Tennis elbow is the pain located on the outside of the elbow most commonly occurring when gripping. It is associated with playing tennis, but can affect activities from doing the house work to shaking hands with a friend. For many people, especially coaches or serious tennis players, tennis elbow can become the bane of your life. I know because I am a tennis coach who had a 12 month battle with tennis elbow and I would like to share my experience with you in the hope of helping other coaches or tennis fanatics overcome the injury.
Tennis elbow is an overuse injury - technically called lateral epicondyle - that affects the tendon on the outside of the elbow. For a tennis player it most commonly occurs due to the constant stress on the tendon from hitting 1000's upon 1000's of balls. This stress can be compounded by mistiming the ball, especially on the one handed backhand. Interestingly the incidence of tennis elbow is far less common in double handed backhands.
In my case it was caused by trialling a stiffer racket - so many of today's modern rackets and strings create a stiffer feel which can place extra stress on the elbow tendon. After just one hour the pain had become extreme and I was to endure it for over twelve months. As a full time tennis coach this was a less than ideal scenario.
With my income on the line I quickly had to get to work treating the problem. As a coach rest was not an option, but I was quickly on the internet - which has a huge amount of data on tennis elbow. In no particular order I undertook the following treatment program:
- Physiotherapy. Once a week massage and manipulation ran into $1000's of dollars over time.
- Anti inflammatory drugs. 3 times a day I took ibuprofen with a cup of green tea [which was highly recommended treatment also]
- Strengthening and stretching. 3 times a day I completed a routine which aimed to strengthen and stretch the forearm extensors and triceps surrounding the elbow joint.
- Elbow brace. I trialled several forms of elbow strap which were designed to take the stress away from the elbow tendon.
- Heat and ice. Three times a day I would ice the elbow then put a heat pack on to stimulate the healing process.
- Acupuncture. Once no progress was achieved with physio I took a course of acupuncture each week.
- Rest. After several months of frustration I set aside 1 month where I would play no tennis.
- Changing racket and string combination.
Despite my best efforts I was experiencing no improvement and the injury was in fact deteriorating.
Various invasive procedures like injecting cortisone were the next option, but this procedure had very weak evidence of success. Using my favorite research tool the internet I turned up a procedure which was achieving promising results called an "autologous blood injection." This involves drawing blood from your body and re-injecting into the elbow. The injection is made under CT scan so that it is made at exactly the right point on the elbow tendon.
The theory is that when blood is taken from the body it reacts by releasing its healing agents. When that blood is then re injected into the injured elbow tendon it will speed the healing process. Tendons are notoriously slow healers as they don't have the blood flow that muscles enjoy. The autologous blood injection gives the tendon the "kick along" it needs. The research on the blood injections showed promising results, although often patients need 2 - 3 injections to fully resolve the problem.
I was prepared to try it. The first step was to visit a sports physician who scheduled a scan on my elbow. Sure enough the scan showed a significant tear in the elbow tendon. Next the injection was organized to be performed by a very well regarded surgeon under CT scan. While a local anesthetic was administered the procedure was very painful. This pain however was short lived, and I was quite comfortable 1 - 2 hours after the injection.
The first week I completely rested the arm in a sling to give the procedure the best chance of success. After two weeks the tennis elbow appeared to have gone. For the first time in twelve months I was able to play and coach without pain - I would estimate it has been a 90% recovery and a fantastic result.
Clearly each case of tennis elbow is different - and sufferers should consult their physio and sports physician to get the best possible diagnosis and treatment. My particular injury was a tendonosis, which is a degenerative problem and therefore a candidate for the autologous blood injection. Tendonitis might be treated by more traditional methods.
What I would recommend is that chronic sufferers of tennis elbow consider the autologous blood injection with their doctor if they can't shake the injury. It worked for me after one injection. The pain and frustration of tennis elbow was ruining my tennis career, the blood injection was nothing short of a miracle for which I am very grateful.