Not to put too fine a point on it, but tennis season is now in full swing. The legendary Wimbledon tournament is coming down the home stretch, and all over the world from Croatia to Germany to Atlanta, tennis is coming into its biggest time of year.

I feel sometimes as though I should hop on a plane to follow and to treat those countless weary, painful elbows.

For many traveling players, as well as those here in Newburyport, there may be a residual pain radiating from the elbow to the wrist and tenderness on the outside of the elbow. We call this “tennis elbow.”

There are other symptoms, as well, and some limitations in movement. Stiffness in the morning is common, as is pain from gripping and from other movements of the wrist, including lifting, especially with the palm down. It could include pain while pouring from a container or sweeping, and even doing such simple tasks as using a toothbrush, knife or fork.

Anyone can get tennis elbow. People who are most at risk are those who do repetitive movements using the wrist, forearm and elbow, especially if gripping something at the same time: tennis racket, hammer, baseball or others. The term “tennis elbow” came about from an 1883 paper titled “Lawn-Tennis Elbow” in the British Medical Journal.

What’s happening in your body?

Let’s start with what I’m calling the outside of the elbow. Put your arms out in front of you with your palms facing upward. In this position, called the anatomical position, the outermost part of each elbow is called its lateral side; the other side is the medial side. Tennis elbow affects the lateral side of the elbow. If the pain is on the medial elbow, then it’s called “golfer’s elbow”; I’ll focus on the more common tennis elbow.

In either case, it’s a serious nuisance and needs some help.

Your forearm has 20 muscles that control a wide variety of movements of your hand, fingers, wrist and your forearm itself. For simplicity, these fall into three groups: those that flex your elbow, wrist, hands and fingers (flexors); those that extend (extensors); and those that rotate (pronator/supinator). Tennis elbow is mainly concerned with the extensors and, more specifically, the tendons of the extensors that attach to the outside of the upper arm bone (humerus) at the elbow.

There may be different causes of the symptoms, but generally, there is some tearing or other damage to the common tendon of the extensors at the elbow.

Contemporary studies suggest that over half the cases may be caused by some trauma such as getting hit on the elbow or doing a sudden forceful pull or extension. In tennis, this might come about through playing incorrectly. That is, the shock of mishitting the ball could cause early stages of tennis elbow. It’s possible also that your tennis elbow is an acute or chronic inflammation and degeneration of the tendons resulting from their being damaged from overuse, frequently repeating the same motions; this was the conclusion of earlier experiments.

Treating tennis elbow

Surgery should be a last resort when other options have been exhausted. And there is little evidence to suggest than any kind of injection (cortisone, for example) is particularly useful. The main body of evidence suggests that with a bit of help, your body can heal itself 90 percent of the time.

Clearly, a first consideration in pain control is to stop or significantly reduce whatever is the activity that brought on the tennis elbow. The longer you can rest the forearm, the faster your body can heal tears or other damage to tendons. In some cases, you may be able to find alternative ways of doing the troublesome activities.

Also early on, use an ice pack on the elbow 20 minutes at a time two or three times daily. If you are comfortable using over-the-counter pain relievers such as aspirin or ibuprofen, they may help control pain. In addition, bracing or taping just below the elbow or at the wrist may help redistribute the forces acting on the tendons and joints.

In my practice, the soft tissue treatment I use for tennis elbow frequently has a double benefit: pain relief and needed postural re-education of your forearm. This gentle treatment provides the nervous system correction and balance that allows you to take full advantage of the exercise program I mention below.

Beyond those ideas, you may wish to start a program of gentle strengthening and stretching. A 2009 study by Timothy Tyler et al. showed remarkable pain relieving effectiveness of what’s called “eccentric” exercise; this means actively contracting a muscle while lengthening it.

Preventing tennis elbow

The human body is naturally pain-free, but the bumps and bruises, anxieties, and stresses of daily living in the real world undermine our natural balance, leaving us open to injury and other distress. It’s for good reason that I come back often to the idea that the best defense against problems is preventing them in the first place. For tennis elbow, the prescription is straightforward: stretch and strengthen.

Here are a couple of wrist-focused stretches that will help to prevent tennis elbow. These work because the muscles you are stretching are those that get irritated in tennis elbow.

Stretch your wrist

1. Extend your arm in front of you with your palm up.

2. Bend your wrist back so that your fingers point toward the floor.

3. With your other hand, gently bend your wrist further. You should feel a gentle stretch in your forearm.

4. Hold this position for 30 seconds, and repeat two or three times.

5. Now, do the same four steps as above, but start with your palm facing downward.

The handshake

1. Hold a can, or similar weight, in your hand with your thumb pointing upward. You may wish to stabilize your forearm by resting it on a table. It’s as though you were shaking hands with the can.

2. Slowly move the weight up and down using your wrist only. At the extremes, hold the stretch for at least 10 seconds, and repeat several times.


Using the same starting position as the handshake, rotate your wrist from side to side. Again, hold the position for about 10 seconds at the extreme of each rotation.

Balance in all things, especially the musculature, is critical to maintaining a healthy, pain-free body.

Bob Keller maintains a holistic pain management practice in Newburyport. His book, “Making Sense of Medicine: Medical Matters Made Simple,” is available locally or online. He can be reached at 978-465-5111 or