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Relief for tennis elbow.

Relief for Tennis Elbow 12 Tips to Avoid Crippling Effects

Now that tennis has become a perennial sport practiced -- and often malpracticed -- by more than 30 million Americans, physicians should not be surprised to see cases of excruciating tendonitis, whether the snow is flying or the summer sun is beating down.

Dr. Willibald Nagler, chief physiatrist at New York Hospital-Cornell Medical Center, estimates that 20 percent of all players develop tennis elbow each year.

He has found that the root of the problem is amateurism. Unlike pros, amateurs play the game awkwardly and in spurts. Clumsy moves put intolerable strains on affected muscles and tendons, and infrequent but frantic tennis weekends, crammed with set after set, overtax flabby racquet arms.

First the weekender notices mild tenderness and stiffness in wrist and elbow, but if he continues to play the game unwisely and poorly, within four to six weeks he will be unable to bend or rotate these joints without extreme pain. At that point the player has become the patient.

Fortunately, Dr. Nagler finds that almost all cases of tennis elbow can be prevented or ameliorated non-surgically. The two necessary and simple steps: first, consult a good tennis coach or manual to learn proper tennis strokes; and second, condition the racquet arm by proper exercise before trying to play the game with the exertion of a Conners or Borg.

Here's the progressive exercise program he recommends, requiring only a few minutes each day and a set of dumbbells that can be increased a pound at a time from three to eight pounds. Each of the four steps is increasingly difficult, and the player -- or patient -- moves up only after mastering the preceding step.

Step One: Grip firmly a three-pound dumbbell in the playing-arm hand and then place the forearm, palm down, on a firm surface of books or cushions, with the wrist positioned at the edge so that the hand gripping the dumbbell hangs free. Then bend the wrist upward and toward the thumb as far as possible. Hold this position for five seconds, then return to the starting position and rest for three seconds. Repeat this ten times, gradually increasing to fifteen times.

Step Two: Hold the dumbbell as in step one, but with palm up, and bend wrist upward toward the ceiling as far as possible. Hold this position for five seconds, then return to starting position and rest for three seconds. Repeat ten times and build up to fifteen times.

Step Three: Holding the dumbbell as in Step One, with palm down, rotate the wrist straight upward toward the ceiling as far as possible, holding this position for five seconds before returning to starting position and resting for three seconds. Repeat ten times and increase to fifteen times.

Step Four: Beginning with palm down, rotate the forearm 180 degrees, bringing the palm upward and the dumbbell to horizontal. This motion should take five seconds. Repeat ten times, building up to fifteen times.

When all of these exercises can be performed easily using a six- to eight-pound weight fifteen times, the patient will have built up the muscle fibers for endurance.

Then an exercise to develop the fibers designed to handle fast movements should be started. As in step three, hold a three-pound dumbbell palm down and rotate the wrist toward the ceiling, but perform this routine eight times quickly, with no rest between repetitions, and three sets of eight repetitions with no more than one minute rest between sets. Gradually, increase the weight until you can comfortably do three sets with fifteen repetitions per set using an eight-pound dumbbell.

Here are some tips, listed in order of importance, that Dr. Nagler recommends to lessen stress on tendons in the arm.

1) Learn proper strokes and play regularly.

2) Learn a two-handed backstroke, or at least avoid sudden elbow extension and wrist dorsiflexion in the backstroke.

3) Use a flexible steel racquet with gut or nylon strings that displace 52 to 56 pounds, since these produce maximum trampolining effect.

4) Meet the ball at the center of the racquet.

5) Avoid playing at the net as much as possible, since this usually calls for more than 70 percent flexion of the elbow.

6) Use a larger size grip and lighter racquet.

7) Avoid top-spin forearms.

8) Don't curl or roll the wrist on backhands.

PHOTO : No dramatic wrestling with a Nautilus gym or heavy barbell, but the short-range, selective motions of Dr. Nagler's wrist exercises do the trick. Here -- with a three-pound dumbbell and slow, up-down movements of the book-elevated playing wrist -- is Step One of the endurance-building portion of the daily regimen.
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Publication:Nutrition Health Review
Date:Jan 1, 1989
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