Tennis elbow, also called lateral epicondylitis (inflammation of the tendon that attaches to the outside bony part of the elbow), is common to over 1/3 of all tennis players at some point in their lives. Typical symptoms are pain in the outside of the elbow when grasping things (shaking hands), or cocking the wrist back. You might feel it during any stroke, but especially a forehand due to the position of the wrist and the stress on the lateral part of the forearm. Typical treatment for the symptom is rest, ice, and anti-inflammatory pain-killers. I highlight the word symptom, because that’s exactly what it is, a reflection of a larger problem. The cause, is not the elbow, or the tendon across the elbow, or your tennis racket, or your age. It’s the position and function of your shoulder.
The shoulder is an anatomical thing of genius. It’s flexible enough to move in all directions and in all planes, yet stable enough to allow you to walk on your hands and swing from trees and not break your neck (at least, that’s how it’s designed). Yet, if the shoulder is out of position in any way, the entire chain of muscles, bones and tendons throughout the arm, hand, and wrist, are compromised. To see what I mean, take a look at your shoulder and arm in the mirror from the front. Chances are, your hand is sitting in front of your body, rather than at the side, and you’re looking more at the back of your hand than just the thumb and pointer finger (internal rotation of your upper arm bone). Your tennis playing shoulder might also be lower than the other. From the side you will see that shoulder, or both shoulders, rounding slightly forward, meaning the shoulder blade and shoulder joint are out of position, and stuck in flexion. If any, or all, of these postural imbalances are present, then you have a shoulder dysfunction. When it comes time for you to hit a tennis ball, instead of your shoulder doing its job of rotating, stabilizing, flexing and extending, the elbow and wrist substitute for those tasks. The shoulder limitation then forces the wrist and elbow to become the major sources of force production, which is a job they aren’t designed to do. Hit like this for a few hours, days, or even weeks and now those muscles and tendons, which attach directly into that elbow, get awfully sore, and tired and they tell you with pain.
The short-term solution, of course, is to continue to rest and ice, but to permanently solve your elbow pain you need to change the position of the shoulder. Here are some exercises that will help restore the position, and function of the shoulder, and relieve the pressure off the wrist and the elbow.
Standing Arm Circles: This exercise restores the ball and socket function of the shoulder that is lost when a shoulder is stuck in flexion (rounded forward). It will also begin to ask the muscles of the wrist, elbow and shoulder to work together again as a unit.
To do this exercise: Stand with your head up, feet squared, and arms at your sides; put your hands in the golfer’s grip, with fingers curled, knuckles flexed, and thumbs extended. Raise your arms to your sides, keeping your elbows straight, palms down, and thumbs pointing forward. Lift your arms until they are level with the shoulders. If one shoulder wants to wobble forward or pop up, lower both until they stay level. Now squeeze the shoulder blades together slightly, and rotate the arms forward (in the direction your thumbs are pointing) in a six inch diameter circle. Do it twenty-five times. Reverse the circles by turning the palms up and thumbs back. Repeat for a total of fifty times in each direction.
Standing elbow curls: The shoulder is a hinge joint as well as a ball and socket, and this exercise restores that function. It also restores the function and motion of the shoulder blades.
To do this exercise: Using both hands and the golfer’s grip (see Arm Circles), raise the palm-out so that the flat area between the first and second knuckle joints of the index and middle fingers rests on the temples in front of the ears; the thumbs are extended downward, parallel with the cheeks. Draw the elbows back evenly and in line with the shoulders. From this starting position, slowly swing the elbows forward until they touch in the front. Keep the knuckles in contact with the temples, the thumbs fully extended and the head erect. If the head moves back and forth, stand up against a wall, slow down, and breathe deeply. Do twenty-five Elbow Curls.
One Arm Circumduction: This exercise restores the normal glide function within the shoulder joint.
To do this exercise: You will need a low bench that will allow you to stand beside it with one leg straight and the other bent at 90 degrees while resting on the surface of the bench. Bend at the waist, placing the hand that is opposite to the straight leg palm-down on the bench for support. Position a five-pound weight under the free hand, where you can reach down and pick it up. The weight should be in a vertical position so that you can grasp its head. Hold the weight lightly – don’t clench your hand or throw your arm muscles into a hard contraction – as you gently swing the fully extended arm in a small circle. Your arm isn’t “windmilling” up and over the head and around; it is inscribing small, easy circles on the floor. Circle twenty times clockwise, and twenty times counter clockwise, then repeat on the other side.
Upper Spinal Floor Twist: This exercise restores rotation to the spine and puts the arms and shoulders back in the same plane. To do this exercise: Lie on one side in the fetal position with your arms straight out ahead of you on the floor. Open the top arm to the other side and look in the same direction. Do NOT let your knees come apart while moving the arm to the other side. You can take your bottom arm over to hold the knees together. HOLD this position for one minute and allow your body to open up.
Gravity Drop: This exercise gets the shoulders, hips, knees and ankles to reconnect under vertical load.
To do this exercise: Wearing rubber soled shoes for traction stand on a step or stairway as though you were climbing upward. Feet are parallel, and hip width apart. With one hand or both, hold onto a railing or other object for support. Edge your feet backward until the heels are off the stairs and your feet are hanging onto the stair with the balls of your feet. Make sure feet remain pointed straight ahead. Let the weight of your body drop your heels off the stair. You will feel a great stretch in your low leg musculature. The key is to keep your hips over your heels and your shoulders in line with them as well. Hold for three minutes.