Signs and Symptoms

A twisted ankle causes damage to ligaments and other soft tissues around the ankle. The damage causes bleeding within the tissues, which produces a swollen ankle that can be extremely painful.

Swelling and bruising can move into the foot and toes, and even upwards above the ankle. Sprains are graded on a scale of 1 to 3 (mild, moderate, and severe), depending on the degree of tearing to the ligaments.

2

Tennis Elbow

Overuse injuries most often affect the upper limb (elbow, shoulder and wrist) and are due to the high-velocity and repetitive arm movements required in tennis. The good news is that these injuries can often be prevented with some changes to technique, equipment and sometimes training routines.

Tennis elbow, also known as lateral epicondylitis, occurs in about 40% of all tennis players, generally more commonly in players aged between 35 and 50. Acute tennis elbow is an injury to the muscles and tendons that extend (straighten) the wrist and fingers. The site of the pain is typically the lateral epicondyle, a bony bump on the outside of the elbow where these muscles attach via the extensor tendon.

Symptoms

The tennis elbow sufferer will experience pain when performing gripping tasks or resisted wrist/finger extension. Pain can also be present when the muscles are stretched. There will be tenderness directly over the bony condyle and tender points (trigger points) in the muscles. Some people may also suffer from neck stiffness and tenderness, and signs of nerve irritation. Most elbow movements are pain-free despite the surrounding area being painful.

Causes

Acute tennis elbow is caused by damaged muscle tissue at the point it anchors to the arm at the elbow, also known as the ‘extensor tendon’. It occurs when more force is applied to that area than the normal healthy tissue can handle.

For example:

• Unaccustomed hand use such as starting the tennis season too quickly (ie. playing too often for too long when re-starting the season)
• Excessive gripping or wringing activities, or possibly using a new racket or different grip size
• Poor forearm muscle strength or tight muscles
• Poor technique (such as a biomechanical inefficient tennis shot).

Chronic (or longer-term) tennis elbow is associated with degenerative changes in the extensor tendon. Although a sudden acute flare of tennis elbow may have some inflammatory response and swelling, chronic tennis elbow is now known not to be due to inflammation. Chronic tennis elbow is associated with changes in the nerves and blood supply to the tendon, as well as changes in the actual tendon structure resulting in the breakdown of the tendon tissue.

Tennis elbow should be diagnosed by a physical therapist or doctor. A history is taken and clinical tests are performed. Referred pain from the neck and reduced nerve mobility can mimic tennis elbow. The physical therapist should check your neck and clear it from any involvement in your elbow pain. An ultrasound scan or MRI are the best tests to identify tendon damage although are usually unnecessary.

Treatment

Untreated tennis elbow can last anywhere from 6 months to 2 years. Physical therapy can however be very effective in both the short and long term. Massage therapy will relieve pain and help lengthen and stretch tight muscles and structures. Manual therapy can mobilise joints in the elbow and around the neck to ensure normal function. Exercise therapy can be prescribed to strengthen and balance the muscles of the forearm; and stretches given to lengthen muscles and relieve pressure on nerves. Taping and braces are beneficial in reducing pain in the elbow and supporting the muscles when you return to sport. Ice and ultrasound therapy may be used to reduce inflammation. Dry needling can also be effective for pain relief, releasing trigger points in the muscle and promoting tissue healing.

Tennis elbow unfortunately has a knack for recurring. It’s important to try and identify what caused the injury and address these issues, a physical therapist may also be able to help with this.

A quick note on grip size: Make sure your racket has the correct grip size and the size and weight of your racket based on your needs and ability. A professional can help you to choose the right racket. If the grip is too small you tend to squeeze the handle excessively to prevent it slipping or moving in your hand and this can overstress the muscles of the forearm and lead to tennis elbow. Check out this link for some guidance on grip size http://spxj.nl/2qvQ9F9. Talk tennis with your local physical therapist so you can play this season in Grand Slam form without any early retirements.

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. ©Co-Kinetic 2019