The early warning signs of Tennis Elbow to watch for, what to do if you start feeling them – And how seriously you should take them
It's that time of year again; longer, warmer days... T-shirts, tee times and tennis rackets... Yes, most call it spring – but I often refer to it as Tennis Elbow Season!
It's that time of year many in the colder climates get back out on the tennis courts and golf courses and start swinging, volleying, chipping and driving!
And gardening, paddling, (my biggest passion!) pitching, playing Frisbee or Lacrosse (which is the type of ball I'm holding in the video above)...
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The problem is that many people lose their conditioning while slogging through the winter doldrums, while their enthusiasm surges as high as ever – if not higher, with all the pent-up energy and desire to be outside playing again.
This is a dangerous combination that catches countless golfers and tennis players by surprise.
Sure, it feels fantastic to be out on the court or the links again under that luscious vernal sun, but it's all too easy to overdo it while under the spell of spring fever, isn't it?
It's so easy to play too much... To not allow your body time to regain its conditioning... And to dismiss those telltale signs that may herald the onset of an overuse injury.
Of course this can still apply regardless of whether you're resuming playing after a winter hiatus or just starting to play golf or tennis for the first time.
And, naturally, people can and do develop these injuries at any time of year. It's just that there's usually a big surge in the spring, so here's what to watch out for!...
The Early Warning Signs Of Tennis Elbow
Although it's true that some cases of Golfer's or Tennis Elbow seem to appear suddenly, without a warning “out of nowhere” with alarming pain – sometimes even in the middle of a round or a set...
Most of the time these injuries creep up on us with pain and other symptoms that escalate gradually over weeks or months, giving us time and opportunity to do something about it, because the vast majority of these injuries involve a gradual breakdown process - Not a sudden, 'acute' injury "event."
Here are the most common signs or symptoms:
- VERY EARLIEST SIGNS: Intermittent forearm muscle tension, fatigue and/or soreness (In the early stages these symptoms often occur only after playing tennis or golf - especially first thing in the morning - and tend to dissipate within a day.)
- EARLY SIGNS: Tenderness or soreness at the outside of the elbow (Lateral Epicondyle) with Tennis Elbow (These symptoms often occur only after playing or exerting oneself - are often worse in the morning - and often dissipating after a day or so in the early stages.)
- Or tenderness / soreness at the inside of the elbow (Medial Epicondyle) with Golfer's Elbow (Again, in the early stages, these symptoms often occur only after playing or otherwise exerting oneself - are at their worst first thing in the morning - and often dissipate after a day or so .)
- INTERMEDIATE SIGNS: Sudden, sharp pains when gripping, twisting and picking up everyday objects and performing routine tasks. (Or a very persistent or constant, burning pain – especially if it's in your tendons near your elbow.)
And when any of these symptoms above start happening WHEN you're playing or exerting yourself moderately - or persist for several days or more - that's a sign the injury is progressing beyond the early stages and becoming a more serious chronic problem.
But, at first, these symptoms may not be easily distinguishable from normal, 'delayed onset muscle soreness.' (The kind of soreness you can normally expect after a hard workout.)
Except that the symptoms tend to be more localized to the forearm area, rather than a more general "a little here – a little there" kind of soreness.
And, again, it starts lasting longer than what you would normally expect as the problem progresses.
(NOTE: Even if your pain did appear suddenly and harshly, and you never got much of a "warning" that doesn't necessarily mean your injury happened all at once. Sometimes the injury process happens quietly with little or no symptoms at first. You don't always get a warning, sadly.)
Here's more about the symptoms of Tennis Elbow in this post
So, You Think You Might Be Getting Tennis Or Golfer's Elbow – How Seriously Should You Take It?
How concerned should you be if you're just starting to experience some of the early warning signs?
Be fairly concerned...
For every tennis or golf-playing injury sufferer who casually claims they never did anything beyond swallowing a few anti-inflammatory pills or slapping a cold pack on their elbow after playing and nothing (apparently) came of it ...
There are two more who didn't think it was anything to take seriously at first, and didn't realize their mistake until months later when their injury was stubbornly resisting treatment and getting worse.
And worst of all, keeping them off the green or the court!
In fact, as someone who's been specializing in treating Golfer's and Tennis Elbow for over a decade (I've heard a lot of stories about how peoples' injuries came about) I would recommend taking ANY warning signs fairly seriously.
For example, you may be wondering, “Why be all that concerned if I'm having only mild symptoms that come and go and only last for short periods?”
One reason is that you can't really be absolutely sure exactly what those symptoms mean.
Yes, generally, your symptoms will tend to be milder and more intermittent (come and go) in the early stages – And, conversely, be more intense and persistent as the injury worsens – But that's not a hard and fast rule.
Hopefully, when you first start to notice the telltale aches and twinges they're just the early warning signs that you're at risk of an injury soon.
But, again, by the time you start to experience symptoms you may already have an injury underway, (although, hopefully a mild one in it's early stages.)
Either way, the most important thing is to take your tension, soreness, achiness or outright pain seriously – And not to assume “it's probably nothing.”
If you've never had a tendon injury before, you might not know any better but the biggest reason why you want to be proactive is that tendon injuries like these are notoriously difficult to treat and recover from.
Tendons heal slowly and often need a lot of help. And past a certain point, you can't just expect them to recover while you're resting, hoping and waiting.
Not that it's an absolute given it will be a grueling, painful struggle. Not if you avoid the typical mistakes most tendon injury sufferers make and take the right course, right from the start.
If you take the “early warning message” seriously, and treat your problem properly, right from the start, you may “catch” and reverse the progression before it becomes an outright injury, which is certainly the ideal!
At the very least, you can treat it early, while it's still a mild / minor problem and not a severe injury.
Being proactive almost always pays off in a quicker, easier recovery!
What To Do And Not To Do If You're Injured
One of your first questions and considerations is probably going to be:
Should I stop playing and rest my arm as much as possible - OR...
Can I keep playing tennis or golf – Even if I have Tennis Elbow?
The obvious, intuitive course of action (or non action) would naturally be to stop the activity that caused the injury (or seems to be causing the symptoms and putting one at risk.)
But that may not always be necessary (in my opinion, anyway) if you're careful and are at least willing to reduce how often and how long you play.
That's a nuanced issue and I'm going to refer you to the links above to my articles (with videos) on the “rest” question and whether it's safe to continue playing.
And Then There's The Question Of Treatment
This is where I diverge from and contradict almost all the “conventional wisdom” on the subject.
Not because I enjoy being a contrarian (OK, maybe I do – a little, anyway) – but because the conventional wisdom is simply wrong.
The standard medical approach and common wisdom blames inflammation for the problem (incorrectly) and takes an approach that is best summarized as:
“Immobilize, Cool and Suppress” – Meaning to immobilize the area with a brace, cool the area with ice and suppress inflammation with pills and sometimes Cortisone shots. (This is a huge error which this website attempts to rectify.)
Whereas I recommend that most Tennis and Golfer's Elbow sufferers follow a “Mobilize, Warm and Allow” approach.
To mobilize the muscles and tendons involved (gently) instead of immobilizing them with a brace,
To warm the area to stimulate blood flow and allow the inflammatory process to do what it's there to do, which is part of the healing process.
No cooling / inhibiting / suppressing ice, anti-inflammatory pills or Cortisone shots.
Here's a video on my Tennis Elbow treatment strategy in more detail
How NOT To Treat Your Tennis Or Golfer's Elbow Injury:
So, when it comes to what NOT to do, please see the following articles and videos going into much more detail about why the standard treatments are not in your best interest (if your goal is healing – and not just temporary pain relief, anyway)
Should You Ice Your Tennis Elbow? No – Here's Why
Should You Wear A Brace To Treat Your Tennis Elbow? No – Here's Why
What about lotions and creams? (Maybe)
Why Getting A Cortisone Shot May Be The Worst Mistake You Could Make!
Some of these mistakes are relatively benign, like icing a little here and there, which may slow healing somewhat.
Unfortunately, some have the potential to completely alter the course of ones recovery for the worse. Cortisone shots being the worst offender.
Even wearing a brace and “resting” the area can have adverse effects that while making you feel better in the short term may prolong your recovery in the long run.
What's The Right Way To Treat These Injuries, Then?
As I said earlier, I recommend that most Tennis and Golfer's Elbow sufferers mobilize the muscles and tendons involved instead of immobilizing them.
I believe that stretching and exercises are an important part of the rehab process…
And sometimes the right stretches and exercises can “nip” the process “in the bud” before it becomes a full-blown injury, if one catches it in time, at the first early warning sign or in the very early stages, at least.
But past a certain point in the injury process, stretches and exercises, alone, may not be enough.
I believe the most important tools in the box when it comes to breaking that vicious injury cycle are very specific, hands-on “advanced massage therapy” techniques.
Here's my article and video describing the 3 most important self-massage techniques
I haven't seen or heard (so far) of a better way to release the muscular tension and scar tissue in the muscles and tendons involved in Tennis and Golfer's Elbow.
That tension, scar tissue stuckness and stagnation is the rot at the root of the injury, and once it's established, it tends to stubbornly resist healing.
The inconvenient fact is that it often doesn't just “go away” no matter how much time one plays the “Resting, Hoping and Waiting” game.
Sure, you can go to a professional like myself who specializes in this kind of therapy, (I'm here in Corte Madera / Marin County in the S.F. Bay Area) if you need me...
However, it's also entirely possible – and often very practical – to learn these techniques and use them on oneself. (In addition to stretches and exercises, of course.)
That's what I teach my student/members to do here at Tennis Elbow Classroom in the members area. Just follow one of the links below to learn more about the Tennis OR Golfer's Elbow program...
Learn To Treat And Heal Your Own Tennis Elbow Or Golfer's Elbow At Home With This Video Program
You'll get instant access to a complete VIDEO program designed by a professional therapist to help you take charge and break your vicious cycle of pain and frustration!...
I'll be your personal tutor guiding you through step-by-step video lessons, where you'll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home. (Without any special equipment.)
Tennis Elbow sufferers: Learn more about the program here
Golfer's Elbow sufferers: Learn more about the Golfer's program here
George Shave says
Alan, you get it. After our phone interview almost a year ago, I went “ALL IN” with your videos for my TE which I suspect was caused by the heavy amounts of Fly Fishing I do. Each night, i started with warm moist heat to the area, then moved into the pin and stretch technique and followed that up with a few of your exercises. I did them at DAYS END BEFORE BED, so my muscles could recover, rather than in the middle of the day where I would continue to use them and perhaps over stress them. I went from excessive pain to manageable pain to pain free.
Allen Willette, Tennis Elbow Tutor says
Hi George. Yes, I remember talking with you! Delighted to hear you’re pain free now, and thank you so much for sharing the good news with me and all the readers and members of Tennis Elbow Classroom!