Although our elbows are built to take a lot of strain, repetitive movements can put too much strain on the joint. When we play tennis or engage in hard manual labour for days on end, the elbow joint starts to succumb to wear and tear - the tendons that attach the muscles to the bone literally get small tears in them.
Tendons have a poor blood supply, and in an attempt to start healing the tears, your body causes the joint to swell. Tennis elbow is also known as lateral epicondylitis - which directly translates to inflammation of the lateral condyle (the outer bony bump of your elbow). Although it is called "tennis elbow," it can occur in anyone who repeatedly uses their forearm and wrist, such as painters, carpenters, and cooks.
What Causes Tennis Elbow?
The tiny tears in the tendon and subsequent inflammation can be painful. You might only notice a slight niggle or irritation at first, but if you continue to use your elbow, the symptoms might gradually become worse over the next weeks and months.
If tennis elbow progresses, your arm might become stiff and weak, especially in the morning or if you’ve been sitting still for a while. You might have difficulty performing simple tasks like opening a bottle or straightening your arm. Your elbow might be tender to touch - even painful.
Understanding the anatomy of the elbow joint can help us move our arms better to recover and prevent further injury.
The Anatomy Of The Elbow Joint
The Bones Of The Elbow Joint
Our elbow joint connects the upper part of the arm with the lower part, allowing the arm to bend and rotate (to a degree). A joint is any place where bones connect; the elbow is made up of the humerus (the upper arm bone) and the ulna and radius (the two lower arm bones). The connection between the ulna and the humerus allows the joint to bend.
The connection between the radius and the humerus allows the forearm to rotate. The radial head is the upper portion of the radius. It rotates around the ulna to allow for twisting (known as supination and pronation) of the forearm. The radius and ulna are held together by a complex system of ligaments that allow for rotation and movement of the forearm bones.
Ligaments, Tendons And Muscles
The joint is surrounded and supported by several ligaments, tendons and muscles that control the movement of the arm. Ligaments connect bones to bones while tendons connect muscles to bones.
It is the muscles, connected to the bone by tendons, that help your arm to move. When a muscle contracts, it pulls on the tendon, which pulls on the bone, moving the limb.
The main muscles responsible for moving our elbows are the biceps and triceps muscles. The biceps muscles are located on the front of the upper arm, and the triceps are located at the back. Biceps muscles help to flex the arm - like when you do a bicep curl with a dumbbell. Triceps muscles help extend the elbow, straightening the arm.
Bones And Soft Tissues - Working Together
This is where it gets technical.
Bending and twisting your arm repeatedly pulls the muscles and tendons of your forearm. The medial epicondyle is the bony bump inside your elbow, which attaches to the muscles of your forearm. The lateral epicondyle is the bony bump on the outside of your elbow, and it attaches the tendons from muscles that control your wrist and fingers.
Now imagine swinging that tennis racket. Your arm bends thanks to your upper arm muscles, but it rotates thanks to the muscles that extend from the outside of your elbow to the inner part of your arm and wrist.
You hit the ball with force. When you do this over and over again, the tendons start to strain and tear - especially those on the lateral epicondyle. Those tendons attach to the muscles that control your hand, so they are working double as hard to help you perfect your swing.
Now that we know how the anatomy works, we know that while the pain of tennis elbow is felt on the outside of the elbow, the actual problem lies with the tendons and muscles on the underside of the forearm.
How Can We Prevent Tennis Elbow?
The most obvious way to prevent tennis elbow is to not overuse the joint. This means resting often, allowing your soft tissues to heal.
You’ve also probably heard that warming up before you jump into your game is important. Warming up means that your muscles, ligaments and joints are given the chance to become more limber and stretchy, giving them a better capacity to accommodate sudden big movements and changes in direction.
It might sound counterintuitive after we just recommended that you rest, but doing strength training can help your muscles become stronger, which will better support your joint. Make sure that the training involves movements that are different from the ones you repeatedly do, so that you train the whole arm - not just one part.
Sports such as tennis also have specific techniques in order to prevent injury. There is a reason that you can go for tennis lessons - a coach can train you on how to properly play, so that you don’t hurt yourself. They can also help you choose the right equipment. A racket with a grip that is too small or too large might do more harm than good.
Most importantly, listen to your body. If you feel that something is wrong, rest a moment and evaluate - will pushing through the pain benefit you in the long run?
What Are The Treatments For Tennis Elbow?
The first line of treatment for tennis elbow is - you guessed it - rest. Tennis elbow is primarily an overuse injury and continuing to use the joint will cause further harm.
Your elbow may be painful during this time, especially if it has been immobile for a while. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help to reduce pain and swelling, but your doctor might prescribe something stronger if the pain and inflammation is very bad.
Another way to deal with pain and inflammation at home is to cool the joint down. You can wrap some ice (frozen peas work well!) in a tea towel and place it on your elbow. The towel is important so that you don’t damage your skin. You can do this several times a day for 15-20 minutes at a time.
Physical therapy will also help to both prevent and manage tennis elbow. Physical therapists use specific combinations of movement, massage, hot and cold therapy and exercises to help strenghen the muscles and improve range of motion. They might also help you select an assistive device, like a brace or strap, to help with recovery.
Wearing a brace or strap will keep the joint stable, which can help with the pain caused by movement. A brace might also help protect the joint from accidental bumps.
If nothing is working and your case is very severe, orthopaedic surgery may be necessary to fix the tendons and remove any damaged tissue.
Understanding Tennis Elbow
Now you know how your elbow joint works and why repeated movement might damage your tendons. Tennis players are particularly susceptible to this type of injury, but it can happen to anyone who uses their elbows a lot.
Rest, cold therapy and pain relievers are your best bet to treat tennis elbow at home, but a physical therapist will be able to provide better guidance in the long run.