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[PATIENT ADVISER]

Keeping Tennis Elbow at Arm's Length: Simple, Effective Strengthening Exercises

Robert P. Nirschl, MD, MS; Barry S. Kraushaar, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 5 - MAY 96


Tennis elbow involves damage to the forearm muscles and tendons. Rehabilitation from this painful condition usually includes rest, icing, stretching exercises, improving tennis technique, and using an elbow strap called a counterforce brace. But perhaps the most important part of rehabilitation is strengthening exercises, which both promote recovery and help keep tennis elbow from returning.Two types of exercise will help you regain strength: exercises with weights and exercises without.

Exercises without weights. Effective strengthening exercises without weights can be done with a thick rubber band and a tennis ball. Do these exercises first with your elbow bent at your side, then progress over time to doing the exercises with your arm out straight in front.

For the finger extension exercise, place a thick rubber band around your fingers and thumb near the base of your fingers. With your palm facing the floor, spread your fingers apart as much as possible. Hold for 3 seconds, then release. Repeat until your fingers and forearm grow tired. After this becomes easy, slide the rubber band closer to your fingertips. When you can readily do the exercise from the fingertips, graduate to a thicker rubber band.

To do the hand squeeze, hold a tennis ball in your palm. Squeeze the ball firmly and hold for 3 seconds, then relax. Repeat until your muscles grow tired. If this exercise is difficult at first, start with a foam ball or racquetball and progress to a tennis ball.

Do these two exercises several times each day. It's a good idea to have tennis balls and rubber bands in convenient places, like at your desk and by the telephone. Continue to do tennis ball and rubber band exercises through the duration of the weight training program described below.

Exercises with weights. Before each weightlifting session, work up a light sweat with 3 to 5 minutes of brisk walking, cycling, or jogging, or warm the elbow directly by using a hot pad. Also, progress gradually: This is extremely important to prevent reaggravating the injury. If you have been prescribed a counterforce brace, wear it while doing the following exercises (figures 1 and 2).

Begin with no weight, and do a set of 10 to 15 repetitions (reps) daily. Once you can comfortably do 30 reps for two consecutive sets, use a 1-pound weight and go back to 10 to 15 reps. Work up to 30 reps.

Over time, increase the weight in 1-pound increments to 3 pounds, then in 2-pound increments to 5 to 7 pounds. But work up to only 20 reps with 3-pound weights and above. At the 3-pound level, gradually work toward straightening your elbow (but not locking it) and not supporting your arm.

Progress in each exercise at its own rate. You will achieve heavier weights faster on some than on others. Ice your elbow for 10 to 20 minutes after each exercise session.

Most important, do not cause pain. If any exercise causes pain, modify it by decreasing the weight, decreasing the number of reps, or reducing the range of motion. If you still feel exercise-related pain after taking one or more of these steps, check with your doctor or physical therapist.

[FIGURE 1] [FIGURE 2]

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Nirschl is the director of the Nirschl Orthopedic & Sportsmedicine Clinic at the Virginia Sportsmedicine Institute of the Arlington Hospital Medical Center in Arlington, Virginia. He is also an associate clinical professor of orthopedic surgery at Georgetown University School of Medicine in Washington, DC, and an editorial board member of The Physician and Sportsmedicine. Dr Nirsachl's Web site is at www.nirschl.com. Dr Kraushaar is an orthopedic sports medicine fellow at the Nirschl Orthopedic & Sportsmedicine Clinic at the Virginia Sportsmedicine Institute of the Arlington Hospital Medical Center.


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