SQUASH ELBOW?

[Liamnolan]

Anyone out there who has suffered from this problem? If so, what did you do about it? Liam

[azx]

I am not sure if mine was a Squash elbow but for the past few months the inner side of my elbow was hurting really game after every game. It would get better after a week off but would get back after every single game. It was pretty localized and when I saw the physio she told me it is because of wrist movement and recommended me to see a coach to get correct technique (I use my wrist alot without realizing it). The coach told me within the first five minutes that it was the wrist movement.

Anyway I suggest you get your technique checked (unless you actually know how to play unlike me then it is something else).

[hs64]

Yes I have, I had some physio on the elbow (6 sessions that the health insurance paid for) and then I started wearing the standard neoprene elbow supports which didn't seem to help. Then I came accross band-it elbow brace which I found really helped. If you do a search you will find some more info about them, I think I bought mine from PWP.com

[squashball]

I had what sounds like the same problem last year. I changed racquets and that cured it.

[trickleb]

Same happened to me. I used to play with Wilson nCode racquets, which are stiff frames, and my elbow would hurt if I played many days in a row. Now I use a more flexible frame (Harrow, in my case) and I don't have that problem anymore.

[Flash]

I feel your pain... literally. I played for over 20 years straight without a problem and then a few years ago I started getting the exact ailment you describe after starting to use a Prince o3. I changed to more flexible Dunlop frames and also used a forearm support (probably similar to those described above) and this has made the problem manageable however it still flares up from time to time. Perhaps it is simply the unthinkable - age related (for me anyway).

[Liamnolan]

I had "Squash Elbow" myself a few years back and had to take my own advice on curing the problem. Below is part of an article I wrote a while back. They are simple guidelines that actually work and I hope that they will be of help to fellow sufferers.

"Thousands of squash players up and down the country, including myself, have suffered from this painful and alarming condition. What can be done? Well, a lot more than the doctor may suggest. Yes, it is regrettably true that anyone going to their doctor with a painful elbow will be advised to rest it for several weeks if not months. Most GP’s will understand the physiological side of things and will treat the conditions as overuse. They play safe by advising rest.
Here are a few well-tried and reliable things to try before you throw yourself at the mercy of the orthopaedic surgeon. They work!!

SIX WAYS TO SAVE YOUR ELBOW By Liam Nolan, Technical Director, UK Racket Stringers Association and Master Racket Technician, USRSA.

1. RACKET FLEX - Have you got the right racket? Each tennis frame will flex a little or a lot. The less it flexes on contact with the ball, the more shock is driven into the elbow tissues. Look at the width of the racket “hoop” The narrower it is the better for your elbow.
2. STRING CHOICE – Natural gut string is an absolute saviour for players with sore elbows or shoulders. Yes, it is more expensive but the benefits are immense. Natural gut has the ability to absorb harmful shock whilst still delivering an unmatched power return to the ball. A soft nylon multifilament such as Tecnifibre 305 or RAB Sensor Fibre is a cheaper but very effective alternative.
3. STRING TENSION – Lower your tension. This will allow more of the impact shock to be absorbed and will deliver more power to your shot.Tensions of around 24lbs will not ruin your game. Peter Nicol has been as low as 22lbs.
4. RACKET MASS – Avoid ultra lightweight rackets. The more mass you have available to meet the ball the less worry for your poor old elbow. If you cannot be parted from your lightweight racket, then ask a competent stringer to add lead weight to the frame around the 3 and 9 o’clock positions. Use a qualified stringer for this work. That old Pro Kennex in the loft might have a new lease of life!
5. INCREASE GRIP SIZE – Use a few thin overgrips to get the biggest grip size feel that you can handle (sorry) and then use grips to adjust your racket. Do not use more that two grips as the natural feel of the bevels will be rounded off. A good stringer will be able to add heat shrink sleeves to build up the grip size and retain the bevels.
6. SOFT GRIP – Use a cushion grip, this will absorb lots of the shock.


Steroidal injections are an absolute last resort and are NOT a solution to Squash Elbow. They will allow a quicker recovery but are useless and potentially dangerous if the recovering player walks back into the same old trap. The above six golden rules have got many young and seasoned players back onto court, they get far more out of their game, play better shots and are able to lift a pint glass afterwards without a grimace!!

Liam Nolan can be contacted at www.ukrsa.com

[ianball]

All good stuff!!
Ian B.

[Liamnolan]

Thanks Ian, kind of you. I am a member of East Anglia Tennis & Squash Club in Norwich, a large tennis/squash complex and so lots of elbow/shoulder pain sufferers. A good cure is usually a simple one and 99% of elbow pain is not actually caused by squash itself as the body has long ago accepted that punishement. It is nearly always the result of a CHANGE in either the weight of the racket, too high a string tension, too stiff a string .... or more often some over enthusiastic DIY screw fixing that involves the arm being rotated a million times.
Prince introduced the Vortex Extender many years ago, priced it at £199 due to the materials and R&D that went into it, could not sell enough of them due to the price and so dropped them. This racket has a unique blend of materials that allow the frame to be soft on drops that have a low swing speed and yet stiffen up for attacking drives where the racket head speed is increased. I managed to acquire two of these rackets and strung them with natural gut at 24lbs and also increased the grip size. That did the trick for me and no problems since then ... except I really must finish off the kitchen!

[squash genie]

Dear Liam,

Thanks for the advice but have some questions:

1. Please elaborate more on No 1 - " hoop " the narrower, the better.

2. No.2 - Using Dunlop 4d Aerogel Ultimate ( 2 months + now ). Previous racket - ICE Elite Jonathan Power.
Strings: Ashaway Super Nick XL. Tension: 28/26 lbs. Tried 26/24 lbs but can't control drop shot. Power is
is good, though....

3. Ultimate is 132 g. Do you consider it light weight ?

4. Squash elbow more of an irritating throbbing sore rather than a severe pain. R.I.C.E only as a last resort.

Any comments ? Thanks.

I had "Squash Elbow" myself a few years back and had to take my own advice on curing the problem. Below is part of an article I wrote a while back. They are simple guidelines that actually work and I hope that they will be of help to fellow sufferers.

"Thousands of squash players up and down the country, including myself, have suffered from this painful and alarming condition. What can be done? Well, a lot more than the doctor may suggest. Yes, it is regrettably true that anyone going to their doctor with a painful elbow will be advised to rest it for several weeks if not months. Most GP’s will understand the physiological side of things and will treat the conditions as overuse. They play safe by advising rest.
Here are a few well-tried and reliable things to try before you throw yourself at the mercy of the orthopaedic surgeon. They work!!

SIX WAYS TO SAVE YOUR ELBOW By Liam Nolan, Technical Director, UK Racket Stringers Association and Master Racket Technician, USRSA.

1. RACKET FLEX - Have you got the right racket? Each tennis frame will flex a little or a lot. The less it flexes on contact with the ball, the more shock is driven into the elbow tissues. Look at the width of the racket “hoop” The narrower it is the better for your elbow.
2. STRING CHOICE – Natural gut string is an absolute saviour for players with sore elbows or shoulders. Yes, it is more expensive but the benefits are immense. Natural gut has the ability to absorb harmful shock whilst still delivering an unmatched power return to the ball. A soft nylon multifilament such as Tecnifibre 305 or RAB Sensor Fibre is a cheaper but very effective alternative.
3. STRING TENSION – Lower your tension. This will allow more of the impact shock to be absorbed and will deliver more power to your shot.Tensions of around 24lbs will not ruin your game. Peter Nicol has been as low as 22lbs.
4. RACKET MASS – Avoid ultra lightweight rackets. The more mass you have available to meet the ball the less worry for your poor old elbow. If you cannot be parted from your lightweight racket, then ask a competent stringer to add lead weight to the frame around the 3 and 9 o’clock positions. Use a qualified stringer for this work. That old Pro Kennex in the loft might have a new lease of life!
5. INCREASE GRIP SIZE – Use a few thin overgrips to get the biggest grip size feel that you can handle (sorry) and then use grips to adjust your racket. Do not use more that two grips as the natural feel of the bevels will be rounded off. A good stringer will be able to add heat shrink sleeves to build up the grip size and retain the bevels.
6. SOFT GRIP – Use a cushion grip, this will absorb lots of the shock.


Steroidal injections are an absolute last resort and are NOT a solution to Squash Elbow. They will allow a quicker recovery but are useless and potentially dangerous if the recovering player walks back into the same old trap. The above six golden rules have got many young and seasoned players back onto court, they get far more out of their game, play better shots and are able to lift a pint glass afterwards without a grimace!!

Liam Nolan can be contacted at http://www.ukrsa.com

[Liamnolan]

[[i]b]1. Please elaborate more on No 1 - " hoop " the narrower, the better.[/b]
The Hoop or the rim of the frame will flex backwards on ball impact, from around the centre of the stringbed. The more it flexes, the more shock and vibration are reduced, but at a slight loss in control as the ball will rest on the strings that little bit more. The thinner the width, the more flex there will be. A pro will never risk using a racket that has a thick beam due to the potential for arm soreness.[/i]

2. No.2 - Using Dunlop 4d Aerogel Ultimate ( 2 months + now ). Previous racket - ICE Elite Jonathan Power.
Strings: Ashaway Super Nick XL. Tension: 28/26 lbs. Tried 26/24 lbs but can't control drop shot. Power is
is good, though....

Two good rackets. I have listed the specs below. The denser string pattern of the Aero Ult is an advantage as the more strings there are the better.
More to share the load of ball impact which means you can lower the tension by around 2lbs and still have the same stringbed stiffness as before.
Think of the stringbed as a trampoline and you as the ball! The string choice is good, no problem there, good for drops, tension is ok.
Both are head light which is very important as the centre of balance should be towards the handle for comfort. So forget the Wilson Hammer range if you have a sore arm.
The Elite is 3gms heavier which is a plus, but all in all I would opt for the Ultimate as you can easily add on a few gms of lead weight later on if you wish.

Dunlop Aero Ult
headsize 500 cm sq
weight 137g
s pattern 16x19
balance head light
string m-fil ts
s tension 20-30lbs

ICE Elite -
headsize 500 cm sq
weight 140g
s pattern 14x19
balance head light
string m-fil ts
s tension 20-30lbs

3. Ultimate is 132 g. Do you consider it light weight ?
No, it is within a reasonable weight range, but as the weight drops, think of lower tensions and soft strings.

4. Squash elbow more of an irritating throbbing sore rather than a severe pain. R.I.C.E only as a last resort.
Try the basic "cures" already mentioned first, they really will make a difference. Watch the ball, as off-centre hits will rotate the racket in your grasp and cause pain, lightly knead the affected area before you get on court as the richer blood flow will make the tissues more elastic and better able to work more efficently. Don't keep the racket in the boot to freeze as the frame and strings will be brittle which may result in the frame cracking or the strings breaking as they cannot easily stretch.

I sound like a doctor after all that lot, you get away with murder when you are young, but all that hammering will catch up one day! Liam

[squash genie]

Thanks for the prompt feedback, Doc. That's why you are the expert. Cheers.

[[i]b]1. Please elaborate more on No 1 - " hoop " the narrower, the better.[/b]
The Hoop or the rim of the frame will flex backwards on ball impact, from around the centre of the stringbed. The more it flexes, the more shock and vibration are reduced, but at a slight loss in control as the ball will rest on the strings that little bit more. The thinner the width, the more flex there will be. A pro will never risk using a racket that has a thick beam due to the potential for arm soreness.[/i]

2. No.2 - Using Dunlop 4d Aerogel Ultimate ( 2 months + now ). Previous racket - ICE Elite Jonathan Power.
Strings: Ashaway Super Nick XL. Tension: 28/26 lbs. Tried 26/24 lbs but can't control drop shot. Power is
is good, though....

Two good rackets. I have listed the specs below. The denser string pattern of the Aero Ult is an advantage as the more strings there are the better.
More to share the load of ball impact which means you can lower the tension by around 2lbs and still have the same stringbed stiffness as before.
Think of the stringbed as a trampoline and you as the ball! The string choice is good, no problem there, good for drops, tension is ok.
Both are head light which is very important as the centre of balance should be towards the handle for comfort. So forget the Wilson Hammer range if you have a sore arm.
The Elite is 3gms heavier which is a plus, but all in all I would opt for the Ultimate as you can easily add on a few gms of lead weight later on if you wish.

Dunlop Aero Ult
headsize 500 cm sq
weight 137g
s pattern 16x19
balance head light
string m-fil ts
s tension 20-30lbs

ICE Elite -
headsize 500 cm sq
weight 140g
s pattern 14x19
balance head light
string m-fil ts
s tension 20-30lbs

3. Ultimate is 132 g. Do you consider it light weight ?
No, it is within a reasonable weight range, but as the weight drops, think of lower tensions and soft strings.

4. Squash elbow more of an irritating throbbing sore rather than a severe pain. R.I.C.E only as a last resort.
Try the basic "cures" already mentioned first, they really will make a difference. Watch the ball, as off-centre hits will rotate the racket in your grasp and cause pain, lightly knead the affected area before you get on court as the richer blood flow will make the tissues more elastic and better able to work more efficently. Don't keep the racket in the boot to freeze as the frame and strings will be brittle which may result in the frame cracking or the strings breaking as they cannot easily stretch.

I sound like a doctor after all that lot, you get away with murder when you are young, but all that hammering will catch up one day! Liam

[thesquashbuckler]

That was a great article thanks Liam

[raji]

'squash elbow' can be caused by all the things that Liam mentioned in his replies!..........however.......two other and more often causes are.....firstly...gripping the racket TOO tight for TOO long......and secondly....often playing the shot as you face the back wall and 'snapping' the wrist through to try and get the ball to go straight/cross-court, instead of facing the side wall when striking as this allows to play through the shoulders!......
Both of these problems cause strain on the Epicondyle ligament that runs through the elbow, hence lateral epicondylitis (tennis/squash elbow) or medial epicondylitis (golfers elbow).
only grip your racket tight when hitting the ball and/or try to get more level when striking the ball!

[elraton]

Very nice article Liam,

What you think of the tecnifibre carboflex texalium 130 in that terms? is it a good racket for avoid the squash elbow?

i used for a while a karakal pro 4ti 135, and i started having squash elbow, so i stop using it. now i am using a carboflex texalium 140 and it seems better, although the problem hasnt gone already totally, and i have just ordered 2 carboflex texalium 130 and i waiting for them.

[Liamnolan]

Hi, In 90% of cases, squash and tennis elbow results from a repepitive twisting overuse of the arm, usually a bit of DIY or a heavy gardening session. It is the body's reaction to an unusual loading on the arm tissues and it tries to recover by causing pain to persuade the victim to stop using it for a while. We sometimes only notice it when we get on court and start hitting, the arm/body is not warmed up anyway and the ball is cold and lumpy, needing a hefty whack to get it going. We associate the pain with the racket/strings and anything else we can dream up quickly, but tend to forget that DIY/gardening etc a few days earlier. All rackets over 130gms are pretty much ok for squash elbow provided that you prepare by having fresh soft strings and a low'ish tension to help absorb the shock of impact and check that the grip is comfortable, adding a thin overgrip if they can play with the resulting half size increase. All squash rackets come in a size 3, whilst in tennis you have an extensive range of grip sizes and so more attention is paid when choosing a racket. Squash players tend to think that the standard size 3 is what they HAVE to use.
I have paid some attention to having a head light racket, but all of the aforementioned is more important if you have a painful arm or shoulder.
I have one Masters player who went down to 22lbs, with TF225 and although he has now moved back up to 27lbs, he felt that the low tension gave him lots of arm comfort, bags of power and felt only slightly lacking in control. That is a player who used to be at 32lbs. In tennis, Roger Federer is down to 47lbs, really low for a pro and he seems to be doing well on control. I worked with him for 5 years at Wimbledon and he went down from 56lbs to the 47lbs as he really enjoyed the added arm comfort, working in the control over time.
The main obstacle that squash players face in getting rid of squash elbow is impatience, trying to get back on court before the arm has had a decent chance to recover. Pain relief sprays should be avoided at all costs, pain is there to help you avoid a bigger problem. Ultra light rackets have much to answer for, easy to swing about but not able to absorb much of the shock from the faster swing speed.
If you have a friendly stringer, ask if you can have a change in tensions on a few rackets, at a reduced cost. It can be a cheap single core nylon, string one at say 28lbs and one at just 22lbs, take them (the same racket model!) onto court and compare them for hitting lengths, standing just behind the service box. This exercise allows you to check ball velocity (power) whilst at the same time checking for control as you need to get the ball coming back to the right place!
I use this exercise when testing strings, keeping everything consistent, boring but useful, Liam

[elraton]

excellent information, i will try that. first try to rest some days, (i hope i can do a week, but is so difficult), then lower the tension of the strings, and then use an overgrip. thanks,

[Surrey_Squash]

Sound advice Liam.

I had a player at my local club complain of squash elbow.
I added a cushion grip, changed his strings (RAB Endurafeel) and strung it at 24LBS (he was used to 28LBS).

He told me soon after the pain was pretty much gone.
Maybe I got lucky but I'm satisfied the changes I made worked for him.

[Crusher]

I think racquet choice plays an important role.

I switched to a new racquet and instantly developed elbow/forearm pain. It was a very large light racquet with a very stiff frame. One day of hitting with his racquet and I sold it the next day. The pain disappeared and I'm therefore convinced the racquet was to blame. I play at at a fairly high level and have used many racquets without experiencing this sort of experience. The thing is that this particular racquet is used by many good players including 3 of the top 5 nationally.

[Liamnolan]

They may use what APPEARS to be the same racket, but it will most likely be either a sprayed up copy that weighs more etc or the same model that has been customised back at the factory, Liam

[Crusher]

They may use what APPEARS to be the same racket, but it will most likely be either a sprayed up copy that weighs more etc or the same model that has been customised back at the factory, Liam

Don't know about the other guys and maybe they uses 'fake stock' rackets but I know the 3rd really well and its just a regular stock racquet. He's gotten blanks and custom racquets though that look the same but are different and don't always have the complete paint job on them. Sometimes if he breaks one he can just go grab one from the shop off the wall and they just replace the shops to speed up the process instead of him waiting to get some shipped. Makes sense.

[Liamnolan]

Only the top ranked players are offered the factory customising. Check how long the grommets are, short looking grommets mean lead underneath.
At a tournament right now and a player has dropped off some rackets for me to work on and then post back to him next week. A VERY famous tennis player dropped in a "Dunlop" racket stringing with a new Prince string and the stringer helping out noticed that it was in fact a Wilson racket sprayed up and the PWS - Perimeter Weighting System - bulge at the 3 and 9 o'clock positions removed and some lead tape positioned there instead. When he remarked on this to the player, the response was frosty!
Squash players are not so finicky with rackets and stringing and can easily adapt to any spare racket for a game. The specialist work is needed when every match is tight and you spend 6 hrs a day on court either playing or training. The racket becomes part of your arm and you want things to be just right for every match. Priority 1 in New York offer a full blown customising service for around $40K a year and will send some of your prepared 30 rackets to your tournament for you, turn up at the bigger ones to string for you and wipe the tears if you lose. Liam

[Crusher]

Only the top ranked players are offered the factory customising. Check how long the grommets are, short looking grommets mean lead underneath.
At a tournament right now and a player has dropped off some rackets for me to work on and then post back to him next week. A VERY famous tennis player dropped in a "Dunlop" racket stringing with a new Prince string and the stringer helping out noticed that it was in fact a Wilson racket sprayed up and the PWS - Perimeter Weighting System - bulge at the 3 and 9 o'clock positions removed and some lead tape positioned there instead. When he remarked on this to the player, the response was frosty!
Squash players are not so finicky with rackets and stringing and can easily adapt to any spare racket for a game. The specialist work is needed when every match is tight and you spend 6 hrs a day on court either playing or training. The racket becomes part of your arm and you want things to be just right for every match. Priority 1 in New York offer a full blown customising service for around $40K a year and will send some of your prepared 30 rackets to your tournament for you, turn up at the bigger ones to string for you and wipe the tears if you lose. Liam

Well, that's really got to depend on each racquet company as I know 2 players who are only ranked PSA 150ish and PSA 80ish and they get some custom racquets all with different balances and weights to them to try and see how they want their racquets to be.

$40K ?!! That's got to be for tennis players. Makes squash pros look like tournament survival experts!

[Liamnolan]

I agree on all counts, companies may invest in some players who they want to keep on their books, even if the rankings are a bit low.
The LTA gets £25M from Wimbledon and another £15M from the media each year, plus some from the Sports Council, so ESR funding is a bit limp and a real shame as we have lots more success at the top than tennis. It all depends on what sport fits well on the box and then if that country has a major event like Wimbledon.
Getting back to squash elbow, the rackets will have been prepared for this potential and so will have the weight spread around the frame to minimise shock and vibration, some serious weight used occasionally, mostly in the handle to get the balance towards the butt, Liam

[Crusher]

I agree on all counts, companies may invest in some players who they want to keep on their books, even if the rankings are a bit low.
The LTA gets £25M from Wimbledon and another £15M from the media each year, plus some from the Sports Council, so ESR funding is a bit limp and a real shame as we have lots more success at the top than tennis. It all depends on what sport fits well on the box and then if that country has a major event like Wimbledon.
Getting back to squash elbow, the rackets will have been prepared for this potential and so will have the weight spread around the frame to minimise shock and vibration, some serious weight used occasionally, mostly in the handle to get the balance towards the butt, Liam

Did you ever string Palmer's racquet? I heard he has it weighted to weigh extra, upwards of 180grams?

[Liamnolan]

Yes, have been doing his rackets for many years but I have not checked the specs. He can really smack the ball but still came over at the last Brit Open to apologise for not being able to break the PN18 string! A friendly bloke who always has time to chat and listen,a great ambassador for Aussie squash and so a pity that squash there is now sadly in decline. I have around 10 Aussies here in Bath playing tennis and many of the past Aussie squash champions came from that sport originally, nice bunch of players who have a brilliant attitude to life, Liam

[Crusher]

Was that just for one match he didn't break them?

Just curious as I'm considering trying them but seeing as I can break Manta Scazon17 in 2 days it doesn't seem worthwhile. The Scazon is a tough string, not much point in me even considering a Zyex string.. I just break them right away.

[stevo]

Palmer played a tournament in Sydney a while after the BO final in 2008. In the final of the tournament he played Matt Karwalski who broke a string (looked like Tecnifibre) near the start of the match. While he was off getting a replacement racket Palmer joked that he should be using Powernick as he still had the strings from the BO final in his racket.

[Crusher]

Think I'll give the PowerNick a try then!