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Tennis elbow

Q: As one who suffers from tennis elbow, I’ve read issue after issue of Tennis magazine looking for articles dedicated to this condition, but found only scant mention of pricey medical procedures and the “Hit or Myth” column by USRSA Executive Director David Bone. I notice that many other topics repeat, but not this one.

I have had to stop playing for several months at a time only to feel a twinge while “testing the water,” getting depressed again, and stopping. I have done ice applications, taken aspirin and other over-the-counter pain killers, done rubber band stretches between my thumb and fingers, done weight curl exercises, and tried two cortisone shots. The two orthopedic doctors I consult don’t know much about tennis.

My backhand is a short “chop” (I wouldn’t even call it a stroke), which is usually when the pain really flares up. But I’ve had the same backhand stroke for 30+ years and never had real tennis elbow. It was always tolerable, especially with some aspirin before and/or after. About a year ago, I bought a new racquet because I loved how light it was in the store and I got a good price on it. It never dawned on me until later, but my tennis elbow got much worse after playing with it. “Post hoc, ergo propter hoc” does not prove causality, but as I’ve been asking supposed experts about racquets and technique and how they may contribute, I heard lots of inconsistent and conflicting messages.

I wanted to check with you to see if I understand the consensus opinion on how best to deal with tennis elbow:

1. A heavy racquet is better, as you wrote in the “Hit or Myth” Column.
2. A flexible racquet is better. Of course, 90% of the racquets seem to run from firm to stiff to very stiff. Flexible racquets are rare.
3. Strings. (a) I’ve heard they should be loose. But others have warned, “OK for tennis elbow but not good for your game, you won’t like strings too loose.” (b) I know the manufacturers make a model especially for tennis elbow sufferers, but I’d still like to know about the tension.

A: Sorry to hear about your tennis elbow. We should preface our remarks by saying that we are not doctors, and you should consider consulting a sports specialist. Most doctors will just tell you to stop playing tennis if it is causing you pain, but a sports specialist will understand how important tennis is to you and will work to get you playing again.

Something you could do immediately would be to buy a heavier, more flexible racquet, and and string it with natural gut. The heavier the racquet the better, providing it doesn’t slow down your swing speed or cause you to make late contact more often. A more flexible racquet is better at reducing shock on impact, which is part of what causes the stress on your elbow. However, with a softer frame you may have to swing a little faster to generate the same power your were used to with a stiffer frame. The good news is that most flexible racquets are heavier as well, so the added weight helps to give you back some of the power you lose by using a softer racquet (presuming your swing speed does not slow down because of the extra weight). Yes, looser strings are probably better for tennis elbow, but string tension is the last step to try changing. Keep in mind also that sometimes a thicker version of a string is more stiff than the thinner version and vice versa. You should always play with new balls, as well. An equipment change may not cure your tennis elbow, but it is quick, relatively painless, and you are probably going to wind up changing racquets and strings anyway, if for no other reason that to eliminate incompatible equipment as one of the contributing factors to your condition.

For a long-term approach, it sounds as though you need to learn a new backhand, based on your description. In our experience, once a player develops a bad case of tennis elbow, the arm becomes so sensitive that changes in equipment must be accompanied by changes in your strokes.

One of the common misconceptions about tennis elbow is that it happens slowly and gradually. It can get worse slowly, but it seems to be the result of a specific, repetitious trauma that causes the condition to worsen. This trauma can happen doing yard work or shoveling snow, and it can happen on the tennis court. When it does, it is almost always the result of poor stroke mechanics. You are probably over-stressing your arm every time you hit a backhand. The problem now is that your elbow has become so sensitive that every backhand hurts, even when you are not “chopping” it.

We would suggest that you rest the elbow for three to six months. When you return to tennis, you need to make sure you don’t re-injure it again by hitting the same backhand stroke. Once you’ve had tennis elbow you are more susceptible to getting it again, even after extended rest. Schedule light lessons for the first few weeks you are back. Only let yourself hit backhands that are bio-mechanically correct. If you don’t know what a correct backhand is, get lessons from a teaching pro who does.

See all articles by Dave Bone

From the February 2004 issue
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