April 2006 -- Question: I have not seen very much recent information on the prevention of tennis elbow. Would you please share the latest thinking on how to prevent this common problem that faces many tennis-teaching professionals?
Answer: I am glad you asked that question. As professionals, we must stay acutely aware of how to prevent injury in our sport. This is especially true since the game is growing and I believe it will continue to grow. Injury prevention must stay front and center on our radar screen and tennis elbow is at or near the top.
Although I try to stay on top of the latest literature regarding sport injury, I felt that I really needed to reach out to some esteemed colleagues to be sure I offered you the best information. I asked for input from orthopedic surgeon Dr. Ben Kibler; physical therapist and chair of the USTA Sport Science Committee, Todd Ellenbecker, PT; biomechanist and director of player development for the USTA, Paul Roetert, Ph.D.; ATP tour orthopedist Dr. Gary Windler; and USTA Sport Science administrator and biomechanist, Scott Riewald, Ph.D. I thought I would answer this question for both students and teachers alike, so please do post this article if it makes sense to you. Here is what I found:
Although there are various suggestions for preventing tennis elbow, the importance of strengthening was noted by everyone. In fact, the surprising part was the almost unanimous agreement on this point. Obviously, the forearm extensors need to be strong since they support the main brunt of force. However, forearm extensor strengthening was closely followed by strengthening the entire upper arm and shoulder girdle, and on into the entire linked system. Most of our experts agree that, to truly prevent tennis elbow, a total body strength training program is necessary; one that involves the legs and torso as well.
In all cases, strength must not only be the maximum force exerted, but endurance must also be considered, especially in the forearm extensors since it has been proven that they constantly fire during the entirety of a tennis match. Muscle fatigue, from a lack of endurance, will prevent the muscle from adequately supporting the elbow joint, thus causing elbow pain.
The next point discussed by almost everyone was flexibility. It has been found that joint range of motion is critical to creating optimum force and accommodating the impact forces of tennis strokes. So, specific stretching of the forearm extensors and general stretching of the other body joints is highly recommended.
The importance of a warm-up and cool-down were cited as well. A slow general warm-up that involves the entire body and then a specific warm-up that isolates the elbow muscles will be highly helpful in preventing elbow problems. A cool-down period should also be general (whole body) and specific with stretching involved. The stretching periods noted above should occur after the warm-up period and after play has stopped.
The next point mentioned by the majority of the experts was that you should always consult with your teaching professional regarding the best equipment for you, your body, and your game style. In general, you will want to have a slightly larger grip size than what you might “feel” is ideal (again, your teaching professional can help you with this). Tennis racquets are developed with strict science and engineering technology in mind. Have your teaching pro help you with the racquet stiffness that fits your needs and keep the string tension within the recommended ranges noted on the racquet frame.
Finally, and in many ways, most importantly, you must examine your technique. Suboptimal technique will definitely lead to injury. But, this is where your teaching professional plays a huge role in your life. What looks like poor technique to a layperson may very well be quite efficient. For example, when Bjorn Borg hit the tennis scene in the ’70s, many thought he wouldn’t be in the game long because of his unorthodox strokes. As we all know, five Wimbledon and six French Open championships later, no one questions that perhaps he looked unorthodox, but he was actually quite efficient.
In summary, there are still many questions as to how to really prevent tennis elbow. All of our experts agreed that we likely have fewer answers than we have questions. In fact, Dr. Kibler took a light-hearted approach to the fact that people over 40 are much more likely to develop tennis elbow. His prevention tip – “Don’t get old.” Now, since that’s not possible, there are some practical things you can do to prevent general elbow problems. There are no guarantees, but we can minimize the occurrence of this problem if we stay diligent and thorough in our training.
Send questions to jgroppel@LGEPerformance.com.
