The most common undiagnosed injury in tennis players – medial epicondylitis

Golfer’s elbow is a repetitive motion disorder where repetitive forearm pronation and wrist flexion and extension movements creates intense forces on the inside of the elbow joint and tendons. There is local tenderness on the anterior aspect of the medial epicondyle and around the origins of the tendons of the forearm flexor muscle group.

In golfers, the cause is attributed to when the club is “thrown” from the apex of the backswing down towards the ball, better known as, “hitting from the top” with the dominant arm. The condition is also found in throwing sports and tennis (note: the tennis serve is essentially a throw). In baseball pitchers, during the late “cocking phase” of the throw, forces are transmitted initially to the flexor pronator group, and then to the deeper medial collateral ligament.

Baseball pitcher throwing the ball off mound

EMG evaluation of the tennis serve showed the highest muscular activity in the flexor-pronator group and mostly in the pronator teres muscle (1). It is during the racket drop phase of the serve, that the wrist is fully extended and there are high “deceleration forces experienced at the elbow. This combination creates high stress on the common forearm flexors.

The modern day forehand is another stroke than can influence the development of golfer’s elbow. Moments prior to hitting a topspin forehand, the wrist is [should be] again fully extended, and upon impact with the ball, the common flexor tendons experience what would be a millisecond stretch-contract response at the elbow joint. Multiply this event by the number of times you have hit a forehand and a serve, in a given time frame, and you should be able to tell for yourself whether you have a repetitive motion disorder or not.

Treatment for golfer’s elbow is similar to that of lateral epicondylitis (tennis elbow) except that the exercises and stretches are directed towards the wrist flexors. Treatment should include joint manipulation or mobilisation, soft tissue techniques (ART is particularly effective), and home stretches and exercises.

More importantly however, your health practitioner should be able to help you prevent this injury from occurring in the first place. In tennis players for example, potential causes could be to do with technique flaws, racket and string setup, or physical health issues such as muscle imbalances. It is usually a combination of all of these factors.

Given the high incidence of golfer’s elbow in tennis players, these people would be best to see a (tennis chiropractor)[], who will not only be skilled in the application of physical therapy, but will also be able to offer sound technical advice as means for preventative care.

A word of caution, golfer’s elbow is a repetitive motion disorder, which if left untreated will continue to get worse. Whilst rest will help, upon return to activity, the condition often flairs up again. If you”re suffering this condition, (seek advice immediately)[] so that you may at least be shown effective means of self-management.

(1) Morris M, Jobe FW, Perry J. Electromyogrphic analysis of elbow function in tennis players. AM J Sports Med. 1989;17:241-247.

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