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Tennis Elbow

Have you been told you have tennis elbow? Been struggling for a long time with pain and reduced function? Need some answers? Read on for a comprehensive description of this injury and how you can treat it.

Tennis elbow is a very common injury and is the most common type of elbow pain. Approximately 40% of people will experience tennis elbow at some point in their life. In the sporting population, 50% of tennis players experience some elbow pain and of this 75-80% will be attributable to tennis elbow.

Essentially this injury is due to overuse that most often will occur due to performing repetitive tasks involving movement or resisted activities of the elbow or wrist. Tennis elbow occurs from the overuse of the tendons attaching onto the lateral epicondyle of the elbow which is a bone situated on the outside of the elbow joint.

However, tennis elbow can be caused by a wide range of activities including computer work, gardening, resistance training and any household tasks. What’s shared between these tasks is extension of the wrist and/or fingers which causes pulling of the common attachment point on the lateral epicondyle of the elbow resulting in inflammation, micro tears, and in chronic cases, degeneration of the tendons.

So, what can you do about this? In cases that have only been present for a few weeks you can usually get good results from simply unloading the tendons by avoiding the aggravating activity as well as taping and icing to reduce symptoms. However, in recurrent or chronic cases it is evident that strengthening of the tendons needs to occur for long lasting relief. To make rehabilitation easy and effective I have designed a 4-step process to effectively treat and recover from tennis elbow to keep you functioning and doing the things you need to.

 

Step 1

Symptom management: This step requires you firstly to identify the aggravating activity, so have a look back at what you’ve done a lot of in the last week that requires elbow movements and either reduce how much of this you do or completely remove it, a diary can help with this. To further manage symptoms, you can ice 3x a day for 20 mins or after any activity. A brace can also be acquired from your local physiotherapist or pharmacy to reduce pain.

Step 2

Wrist extension Isometrics: Isometrics have been shown to be fantastic in firstly reducing pain and increasing strength early in rehabilitation. Isometric means resistance without movement. This exercise should be relatively pain free.

  • Place your hand over the edge of a table with your palm facing down.
  • Contract your forearm muscles to stop your wrist from dropping. No movement should occur.
  • Begin with 3×30 second contractions and progress to 5×30 seconds. Once at this stage add resistance by either using your other hand to push down, holding a dumbbell or bottle of water.
  • If this exercise is painful regress by turning your hand so that your thumb is pointing up and perform. Progress to palm down 5×30 sec with resistance before moving to step 3.

Step 3

Eccentric wrist extensions: Eccentric exercises have been shown to increase strength whilst also increasing fascicle (muscle) length. Again, this exercise should be relatively pain free but is more discomforting then isometrics.

  • Place your hand over the edge of a table with your palm facing down.
  • Lower your wrist until fully bent slowly. Lower the wrist to this position – (5 second descent. Then use your other hand to bring it back to the starting position.
  • Perform 3×10, progress to 5×10 and add resistance by using your other hand to push down, holding a weight or water bottle.
  • Progress to using resistance for 5×10 before moving onto Stage 4.

Step 4

Concentric/Eccentric: Concentric/Eccentric is a more functional form of exercise which utilizes resistance through the full range of motion of the wrist joint. Again, relatively pain free.

  • Place your hand over the edge of a table with your palm facing down
  • Lower your wrist until fully bent, then contract to bring the wrist back to the starting position.
  • Perform 3×10 add resistance by using your other hand to push down, holding a weight or water bottle.
  • Progress to using resistance for 5×10.

So there’s my 4 step process to beating tennis elbow. Progress through all 4 steps to increase strength and wave pain goodbye. If you are still suffering from symptoms or are having trouble progressing through the rehab please call our practice on 02 9569 5145 or book an appointment online.

Thanks for reading,
Insync Physiotherapy Team

 

References:

H.W. Gruchow, D. PelletierAn epidemiologic study of tennis elbow. Incidence, recurrence, and effectiveness of prevention strategies

Am J Sports Med., 7 (1979), pp. 234-238