Is it really necessary to stop playing tennis or golf when you have Tennis Elbow – Or is it sometimes okay to “play through it” – IF you’re careful?
Or if you DO need to take time off from the court or course to focus on healing, when is it safe to start playing again? – Two questions I’m often asked by tennis players and golfers, and do my best to answer in this video:
In addition to this post and video please see my Tennis Elbow Exercise posts – Especially the closely related: “Can You Still Work Out When You Have Tennis Elbow?“
Playing Tennis With Tennis Elbow [Podcast]
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The good news is, although it may be wisest to take time off, it is possible to keep playing and still recover – IF your injury is not severe, AND you do the right things to treat it in the process.
Like everything related to this vexing injury, the answer is nuanced and I’ve broken it down into:
5 Key Guidelines If You Want To Continue Playing Tennis Or Golf:
Table Of Contents: Links jump to sections of this article
- Don’t play if you have a severe injury – or when it’s really flared up (duh, right?)
- Choose your priority: Continuing to play or having a faster recovery,
- STOP playing if it starts hurting – (Another “no-brainer,” Hopefully, right?)
- Modulate your playing: Play less hard, less often, play alternate days, ect.
- Treat your muscles and tendons properly – If you do the right things to treat it OFF the court/course, you can get away with more time ON it! (THE most important tip if you continue)
Followed by a couple of suggestions if you are taking time off and wondering: “When can I start playing again?”
Wrapping up with a few general tips and suggestions.
Isn’t It A Given You Should Stop And Rest To Heal Your Tennis Elbow!?
Many authorities will tell you that you must rest your injury “so it can heal” leading you to believe this is a predetermined decision…At which point it becomes a question of “How long do I need to rest and wait?”
But this often stems from a misunderstanding about the nature of the injury – It’s not a given!
Please see my article and video on “How Important Is Rest In Healing Tennis Elbow?”
It goes into detail explaining why “absolute rest” is probably not the answer for most Tennis Elbow sufferers.
In brief, there’s no guarantee healing will happen in a tendon (or ligament) when it’s given complete rest from all activity – even for months on end.
As a general rule, it’s usually a good idea to stop the activity that caused your injury for a while – or at least reduce the time you spend doing it.
But, although it may be the smartest thing to do – the good news is it isn’t always necessary!
It is possible to recover from milder (and even sometimes moderate) Golfer’s and Tennis Elbow injuries while continuing to play.
Obviously, there’s still the question of where to draw the line when it comes to severity, which leads us to our first guideline:
Naturally, your first consideration will have to be how severe your injury is.
If you have a more severe injury, (or it’s extremely painful at the moment) you may need to take time off from playing.
If you know for a fact (MRI or ultrasonic scan) you have a bad injury, like a significant tendon tear (not as common as you might think) or moderate to severe Tendinosis (degeneration = more common) that’s a deal breaker.
Lacking a good scan, it can be very challenging to determine how severe your injury really is, because the symptoms don’t necessarily correlate with the severity.
Minor injuries sometimes hurt like hell and severe ones are sometimes deceptively low on the pain scale; the punishment doesn’t always fit the crime!
Symptoms are often all you have to go on though – So just be sure to pay attention to how strong or weak your grip and wrist feels and not just how much it hurts.
Just the same, if it’s so flared up it’s hurting while you’re walking around, driving or doing simple, light tasks around the house or office, then playing tennis is probably going to aggravate it further, and you may have to at least wait for it to “calm down.”
(You’re not just going to pop a few pain killers or anti-inflammatories and get back on the court – Are you!?)
In the case of a more severe injury you may have to wait months, but if it’s simply a bad “flare up” of a milder injury, you may just need a few days or a week or so.
When I treat a tennis player or golfer at my office for the first time, and I’m invariably asked “Do I need to stop playing?” I answer their question (rather impolitely!) with one of my own…
Which is a higher priority to you?…
A. Recovering as quickly as possible – With the lowest chances of re-injury? OR…
B. Continue to play – Even if it takes longer to recover from your Tennis Elbow?
Keep playing or recover faster / Have cake or eat cake!?
Sure, it’s only natural to want both! (Hey, I know you golfers and tennis players! But let’s be real.)
Know your priorities, pick one and live with the consequences of it.
All things being equal, the player who takes time off will likely recover faster AND have less chances of worsening their injury than the one who doesn’t… (But will he or she have as much fun!?)
However, in my experience, how you treat your injury trumps most other factors (more on that when we get to #5) and that’s your leverage.
All things NOT being equal, the tennis player or golfer who continues to play (in a cautious, moderate fashion #4) and gets the right treatment / follows the right self-care protocols…
Will outperform (healing and recovery-wise) the tennis player or golfer who follows the common wisdom / standard medical treatment and takes a long break from playing!
(If you’ve spent any time on this site beyond this article, you already know how little I think of and how much I criticize “the common wisdom” and hopefully understand why.)
I expect your skepticism on this! But, I can only tell you, this is generally what my patients have been doing prior to seeing me.
But once we get them out of the “Triple Trap” doing some serious Soft Tissue / muscle and tendon therapy and progress is made, recovery while playing becomes not only possible but very likely.
And the likelihood of making a full recovery – while still playing and while following the standard treatment protocol – is quite low, in my opinion, (especially if the injury is beyond the early stages and is in the moderate-to-severe stages)
I don’t recommend trying it.
How it feels when you’re playing, swinging that racket or club is what matters most and what you want to pay the most attention to…
How it feels when you’re doing minor-effort daily tasks is not what you should focus on.
Yes, it’s probably going to be stiff and achy in the morning, sore throughout the day and may give you the occasional sharper twinge when you grab or twist something…
That’s absolutely typical and par for the course, and unless it really ramps up in intensity, and hurts a lot with every little thing you do, you don’t want to pay too much attention to it / overreact to it.
Those symptoms often come and go without necessarily having any immediate correlation to your progress and what’s really going on – and shouldn’t necessarily deter you.
Yes, they will be 100% gone when your Tennis Elbow is 100% healed, but don’t always expect a 1:1 ratio, as in 75% less pain = 75% healed.
And a big flare-up of symptoms doesn’t necessarily mean there has been a correspondingly significant re-injury. (That could be the case but it’s not always so.)
What you absolutely have to listen to is when you’re out there playing all warmed up, all systems go and it starts hurting.
You can give it the benefit of the doubt if you’re just starting to play and it’s not that much pain – IF it diminishes to a whisper and stays there while you play.
But if it’s more that a little pain and it continues at that level or starts to worsen you have to stop.
Promise yourself in advance that you will stop in that case.
There are few worse things you can do than to keep playing at that point.
What ever you do, if you’re going to play through your recovery, modulate – Don’t blast forward.
Play less hard, less often, play on alternate days, take a week off if necessary, ect…
Always be thinking recovery time!!
I’m convinced that it’s more important for most tennis players and golfers (with mild-to-moderate injuries) to modulate their playing than to stop and rest for weeks or months on end, for a couple of reasons:
First of all, as stated earlier, tendon healing doesn’t necessarily just happen while you’re resting, hoping and waiting.
I can’t tell you how many tennis players and golfers have walked through my clinic doors and told me they took 3 weeks, 6 weeks – or even 2-3 months off from playing and when they started playing again their symptoms came right back with a vengeance!
Time alone does not cure this wound. How you treat it OVER time and modulating your activities over time, so as not to overly stress it, does heal it.
The other big thing is morale.
Whereas the scenario I just described; waiting for a set (and arbitrary?) period of time to play, then discovering when you finally do again that it hurts as much as ever, can be devastating to your morale…
Small successes and the ability to continue playing – even if there are some setbacks – can do a lot to maintain your morale and motivation.
It’s just not realistic to expect perfect, steady progress and symptoms that gradually fade over time like a catsup stain in a white T-shirt.
More often than not, it’s “two steps forward – one step back!”
And if you’re going to be dancing that “two-step dance of recovery” you might as well be doing it on the court, right?
My patients who play through their recoveries are always so much happier!
They key is to be disciplined about it.
If you’re going to play:
- Warm up well first, including doing some stretching and self therapy,
- Play for a shorter duration – even if it feels fine. (Do you know how it’s going to feel tomorrow? No? So don’t push your luck, right?)
- Do not play on consecutive days! And if your elbow flares up a lot from playing one day take extra time before you play again, and redouble your self care,
Again, always be thinking about your recovery time and be prepared to take more time for it…
BUT, at the same time don’t let your symptoms “rule” you; if you’ve taken a week or the better part of it off for recovery, and your elbow is better but still a little cranky, don’t let that stop you from testing it out!
You can always stop playing if it hurts like hell.
And here are some more tips on modifying, modulating and easing back into your game for tennis players, from the International Tennis Federation:
Now we come to the most important rule…
If you do the right things to treat it OFF the court/course, you can get away with more time ON it!
And I will sum up the most important part of this tip in three words:
Soft Tissue Mobilization
How are you treating your injury? Are you:
- “Playing it safe” by following the common wisdom?
- “Hedging your bets?” by doing a little of both?
- OR “going all in?”
If you’re going to continue playing through your injury then it makes no sense to play it safe or to hedge your bets off the court / course.
What I mean by that is following the common wisdom; doing things like icing, taking anti-inflammatories, wearing a brace (besides while playing) and getting Cortisone shots etc.
The “immobilize and suppress” approach that treats Tennis Elbow as if it were a problem of “chronic inflammation”
Despite all tradition and the repeated admonitions of authorities this is wrong. Dead wrong.
It’s a 30-40 year debacle of failure.
And if this is what you’re doing when you’re not playing, you’ll be lucky if your injury doesn’t get worse.
The Answer Is Mobilization NOT Immobilization:
- Frequent, *aggressive Soft Tissue Therapy on your muscles and tendons, (*”Aggressive” if and when appropriate!)
- Correct, safe, frequent stretching of your involved muscles,
- And the gradual introduction of Tennis-Elbow-specific rehab exercises (sometimes delayed, depending on severity).
(Which is what I teach here in the Tennis Elbow Classroom self-help program)
I’m very confident the more time you spend here reading and watching my videos, the more you’ll understand why this is the logical approach.
And if you do already understand and agree, don’t hedge your bets!
I sometimes have patients come in my office who say “What you say makes perfect sense, now that I think about it!”
They come to see me for Soft Tissue Therapy and learn my techniques to do themselves, which, on one hand, is to choose to mobilize and encourage healing.
But some will still hedge their bets by continuing to wear a brace, ice regularly and take anti-inflammatories, which is the opposite approach; immobilizing and suppressing healing.
Most abandon this bipolar, hedging approach not too long after, once they start making some progress with the addition of the Soft Tissue Therapy, but…
The sooner you go all in – The sooner you get on a program of Soft Tissue Therapy and start strategically mobilizing – And the sooner you stop immobilizing and suppressing your symptoms and healing process, the better!
Again, tendons (Tennis Elbow is a tendon injury) don’t just automatically heal while you’re resting, hoping and waiting.
You need to be treating, mobilizing and encouraging healing in those tendons (and muscles) frequently while you’re off the course or court.
And then carefully testing out your progress; modulating your playing as necessary.
As long as you’re fairly healthy and don’t have too severe an injury, you should be able to heal and strengthen while continuing to play.
(Although, once again, you will probably make faster progress if you don’t continue playing, and should be clear with yourself about the tradeoff.)
I’m convinced this is the one of the top “secret weapons” the pros have that keeps them free of Tennis Elbow and other injuries. (In addition to perfecting technique.)
I’m sure that on a regular basis (probably sometimes constantly) they receive the very best in Soft Tissue Therapy.
They get preventative therapy; they get immediate treatment to nip little problems in the bud before they become chronic problems; and if they should somehow develop a chronic problem (or more likely a sudden, acute injury) they get aggressive, continuous muscle and tendon treatment until it’s gone.
If you do take time off from playing in order to give your injury the best chance to heal, when do you know it’s safe to start playing again?
First of all, I think it depends on whether you really needed to stop, because your injury was severe…
Or you decided to stop for awhile, because it seemed like the wisest choice, even though your injury wasn’t that bad.
After A More Severe Injury
If you had or still have a severe injury then you may want to wait until you’re:
- Symptom free for at least a month, and
- Have made significant strength gains in your rehab.
Chances are if you’ve been battling a severe injury your confidence is pretty low, and it’s just not worth taking the risk of re-injury, is it?
In that case wait as long as you can stand it, and when all signs are positive (strength regained or better than ever and symptoms gone) ease back into the game.
After Stopping To Be Cautious
If you decided to stop even though your injury wasn’t severe and there isn’t as much riding on it then you can test the water whenever you feel confident enough.
Again, I think it’s more important for most tennis players and golfers (with mild-to-moderate injuries) to modulate their playing than to stop and rest for weeks or months on end…
So, the question of when to start playing again is not a critical to me as it may be from other perspectives, as long as you:
- Do your homework and do lots of Soft Tissue Therapy,
- Warm up thoroughly, ease into it and modulate your playing,
- Stop playing if it starts hurting.
One of the advantages of continuing to play at a reduced frequency and duration is that it can help motivate you.
To follow your Tennis Elbow self-help program and do your Soft Tissue Therapy, Stretching and Exercises,
To focus more on working on your technique – And to stay fit and conditioned.
If you have to take time off you have to – But if it’s not strictly necessary, how motivated are you going to be sitting around doing your self-help program if you’re not playing?
Consider allowing yourself to keep playing if you can. If you have a setback it probably won’t be a big one if you’re being careful.
But it will motivate you to work harder on your therapy and rehab exercise!
Never play cold or IN the cold!
Warm up first with some cardio: Take a run, bike to the court (tennis players) and really get your circulation going.
Then do some stretching and, even better, some therapy on your muscles and tendons.
Don’t rely too heavily on braces and bands!
I am opposed to braces and bands as a supposed “first aid” or long-term aid to healing…
But I am not against wearing the strap / counterforce-type brace while playing as a form of protection.
What ever you do, just don’t wear one around during the day or at night.
(More to come in this final part – I just can’t wait any longer to post this. The Open is on!)
Learn To Treat And Heal Your Own Tennis Elbow Right Here:
I’ll be your personal tutor guiding you through easy-to-follow lessons, where you’ll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home.
Just watch the videos, follow along and start putting an end to your elbow pain today.
Learn more, and get started here: Tennis Elbow Self-Help Program
Golfer’s Elbow sufferers, get started here: Golfer’s Elbow Classroom