Exercises for Tennis Elbow

These simple exercises for tennis elbow will allow you to shake hands without wincing, lift your mug of tea - and sleep through the night more comfortably for the first time in ages. And the good news here is that you can do more to rectify this problem yourself than any formal physical therapy treatment for tennis elbow. 

What Causes Tennis Elbow? 

Tennis elbow is caused by strenuous clenching activities of the wrist, such as when using secateurs, or with specific back-wrist actions such playing the backhand at tennis. It's all to do with where the powerful wrist extensor muscles glue themselves to the bone on the outer side of the elbow. 

Strange to say, it's not so much the gripping action (that uses the flexors on the inner side of the forearm) but the very strenuous cocking-back action of the wrist, which allows you to get a stronger grip. The extensor muscles that do this have a very small area of insertion on the bone at the lateral epicondyle. With tennis elbow, you can feel this as an intensely sore knob on the outer side of the elbow.

Repeated strenuous cocking-back of the wrist sets up inflammation from the common extensor tendon tugging at the bone. As the entire muscle group becomes irritated it develops raised tone (a low-grade cramp). The arm feels sore and the muscles from elbow to wrist feel hard, cordy and painful, often requiring kneading and pummelling by the other hand to make them feel more comfortable.

Repetitive Outward Twisting of the Wrist 
also causes tennis elbow

The supinator muscle of the forearm also has a very strong action. It twists the wrist outwards, as seen with turning a doorknob or using a screwdriver (the opposite action of pronation - turning the doorknob the other way - is a much weaker action, which is why all doorknobs turn the same way to open). The tendon of this powerful muscle of the upper forearm blends with the wrist extensors, inserting into the same small area of bone (the common extensor origin) at the elbow. This adds to the tugging on the bone and results in residual clench of the muscles. 

So what are the best exercises for tennis elbow?

The exceedingly strong action of supinator pinches shut the outside elbow compartment and makes the joint run out of kilter as it opens and closes. With the loss of joint space the bones start chafing and running hot, creating additional joint inflammation and pain. The outside of the elbow losing 'joint play' also clutters the head of the radius bone below the elbow, making it harder to twist the forearm (you notice this particularly with writing). This is why exercises for tennis elbow also involve purposeful stretches of the inner side of the forearm; they are designed to pull down the radial head to help release it, see below.  

In addition, it may be necessary to have the elbow mobilised, particularly the radial head. It is not a comfortable mobilisation but the effects are profound and almost immediate. 

You can also mobilise your own elbow to open the lateral compartment and gap the joint space. It is quite tricky getting the angle correct and you literally have to lean in to the inner side of the elbow with the heel of your other hand, with a sideways shunting action from the inside out, to forcibly straighten out the lateral kink of the elbow. The force creates an uncomfortable but nevertheless pleasing 'sweet pain' right through the elbow and down the arm. After several seconds only, the joint runs freer and is less painful. 

In the book Body in Action (known in the UK as Keep Your Joints Young) Sarah Key explains how all joints need the critically important essence of 'joint play' to give the bones internal manoeuvrability. This lets them lever against each other properly so they can run true and be accurate in what they do. Sarah explains the idiosyncratic 'hidden accessory movements' of each joint - shoulder, wrist, hip, knee, ankle and foot - that make each of them healthy and floppy and loose, like a floppy bag of bones. Also explained are the stretching exercises you can do yourself, which include spinal stretching exercises.

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The 'arms tangle' is one of the most effective exercises for tennis elbow as it mobilises the radial head as well as opening the lateral compartment of the joint. It is another of those seemingly innocuous but nevertheless quite difficult exercises that's worth persevering with, simply because of it's so effective immediately. You may need to read about it in the book to gets to grips with it completely. 

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