Getting to grips with tennis elbow

Wimbledon is upon us. We may not have 100 mile-an-hour serves, but many of us will be out on the tennis court or at least pruning the roses. And if we do, we put ourselves at risk of the misery of tennis elbow. However, a few simple steps may help you avoid it, or at least relieve your symptoms.

Wimbledon is upon us. We may not have 100 mile-an-hour serves, but many of us will be out on the tennis court or at least pruning the roses. And if we do, we put ourselves at risk of the misery of tennis elbow.

You have two 'epicondyles' at each elbow - they're the bony lumps on either side of your elbow if you put your arm straight out with palm forward. If you get inflammation at the outer, or lateral, epicondyle, it's called tennis elbow. If you get inflammation at the inner, or medial one, it's called golfer's elbow. You get tennis or golfer's elbow when tendons, which attach the muscles of your forearms to your elbow, become damaged and inflamed. However, a few simple steps may help you avoid it, or at least relieve your symptoms.

Who gets it?

Sadly, avoiding tennis elbow isn't as simple as staying off the tennis court! Only about one in 20 sufferers get tennis elbow as a direct result of playing racket sports, since lots of activities can cause tennis (and golfer's) elbow. Every year, about one in 200 people get tennis elbow - which adds up to a lot of people affected over a lifetime. You're most likely to get it in your 30s-50s.

How can I avoid it?

The key culprits are repeated movements (such as using the same action repeatedly with a paintbrush, a spade or garden rake), especially if they involve twisting and gripping. Very heavy exercise involving your arms can also cause symptoms, and you're most likely to suffer if you suddenly start a lot of activity when you're not fit.

You don't need to avoid DIY and gardening completely, but do:

  • Build up slowly if you're exercising, and always warm up before you start
  • Throw out the heavy Bjorn Borg-style racket and invest in a lightweight modern one
  • Take regular breaks from activities that involve the same repeated movement
  • Make the most of power tools, including screwdrivers, if you do a lot of DIY
  • Avoid lifting heavy loads, especially repeatedly. Take a few trips with smaller amounts of garden waste, and lift with your whole arms rather than from the elbows.

What are the symptoms?

The main symptom is pain, usually in your dominant arm (the hand you write with). It may only be brought on by moving your elbow or wrist, especially by twisting movements like turning a doorknob. You may feel the pain only over the epicondyle of your elbow, or it can travel down your forearm. If it's severe, you can get pain at rest which may stop you sleeping. In severe cases, the pain may last for several months.

How can I relieve the symptoms?

Your body will tell you which movements are putting further strain on the affected tendons by bringing on the pain. Try to avoid these as much as you can. Sometimes, trying to take a complete rest from any lifting, twisting or gripping for a few days will reduce inflammation and start the healing process, especially if you combine it with anti-inflammatory medicines.

An ice pack on the painful area (never apply ice directly on to your skin) for 10-15 minutes can help relieve symptoms. If your symptoms persist, your doctor may recommend a steroid injection straight into the most tender spot, although this may only help in the short term (for a few weeks). Physiotherapy may help more in the long term if your symptoms are severe.

Will painkillers help?

Anti-inflammatory tablets like ibuprofen will often be particularly helpful because they reduce inflammation as well as pain. You can get them as tablets, or as a gel to rub into the painful spot. Gels and creams can be especially helpful if you get indigestion or other side effects when you take anti-inflammatory tablets. Painkillers like paracetamol can also help.

How do I decide which treatment is best for me?

The options for treating tennis elbow include; 'watchful waiting' (just resting and particularly avoiding activities which make your symptoms worse), using regular or 'as needed' painkillers, physiotherapy, steroid injection into the affected part or surgery. Each option carries risks as well as benefits. For instance, the one benefit of watchful waiting includes avoiding over treatment for a condition that often settles on its own within six to 12 weeks. The risk is that it can be hard to know if you're in the one in five people whose symptoms will take from six to 24 months to settle without treatment, and rest is often easier said than done. To help you understand all the treatment options, and their benefits and consequences, see our Brief Decision Aid for tennis elbow. Going down one route doesn't mean all other avenues are closed if the first option doesn't work, but the aim of Brief Decision Aids is to put you in the best position to make an informed decision about which options might be suitable for you and how they fit with your lifestyle.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.