What can athletes do to reduce their risk for tennis elbow?
What treatments are available for those suffering from tennis elbow?
Learn more from Dr. Nicole Deal, a UVA expert in elbow injuries.
Selected Podcast
Treating and Preventing Tennis Elbow
Featured Speaker:
Nicole Deal, MD
Dr. Nicole Deal is a board-certified orthopedic surgeon and hand surgeon whose specialties include caring for patients with hand, wrist, elbow and upper arm injuries. Transcription:
Treating and Preventing Tennis Elbow
Melanie Cole (Host): Tennis elbow is a painful condition of the elbow caused by overuse and, not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities can also put you at risk. So, what can athletes do to reduce their risk for tennis elbow? My guest today is Dr. Nicole Deal. She’s a board certified orthopedic surgeon and hand surgeon who specialties include caring for patients with hand, wrist, elbow and upper arm injuries at UVA Health System. Welcome to the show, Dr. Deal. Tell us a little bit about what tennis elbow is. People have heard this term for years. What exactly is it?
Dr. Nicole Deal (Guest): Well, thanks, Melanie. It’s an overuse injury, as you said. It’s a painful condition about the outside or the lateral part of the elbow which is really a tendonitis – an inflammation of where the muscles insert on bone in that region of the elbow.
Melanie: What are the causes of this injury? Is it strictly overuse?
Dr. Deal: In general, yes, it is overuse. It’s a myth that it’s always caused by tennis. In fact, I frequently see it in patients who don’t play tennis, although I do see it in tennis players also. It’s a really common condition.
Melanie: So, what other activities? Does golf cause this? What about the pitchers who now have pitching limits on how many times they can pitch?
Dr. Deal: Sure. That tends to be an unrelated thing in younger athletes. This is more of 30’s to 40’s to 50’s type of age range and sometimes we see it in people who go out and do an overuse activity--sort of a weekend warrior type of a thing. Another example is people who are taking up weight lifting. Golfers can get it but that tends to be more on the inside part of the elbow. It’s just when people don’t listen to their body and they try to push through an activity that’s really causing them a lot of discomfort.
Melanie: Let’s start with prevention, then. Is there anything that you recommend people can do to prevent this painful condition?
Dr. Deal: Sure. What I just said, I think, is the very most important and that is just to really listen to your body. If you’re going out and doing an activity that is actually painful--you know, we all get sore from time to time and we all want to be physically fit--but if you’re doing something that’s really bothering you and that lasts for a long time after the activity and limits your ability to do your daily activities, then you’re doing too much. You really need to back off and see someone and learn how to get fit without hurting yourself. I would say that’s number one. Number two is, really think about stretching before you do activities. If you’re feeling a little bit of discomfort after an activity, consider icing after activity and sometimes anti-inflammatory medications, like ibuprofen, can be really helpful on an intermittent type of basis. You don’t want to take those all the time but if you have a little flare up, sometimes those of us who are in that age range need a little help.
Melanie: You said stretching. People really don’t know to stretch the area and the tendons around the elbows. Give us some advice.
Dr. Deal: Sure. There are some good online resources about that. If you have tennis elbow, you’ll notice that tone of the most painful activities is holding your arm away from your body with your elbow straight and trying to raise your wrist. That really tends to hurt, so if you can get in a position where you’re doing that activity but you’re stretching the wrist down and pulling gently on those muscles and sort of warming those up before you begin to do your activities, that can really help quite a lot.
Melanie: Then, you mentioned icing afterward and we’ve seen the athletes with their elbow jammed into a bucket of ice and then, what? Some people like to brace Dr. Deal. What do you think about bracing?
Dr. Deal: Sure. So, a lot of people come in with what’s called a counterforce brace on their arm and you can get those over the counter. They are straps that go around just below the elbow to sort of hold your arm. What I see people do--and some people love those--but what I see people do that’s an error is wearing it extremely tight because that actually exacerbates the problem. I think if you’re going to use that particular type of brace, you should use it as a reminder to yourself how “my elbow’s a little sore. I better not do those extreme activities” but don’t wrap it so tightly that it’s really pinching that part of the elbow because that’s not helpful either. One brace that is helpful can be a wrist brace and that sounds strange but we talked at the beginning about how these muscles are the muscles that are on the outside part of the elbow, they actually don’t work they elbow, they work the wrist. If you can rest your wrist, you really rest those muscles that are constantly working to pull your wrist up.
Melanie: If they do some strengthening exercises like forearm exercising, flexion and extension of the wrist, do those help or are they counterproductive?
Dr. Deal: They can help. I think once you’re in the acute inflammatory phase, strengthening is not a good idea. You need to get out of the extremely uncomfortable phase before you can begin to strengthen. The first thing is to really stretch it out, rest it, let those tissues heal. You can think of this as a micro-tearing of the muscle, if you will. So, it’s actually an injury that needs to heal before we can begin to strengthen again.
Melanie: That’s such great advice and if it does become really, truly problematic and somebody is an athlete and they really need to kind of get through this, what treatments are available?
Dr. Deal: There are a few things. The first thing we do, even in athletes, is really have you see our therapist because they can educate you in ways to prevent this becoming a chronic problem and also begin strengthening you in safe ways. We brace your wrist when we see you the first time, too, for a few weeks, and put you on a course of anti-inflammatories. If those modalities fail to alleviate all your symptoms, we can consider doing cortisone injections into the region. That is not always beneficial for people. Some people have great relief and some people don’t.
Melanie: I’m glad you brought up cortisone because some people do want to come in for those more than is indicated. If they do work, how many are you willing to give somebody before you say “no more”?
Dr. Deal: Not more than a couple and not more frequently than a couple of times a year. If you’re having them more frequently than that, you can weaken the tissues and also it’s putting a band aid on something that you really should be trying to heal using other methods. Sometimes--very, very rarely--this does become a surgical problem and we do operate on this. I would say that’s a very uncommon thing to have to do.
Melanie: In just the last few minutes, kind of reiterate your best advice about maybe cross-training, resting and using flexibility and stretching it, ice. Kind of wrap it all up for us.
Dr. Deal: Sure. I think if you’re having symptoms of tennis elbow, you know, we all want to just push through and keep doing that activity. “Hey, I want to have stronger arms, etc.” Back off a little bit. Do a little more cardio, do your legs. Let your body have a chance to heal and then see someone. Let us help you figure out the way that you can achieve your physical fitness goals or get back to the level of activity you want in a safe way that you’re not going to consistently inflame this area and make it a chronic problem.
Melanie: Dr. Deal, why should patients come to UVA Orthopedics for elbow and other arm injuries?
Dr. Deal: Well, we have a great center called the “UVA Hand Center” and we have four specialty-trained upper extremity surgeons and two physician assistants on site who specialize in treatment of the arm, including tennis elbow. In additional, we have our therapists right on site with us. We can take x-rays if we need to and we can do injections right there in the UVA Hand Center also. So, it’s a one stop place to go to have all of your diagnosis and your treatment in one spot.
Melanie: That’s great information. Certainly very useable things people can do right now, today. Thank you so much, Dr. Deal, for being with us. You’re listening to UVA Health System Radio. For more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
Treating and Preventing Tennis Elbow
Melanie Cole (Host): Tennis elbow is a painful condition of the elbow caused by overuse and, not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities can also put you at risk. So, what can athletes do to reduce their risk for tennis elbow? My guest today is Dr. Nicole Deal. She’s a board certified orthopedic surgeon and hand surgeon who specialties include caring for patients with hand, wrist, elbow and upper arm injuries at UVA Health System. Welcome to the show, Dr. Deal. Tell us a little bit about what tennis elbow is. People have heard this term for years. What exactly is it?
Dr. Nicole Deal (Guest): Well, thanks, Melanie. It’s an overuse injury, as you said. It’s a painful condition about the outside or the lateral part of the elbow which is really a tendonitis – an inflammation of where the muscles insert on bone in that region of the elbow.
Melanie: What are the causes of this injury? Is it strictly overuse?
Dr. Deal: In general, yes, it is overuse. It’s a myth that it’s always caused by tennis. In fact, I frequently see it in patients who don’t play tennis, although I do see it in tennis players also. It’s a really common condition.
Melanie: So, what other activities? Does golf cause this? What about the pitchers who now have pitching limits on how many times they can pitch?
Dr. Deal: Sure. That tends to be an unrelated thing in younger athletes. This is more of 30’s to 40’s to 50’s type of age range and sometimes we see it in people who go out and do an overuse activity--sort of a weekend warrior type of a thing. Another example is people who are taking up weight lifting. Golfers can get it but that tends to be more on the inside part of the elbow. It’s just when people don’t listen to their body and they try to push through an activity that’s really causing them a lot of discomfort.
Melanie: Let’s start with prevention, then. Is there anything that you recommend people can do to prevent this painful condition?
Dr. Deal: Sure. What I just said, I think, is the very most important and that is just to really listen to your body. If you’re going out and doing an activity that is actually painful--you know, we all get sore from time to time and we all want to be physically fit--but if you’re doing something that’s really bothering you and that lasts for a long time after the activity and limits your ability to do your daily activities, then you’re doing too much. You really need to back off and see someone and learn how to get fit without hurting yourself. I would say that’s number one. Number two is, really think about stretching before you do activities. If you’re feeling a little bit of discomfort after an activity, consider icing after activity and sometimes anti-inflammatory medications, like ibuprofen, can be really helpful on an intermittent type of basis. You don’t want to take those all the time but if you have a little flare up, sometimes those of us who are in that age range need a little help.
Melanie: You said stretching. People really don’t know to stretch the area and the tendons around the elbows. Give us some advice.
Dr. Deal: Sure. There are some good online resources about that. If you have tennis elbow, you’ll notice that tone of the most painful activities is holding your arm away from your body with your elbow straight and trying to raise your wrist. That really tends to hurt, so if you can get in a position where you’re doing that activity but you’re stretching the wrist down and pulling gently on those muscles and sort of warming those up before you begin to do your activities, that can really help quite a lot.
Melanie: Then, you mentioned icing afterward and we’ve seen the athletes with their elbow jammed into a bucket of ice and then, what? Some people like to brace Dr. Deal. What do you think about bracing?
Dr. Deal: Sure. So, a lot of people come in with what’s called a counterforce brace on their arm and you can get those over the counter. They are straps that go around just below the elbow to sort of hold your arm. What I see people do--and some people love those--but what I see people do that’s an error is wearing it extremely tight because that actually exacerbates the problem. I think if you’re going to use that particular type of brace, you should use it as a reminder to yourself how “my elbow’s a little sore. I better not do those extreme activities” but don’t wrap it so tightly that it’s really pinching that part of the elbow because that’s not helpful either. One brace that is helpful can be a wrist brace and that sounds strange but we talked at the beginning about how these muscles are the muscles that are on the outside part of the elbow, they actually don’t work they elbow, they work the wrist. If you can rest your wrist, you really rest those muscles that are constantly working to pull your wrist up.
Melanie: If they do some strengthening exercises like forearm exercising, flexion and extension of the wrist, do those help or are they counterproductive?
Dr. Deal: They can help. I think once you’re in the acute inflammatory phase, strengthening is not a good idea. You need to get out of the extremely uncomfortable phase before you can begin to strengthen. The first thing is to really stretch it out, rest it, let those tissues heal. You can think of this as a micro-tearing of the muscle, if you will. So, it’s actually an injury that needs to heal before we can begin to strengthen again.
Melanie: That’s such great advice and if it does become really, truly problematic and somebody is an athlete and they really need to kind of get through this, what treatments are available?
Dr. Deal: There are a few things. The first thing we do, even in athletes, is really have you see our therapist because they can educate you in ways to prevent this becoming a chronic problem and also begin strengthening you in safe ways. We brace your wrist when we see you the first time, too, for a few weeks, and put you on a course of anti-inflammatories. If those modalities fail to alleviate all your symptoms, we can consider doing cortisone injections into the region. That is not always beneficial for people. Some people have great relief and some people don’t.
Melanie: I’m glad you brought up cortisone because some people do want to come in for those more than is indicated. If they do work, how many are you willing to give somebody before you say “no more”?
Dr. Deal: Not more than a couple and not more frequently than a couple of times a year. If you’re having them more frequently than that, you can weaken the tissues and also it’s putting a band aid on something that you really should be trying to heal using other methods. Sometimes--very, very rarely--this does become a surgical problem and we do operate on this. I would say that’s a very uncommon thing to have to do.
Melanie: In just the last few minutes, kind of reiterate your best advice about maybe cross-training, resting and using flexibility and stretching it, ice. Kind of wrap it all up for us.
Dr. Deal: Sure. I think if you’re having symptoms of tennis elbow, you know, we all want to just push through and keep doing that activity. “Hey, I want to have stronger arms, etc.” Back off a little bit. Do a little more cardio, do your legs. Let your body have a chance to heal and then see someone. Let us help you figure out the way that you can achieve your physical fitness goals or get back to the level of activity you want in a safe way that you’re not going to consistently inflame this area and make it a chronic problem.
Melanie: Dr. Deal, why should patients come to UVA Orthopedics for elbow and other arm injuries?
Dr. Deal: Well, we have a great center called the “UVA Hand Center” and we have four specialty-trained upper extremity surgeons and two physician assistants on site who specialize in treatment of the arm, including tennis elbow. In additional, we have our therapists right on site with us. We can take x-rays if we need to and we can do injections right there in the UVA Hand Center also. So, it’s a one stop place to go to have all of your diagnosis and your treatment in one spot.
Melanie: That’s great information. Certainly very useable things people can do right now, today. Thank you so much, Dr. Deal, for being with us. You’re listening to UVA Health System Radio. For more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.