How To Identify and Treat Tennis Elbow - and When to See a Doctor

Tennis Elbow is a 100-Year-Old Injury.

 

Doctors first identified tennis elbow more than 100 years ago. Many medical textbooks treat tennis elbow as a form of tendonitis which is often the case, but if the muscles and bone of the elbow joint are also involved then the condition is epicondylitis.

Tennis elbow, or lateral epicondylitis, is one of several injuries that result from overuse that can affect the elbow. While playing tennis may be a cause, so are many other common activities, including using a screwdriver, painting, raking, and weaving.

Is it tennis elbow?

Consider the differences in aches in and around the elbow joint:

Tennis elbow: Gradual onset of feeling pain when gripping, lifting and carrying objects on the lateral side of elbow.

Golfer’s Elbow: Pain radiates throughout the joint on the medial side of the elbow.

Bursitis: Swelling on the posterior aspect often caused by leaning, falling or hitting the back of the elbow.

 Other signs of tennis elbow include:

• Pain that radiates along outside of elbow possibly into forearm and fingers
• Pain if you touch or bump the lateral side of the elbow
• Pain with wrist extension
• A weakened grip with muscle soreness along the lateral side
• A painful grip during shaking hands, turning doorknobs, lifting or bending the arm
• You may even experience pain upon extending the forearm if muscle/tendon become tight and sore

Relief of Tennis Elbow

1. Stop any activity that causes pain if possible.
2. Use NSAIDs.
3. Apply ice after use and heat before/during activity.
4. Wear a tennis strap such as Tennis Elbow Strap by Cramer, Aircase Pneumatic Armband, PRO Neoprene Elbow Sleeve, or Thermoskin Elbow Sleeve around upper forearm.
5. If you find the cause was work-related, take frequent breaks.
6. If standard conservative methods are ineffective, seek medical intervention.

For the tennis player with tennis elbow

Recreational players need to carefully monitor and check their equipment. Items to consider include:

• Racquet material - graphite composite materials are considered best for torsion and vibration control.
• Head Size - a midsize racquet (95-110 sq inches) is preferred. Oversize racquet heads may result in injury due to increased torque with off center hits.
• String tension - you might consider staying at the lower end of the manufacturer’s recommendations. While higher string tension increase ball control and spin, it also requires greater forearm strength and torque control.
• Stringing - consider using synthetic material and re-string every 6 months.
• Grip Size - a grip too large or too small lessens control and promote excessive wrist movement.

When to seek medical help

If your game has not improved due to discomfort and you have tried standard conservative methods of care (ice, NSAIDs, rest) plus have examined your equipment, seek medical assistance. If your elbow is hot and inflamed, you cannot move your elbow/forearm without pain, your elbow looks deformed, you have numbness in one or more fingers and you seem to have no grip strength anymore, also seek medical assistance.

View Tennis sports medicine products for the prevention and relief of tennis-related injuries >>

How to Choose an Effective Post-Exercise Drink

Could Milk Be Your Secret Muscle Building Weapon?

As science catches up with athletic medicine, it certainly is within the role of the certified athletic trainer to have opinions on the fuel used by athletes to replenish and recharge after exercise.  Look around you, check the internet, have conversations with colleagues and attend meetings to find out more about this area. While it is undoubtedly within the domain of sports nutritionists and dieticians, most high schools and many colleges are not fortunate enough to this caliper of professional on staff.

Cost, convenience, availability and taste are all factors to consider when urging your athletes to utilize something during that two hour post-exercise window to recharge energy stores and replenish depleted protein sources.
I started urging something as simple and yet effective as chocolate milk when I speak to teams during preseason. Consider what the research says about chocolate milk as a post-exercise drink:

1. Protein.Helps build muscle, reduce muscle breakdown and works with carbohydrates to restore muscle glycogen.
2. Carbohydrates.Refuels muscles (restore muscle glycogen).
3. Electrolytes.Helps replenish what’s lost in sweat (sodium, calcium, potassium and magnesium).
4. Fluids.Helps rehydrate the body.
5. Calcium and vitamin D.Strengthens bones and reduces the risk of stress fractures.
6. B vitamins.Helps convert food to energy.
7. 9 essential nutrients.Offers additional nutrients not typically found in traditional sports drinks.

Adding milk vending machines or selling milk at games for fund-raisers are ways to incorporate milk onto your team.

For more information on milk, go to the below links.  Or, sign up for our enewsletter to keep current on the latest sports medicine trends.

• www.milkdelivers.org
• Rolando Blackman, NBA Dallas Mavericks speaks at http://www.courier-gazette.com/articles/2010/12/16/carrollton_leader/news/163.txt
  
  • Crafting Diet for Peak Performance Discussed - go to http://www.northjersey.com/news/111578364_Crafting_diet_for_peak_performance_discussed.html

Phil Hossler, ATC has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.

Emergency Preparedness is Now the Norm

Certified athletic trainers have always been at the forefront of being prepared. But like any science or movement, this too has been evolving. Consider the recent action by the Professional Hockey Athletic Trainers’ Society (PHATS)(NATA NEWS 2/11) to actually place an identically prepared and stocked medical/emergency bag in each of their 30 arenas so that the visiting team may always be assured that vital supplies and equipment will always be there for them. Congrats to PHATS and to Sports Health for crystallizing this forward thinking idea!

On the high school wrestling front, look at this idea which I call the Mat-O-Matic. We all know that when a wrestler comes to the edge of the mat that having all necessary supplies on hand to save time is critical. Nose bleeds, cut lips, the opponent’s blood and blood on the uniform are all routine occurrences that need to be dealt with quickly.

The Mat-O-Matic is a garbage can with a plastic bag liner mounted onto wheels. It can roll to the edge or onto the mat for both home and visiting benches. The outer rim of the garbage supports a plywood circle with multiple holes drills around its circumference. Here are the items that are able to be positioned in these circles:

• Vaseline
  
• Gauze pads
• Nose plugs
• Hand sanitizer
• Vinyl gloves
• 3-4 cups of water
• Blood Buster
• Adhesive tape
• Elastic wrap
• Pre-wrap

In addition, hanging along the sides are:

• A container of antiseptic wipes for the athlete’s skin
• A squirt bottle of mat cleaning solution
• A Swiffer-type mop to clean blood from the mat
• Additional pads for the mop cleaner

Just like the PHATS’s philosophy of visiting teams being well taken care of, the Mat-O-Matic has become the norm at my school by visiting coaches.

Caring for Typical Baseball/Softball Injuries and Conditions

The following information is provided to assist athletes and parents in the event of a typical injury or condition associated with sport participation. This information should never be used as a substitute for competent medical attention from a physician or certified athletic trainer.

First aid for most sports injuries consists of following the RICE principle of Rest, Ice, Compression and Elevation. Rest is important because irritating tissues while they are trying to heal result in swelling. Ice causes blood vessels to constrict, which reduces the influx of fluids to the area and controls swelling. Compression provides a mechanical restriction to expansion so as to control swelling. Elevation fights the flow of fluids due to gravity to the injured area to control swelling.

Sports Health has many products to assist you follow the RICE principles such as:

Sports Health Elastic Bandages
- Elastic wraps should be applied below the injury
and wrapped up toward the heart

Extra Strength Pain Reliever Tablets, (50/2's) - Reducing pain helps the body reduce the amount of inflammation

School Health Instant Cold Packs - The application of cold is vital to reduce swelling
and promote healing.

Scrapes and abrasions are common in baseball and softball due to sliding feet first (hips/shins) and diving head first (hands/elbows). All abrasions should be cleaned thoroughly, covered with antiseptic cream and covered to promote healing.

Studies have shown that wounds thoroughly cleaned, moistened with antibiotic cream and covered actually heal better and faster than wounds left to "air out". Consider using products such as the following to clean and protect baseball/softball athletes' scrapes:

Cramer Cinder Suds


Antiseptic Spray - 3 oz. Aerosol


Triple Antibiotic Ointment

HARTMANN Flex-Band Adhesive Bandages


Sprains occur when ligaments are stretched and/or torn and is common to all sports. Ligaments stabilize movement around the joint and have a limited range of motion normally. When injured, joints swell much the same way an air bag goes off in a car when involved in an accident. Rapid swelling should be stabilized and x-rays may be warranted.. The RICE principle must be followed immediately. A "turned" ankle is still a sprained ankle. When in doubt, seek medical attention.

Sprained ankle joints need treatment and strengthening. Joint stabilization is often a good idea during and after reconditioning. Athletic stabilization may accompanied by using braces such as the following.

Active Ankle AS1 Ankle Brace Cramer

Hg80 Ankle Brace With Straps


Strains or "pulls" occur when muscles are rapidly overextended. Lack of flexibility training sets muscles up to become chronically tighter. Depending upon your sport or lifestyle demands you need varying amounts of adherence to daily stretching as well as which muscles you should target. Baseball/softball players need to emphasize calves, hamstring, lower back, chest, hip, upper arm, forearm and wrists. It takes longer to become flexible than it does to lose flexibility, so maintaining it is smarter than recapturing it.

When injured, RICE is best. Rest, ice and gentle stretching can begin shortly after the incident. Do not push too hard early or you will repeat the injury mechanism!

After a few days, heat to warm muscle prior to stretching will increase elasticity. Ice after use will reduce inflammation. Supportive garments and sleeves will "recruit" uninjured muscle fibers to assist the injured fibers perform movements.

Jobst Medical Legwear Compression Garments


Sports Health Neoprene Thigh Sleeves


Sports Health Neoprene Elbow Sleeves


HARTMANN-CONCO Shur-Band Latex Free Elastic Bandages


Application of the RICE principle, proper and adequate flexibility exercises, and sterile cleaning and covering of scrapes should all be a part of baseball/softball players’ and parents’ "first aid kit". For a complete line of related products go to www.esportshealth.com .

Ways to Disinfect Wrestling Mats

Winter season is the time for wrestling. Wrestling has some unique features associated with it such as one-on-one competition, weight controlled competition, hydration testing, injury time, blood time, and mat cleaning.

Several years ago I found an easy way to clean blood from the wrestling mat. Using one of those spray-then wipe with disposable pads style mops, I was able to disinfect mats without ruining my clothes. Cleaning off the athlete’s blood or his opponent’s blood from body parts is also a concern for hygiene as well as time constraints. So you might consider always having germicidal wipes in your mat-side kits as well as with your coaches.

Take a look at Sports Health's MRSA-killing products >>

Phil Hossler, ATC has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.

Hand Hygiene in Sports

Recently I spent a long day at a wrestling tournament as the athletic trainer on staff. What was interesting about this one was it was the first time athletes, coaches and officials came up to me seeking hand sanitizers. As hand hygiene awareness has grown, there are now many types of hand sanitizing products available including gels, foams, creams, creams with aloe, and antimicrobial towelettes in a variety of sizes. The next such tournament I do, I will have a larger bottle or floor stand as a part of my table set up.

I just reviewed a study for an educational journal on the possible value of an online tutorial on hand hygiene among healthcare workers. The value of quality hand hygiene to prevent infection transmission cannot be overstated in athletics, families and clinical settings.

As we interact with each other on wrestling mats, and in weight rooms, health clubs, locker rooms and even our homes, we should be conscious of the value of hand hygiene products in microbial infection prevention. Beyond hand hygiene, we shoud also clean surfaces so as to prevent infection spreading among our families and teammates.

Researchers stress hand hygiene in MRSA fight - Read more >>

Consider these antibacterial skin products from Sports Health.

Liquid Dial® Gold Antimicrobial Soaps and Dispenser

Sani-Hands® ALC Antimicrobial Alcohol Gel Hand Wipes

Phil Hossler, ATC has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.

Concussion Legislation

Concussions have gained considerable notoriety recently on all levels of sport. Consequently, the spotlight has been turned to the need for concussion recognition education among parents, athletes, coaches, athletic trainers and physicians. There are a number of states as well as the federal government that have passed or proposed legislation detailing steps that school districts must implement. As of December, 2010 the list is

• New Jersey (Assembly Bill No. 2743 and Assembly Resolution No. 85/Senate Resolution No. 74
• Pennsylvania (House Bill No. 2728 and House Bill No. 2060)
• United States (House Resolution No. 1347/Senate Bill No. 2840)
• Connecticut (Public Act No. 10-62)
• California (Assembly Bill No. 533 and Assembly Bill No. 1646)
• Maine
• Massachusetts (Senate Bill No. 796)
• Missouri (House Bill No. 1548)
• Oregon (Senate Bill No. 348)
• Rhode Island (House Bill No.7036)
• Suffolk County, New York (No. 1174)
• Texas (No. 4627)
• Washington (Senate No. 1824)

In the proposed New Jersey legislation, the spotlight is on education. The New Jersey Department of Education will develop a fact sheet for school districts to distribute annually to coaches, athletes and parents. The state department will also develop a model concussion policy for school districts to use. In addition, the New Jersey State Board of Medical Examiners will require athletic trainers in both public and private high schools to obtain 24 hours in concussion education in order to renew their state license biannually. In order to return after a concussion, New Jersey’s proposed legislation will require written return from a physician trained in the evaluation & management of concussion.

Sports Health carries a Sports Concussion Tool Kit for Athletic Trainers and Coaches with contributions by noted authors Phil Hossler, ATC, Michael Collins, Ph.D., Chris Nowinski, John Leddy, M.D., Ron Savage, Ed.D., and Barry Willer, Ph.D. that contains many unique items to assist school districts in their preparation for safely dealing with student-athlete concussions.

For more information on concussion and legislative efforts go to:
http://www.kttc.com/Global/story.asp?S=13629611
http://www.scrippsnews.com/node/58285

Phil Hossler, ATC has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.