Player Analysis - Tennis Elbow

The other day a player came up to me to mention that he had been dealing with a bad case of tennis elbow.  The pain is worse in general when playing, but especially when doing backhand blocks.

After explaining his symptoms, he proceeds to show me how he moves his arm to block a shot to his backhand.  He demonstrates getting into a wider, stable stance with his knees bent - great!  His forearm comes in towards his chest in anticipation for the ball, movement generated by the shoulder - great.  He then demonstrates the return and follow through.  While his shoulder does a considerable amount of the effort of absorbing the ball's force and following through, his wrist also flicks back every time he does so.  The shoulder motion is great, the wrist flick not so much (I do want to mention that this player was not going out of his way to try to use his wrist as a method to impart spin on these shots).

So what does the wrist have to do with tennis elbow? Everything, actually.  The same muscles that allow our wrist to extend/bend back actually connect all the way up at the outer elbow.  Repetitive overuse of these muscles and their associated tendons causes inflammation (and eventually physiological changes to the tendons themselves), and this causes the issue we commonly call tennis elbow.

After doing some explaining, his wife asks me if this issue can be healed by doing massage to the muscles I was just talking about.  The answer is a little more complicated than just yes or no.  If her husband had been experiencing his elbow issue for a few days, most likely he would only be dealing with inflammation caused by micro-tearing of the tendon - in this case, massage type treatment isn't necessary at all (and may introduce more swelling to already inflamed areas).  The goal there would be to rest to let the inflammation subside and the tendon heal, and then address the root cause of the overuse.

However, this gentleman had been dealing with his tennis elbow issue for several months.  What eventually happens is that repetitive overuse leads to repeated inflammation.  In response, eventually the tendons of the outer elbow heal abnormally in a way that results in a thickened and dysfunctional tendon.  The extent of dysfunction, poor healing, and injury susceptibility often becomes worse over time, and is both harder and takes longer to recover.  Though many people choose to ignore their tennis elbow issues, doing so really does create a worse issue.

In order to treat a tennis elbow where the tendon itself has become dysfunctional, soft tissue work to help address adhesions is important, as well as exercises to work on 'remodeling' (promoting proper function of healing of) the tendon.  The exercise component is essential.

Ultimately, I find the most critical part of treating tennis elbow is to see and address what is happening on the court, though.  A person could do all of the soft tissue treatment in the world, but if the way that their hitting a pickleball hundreds and hundreds of times makes them susceptible to this injury, treatment will likely be unsuccessful in the long term.  I do also want to mention that I've met numerous people who had tennis-elbow like symptoms, only to find that it was a different elbow problem, or was actually pain being caused by their neck (think similar to sciatica, but for the upper body)!  It can happen, and treatment looks very different for those issues even though they can cause similar types of pain.

I often find that players who have tennis elbow are very 'wristy' for many of their shots.  They often have weakness in the shoulder, which is likely part of why they tend to overuse their wrist.  Though it may seem counterintuitive, a lot of times footwork is also a critical thing to work on - if players aren't using their feet enough, they overuse their arm in general to make their returns.  In addition to doing an in-home exam, I also like to eventually get on the court with players to see them move and determine what aspects of their game may need to be worked on to ensure long term success.

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As the owner of Serendipity Physical Therapy and Wellness, I’m an avid pickleball addict in Naples, Florida, with a goal of keeping pickleball players moving at their best and injury free. I work with players for anything ranging from reducing various pains, weakness, or tightness, to helping with injury prevention, proper conditioning, and good technique.

If you’re new, you can check out more of my advice and content here: https://www.serendipityptw.com/blog.

If there is anything I can help you with or you have questions, please send me an email at Contact@SerendipityPTW.com. I would love to see how I can help get you moving at your best!