it occurs in the first place is the repetitive nature of tennis. The repeated contraction and stretch of these forearm muscles places a lot of strain on these tissues, resulting in the damage.
How Can I Minimise/Manage Tennis Elbow?
In order to minimise any injury or degeneration we need to address the scarring, blood flow restrictions, and ultimately reduce or prevent any pain. There are several treatment methods I have used in combination to address all of these factors. These are as follows:
Friction Massage
This is a very simple self-massage technique and the aim is to breakdown any scar tissue that has formed, it is also a good way of encouraging blood to flow to the area. To do it find the bony point on the outside of the elbow with your opposite thumb or fingers. Then slide down slightly until you feel the bulk of the muscle and tendons. Once you are on the spot (it will likely be tender) slowly rub across these tissues with as much pressure as you can stand. Work your way down your forearm but the main focus should be around that bony point of the elbow, usually the most tender part. Do this for 5-10 minutes or until you notice a reduction in pain and tenderness.
Heat Therapy
This is a very simple method but is very effective at increasing blood flow and relaxation. Simply apply a wheat bag or a hot water bottle to the muscular portion of the outer elbow (the same area you massaged). Leave the heat on for 15-20 mins but make sure you do not place a hot water bottle directly on the skin, use a towel as a barrier but make sure you can feel the heat coming through. Using this after a massage is ideal because will help deliver the nutrients needed for repair after we have broken down the scar tissue.
Stretching
Stretching is going to further help realign the structure of the scarred and damaged tissues and achieve optimal length in the muscles and tendons. To ensure we have unrestricted range of movement, and the muscle can work optimally stretching is vitally important. Stretching the wrist and finger extensors is very simple simply push the wrist and fingers into flexion (folding the palm forwards and rolling your fingers into your palm. You can use your opposite hand to apply extra pressure for further stretch. Hold the stretch for approx. 20-30 secs and repeat it 2-3 times a day.
You can also do this more actively by starting with your wrist in a neutral position so your hand is in line with your forearm. Then fold your wrist forwards as far as it will go then return to neutral and repeat this for 2-3 sets of 15 reps.
Exercises
In terms of exercise we don’t want to tighten shorten the muscles again or cause further irritation. One of the most effective exercise methods I have used in clients with tennis elbow is to progressively load the muscles but in a controlled fashion. The following are a selection of exercises to progress your way through
Eccentric Wrist Extension…
This basically means that instead of loading the muscle as it shortens, we load it as it lengthens controlling the opposite movement that the muscle usually causes. So the muscles that are injured are the wrist extensors, so we would need to control wrist flexion.
To do this grab something light in the injured or affected hand (can be a light dumbbell or tin of beans) and place your forearm flat on a desk or bench with the hand hanging over the edge. Use your good hand to lift the bad hand and wrist up and backwards (into extension) because we don’t want the injured muscles shortening under load just yet. Once the bad wrist is lifted, let go with the good hand and allow the weight to slowly be lowered as far as it will go. Try to control this lowering over about 10 secs. Once you get back to the bottom of the movement use the good hand to lift it back up and repeat. Do 2-3 sets a day or one day on one day off.
Banded Pronation/Supination…
Attached a band around standing elbow height to a stable object at your side. Bend the elbow to 90° with the palm facing upwards and grasp the loose end of the band. Then roll your wrist so the palm turns face-down. Slowly relax controlling to the return position. Do 2-3 sets of 15 reps.
Once the above has been done, grasp the loose end again but with the palm down and thumb closest to the band. The roll the wrist so the palm is face-up and then relax and control to return position. Do 2-3 sets of 15 reps.
Finger Extensions…
Place an elastic band around all your fingers and thumbs of one hand. Starting with all the fingers and thumb bunched together, open and extend the fingers and thumb as far as you can then slowly relax and return to starting position. You are looking to open the fingers as far as you can. Do 2-3 sets of 15 reps.
Racket Rotations…
Take hold of your racket with a very light grip, the holding it in neutral position slowly and in a controlled fashion rotate your forearm and wrist from side to side. Start to increase your grip as pain allows, we do not want to go straight into a full grip as this can bring about symptoms.
Light Racket Flexion/Extension…
Hold the racket in a neutral position with thumb towards the ceiling (as with the rotations) then flex and fold the wrist forwards so the palm moves towards the inside forearm, then slowly return and extend and fold the wrist backwards so the top of the hands moves towards the outside forearm. DO this slowly and control for 2-3 sets of 15 reps. Do not work into pain on this.
Take Home Message
To fully prevent tennis elbow and other degenerative, chronic injuries you should assess your technique, equipment, and training volume in order to highlight any contributing factors. Often people grip their racket too tight, or their racket will be too heavy for them but these things would need to be physical observed and assessed by a health professional. The above is only suggested exercises I have used and not a complete diagnosis or specific rehabilitation program. However, they will be good additions to your training and playing warms ups to protect your forearms, wrist and elbows.