By Allen M. Maryott, DC

What is tennis elbow?

Tennis elbow is an injury of the tedons of the muscles that cock the wrist back when you make a hard fist. The injury occurs when some of the fibers attaching the wrist extensor muscles to the elbow, at a spot called the 'lateral epicondyle' are overstressed and tear.

How does it happen?

The most common cause is repetitive overuse of the forearm extensor muscles. Hitting a backhand in tennis is exactly the kind of movement that puts the greatest strain on these muscles. However, any repetitive movement in which the wrist is cocked back and pulled toward the thumb side of the forearm can cause lateral epicondylitis.

How do I know if I have it?

Tennis elbow is usually easy to diagnose. The major symptom is pain over the lateral elbow where the muscle tightens as you cock your wrist. Certain tests which stretch the involved muscles can confirm the diagnosis. X-rays and other tests are rarely needed.

Will it get better on its own and what's the risk of not getting treatment?

If the pain persists for more than a week or two, or it returns when you resume the activity that caused it, you should seek treatment. To understand the risk of not treating tennis elbow, it will help to understand how your body heals.

When you are injured, your body repairs the damage with 'scar tissue'. Scar tissue is a non-specific type of tissue which is not identical to the original. In the case of an injured tendon, the major difference between the original and the scar is in the alignment of the fibers. The original fibers of the tendon are all aligned roughly parallel to each other -- like uncooked spaghetti in a box. Scar tissue, on the other hand, is laid down like a patch of cooked spaghetti. The more of an angle the scar fibers have to the original alignment, the easier it is to break them--and start a new inflamatory process and additonal scarring. This process of forming a scar and then breaking it can become so bad that even simple activities that use the muscles of the back of the elbow, such as opening a door or picking up a cup of coffee, can be impossible because of the pain.

What is the treatment?

Treatment depends on the severity and duration of the injury. In milder injuries of shorter duration, ice, rest and specialized cross fiber massage are sufficient. Cross fiber massage actually breaks down scar tissue and remodels the scar so it looks and functions more like the original tendon. In more severe or chronic cases bracing, deep massage of the muscles and manipulation of the elbow joint may be necessary.

How long will it take?

If you get appropriate treatment and follow your physicians instructions, the time it takes to heal depends on three factors: the severity of the injury, the length of time you have had the problem and your general state of health. Generally, this means two to six weeks. Supportive bracing may be needed for as long as six months.

Will it recur?

Re-occurrence can be prevented by either stengthening the forearm extensor muscles and tendons and/or decreasing the stress activity in the activity which provoked the problem. If the injury resulted from playing tennis, a more resilient graphite or ceramic racket strung at slightly less pressure will help. Sometimes the cause is bad form, usually hitting a backhand. In this case, it is necessary to correct your form. The use of a tennis elbow brace may also be of help.