Ease elbow pain like the pros

Stay off the sidelines and in the game. Our espnW physical therapists dish out cutting edge advice for avoiding (and quickly rehabbing) common sports-related injuries.

The injury: Lateral epicondylitis. Commonly called "tennis elbow," this condition often flares up seemingly out of nowhere. The wrist extensor tendon that attaches to the bone right above the elbow on the outside of your upper arm becomes strained and inflamed from overuse. This tendon's job is to transfer load from your muscles to your bone as you lift, twist and swing your arm in sports and daily life. When the tendon is weak, your forearm muscles bear too much burden and cry uncle. Though it's common among the racket sports crowd (hence the name), anyone who grips, twists, lifts or throws a lot -- like painters, ballplayers, cooks, weightlifters and cyclists -- is vulnerable. Heavy computer users are susceptible too, from gripping, squeezing and manipulating a computer mouse for hours on end.

What it really feels like: Sharp, shooting pain radiating from the elbow into your forearm (where it hurts most) when you grasp or twist with that hand or when you extend your wrist. It also can weaken your grasp, so that it's difficult -- and ridiculously painful -- to pick up a coffee mug or turn a doorknob. The affected area is tender to the touch.

Who's been there: Brett Favre. Tennis elbow was nearly the kryptonite to end Favre's starting streak at 290 games last fall. (The NFL ironman ended up getting a cortisone shot and playing through the pain, ultimately beating the Cowboys.)

Don't feel his pain: Erase elbow pain in two phases: "Heal it; then work it," said ESPN injury analyst Stephania Bell, P.T.

Here's how:

Heal it: When pain flares, calm the inflammation: Ice the injury three times a day for the first few days and take NSAIDs (such as Advil, Aleve or Motrin) if you tolerate them. And, of course, steer clear of activities that cause the pain. "Avoid reaching extensively with that arm," Bell said. "Keeping a little bend in your elbow puts less tension on the strained tendon." A cortisone shot may help, but according to Bell, elbow braces are of limited use. "Braces are designed to take the pressure off the tendon, but they should only be used temporarily to help alleviate the pain because they don't fix the root of the problem." After two to three days, massage the affected area and do assisted stretching three times a day.

The best move:

Assisted stretch: Extend the affected arm, wrist relaxed, fingers facing the floor (palm down). With the opposite hand, gently pull the hand of the arm farther toward the floor until you feel a stretch in the forearm muscles. Hold for 15 to 30 seconds.

Work it: Tennis elbow can become chronic. Let's face it: Can you really not use your arm? Exactly. The ticket to ridding yourself of it is eccentric exercises. "These lengthen the muscle as it resists the force of gravity," Bell said. This not only strengthens and lengthens the muscles, but seems to remodel the tendon. Ultrasound studies have shown that injured tendons become less thick (i.e., less scarred and inflamed) after eccentric training.

The best move:

Resisted wrist extension: Hold a very light weight (1 pound) in your hand. You can also opt for no weight if 1 pound causes a strain. Rest your forearm on a firm surface and allow the wrist to hang freely, palm facing down. Use the other hand to extend the wrist up. Then lower the wrist to full flexion, slowly resisting the pull of the weight. Repeat five times. Rest. Repeat two more sets of five. You can increase the number of repetitions as the exercise gets easier.

Don't call it a comeback: Finally, examine what caused the flare-up. If it's sports- or work-related, have a pro evaluate your form and technique. You may need a different racket or to switch to a two-handed backhand for tennis. Computer users should sit closer to the keyboard and make sure your workstation is ergonomically correct.

On deck: Plantar fasciitis

* -- This does not substitute for medical advice.

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