Tennis Elbow Treatment

Tennis Elbow Exercises | Lateral Epicondylalgia Rehab

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Tennis elbow exercises

Tennis Elbow Exercises | Lateral Epicondylalgia Rehab

Although the course of LE is favorable with 89% of patients reporting improvement in pain after a 1-year follow-up, a randomized-controlled trial by Peterson et al. in the year 2011 has shown superior outcomes regarding pain with daily progressive exercise compared to a wait-and-see approach at three months follow-up. Currently, there is no common consensus as to which exercise modality is superior to another. Although isometric exercise generally seems to decrease pain in tendinopathy, Coombes et al. in the year 2016 have shown an increase in pain intensity after an acute bout of isometric exercise performed at an intensity above, but not below, the individual pain threshold. So while isometric exercise might still have a place in lateral Epicondylalgia rehab, exercising above the pain threshold might be less effective in the elbow compared to other body regions.

Another study by Peterson et al. in 2014 compared a concentric vs. an eccentric daily home exercise program in patients with chronic LE. They found a faster decrease in pain and increase in strength in the eccentric exercise group from two months onwards. However, both groups improved significantly regarding pain and strength and the crude difference between the groups was not significant at 12 months follow-up. For this reason, the authors conclude that both modes of exercise may be used in order to simplify the execution of the exercise, but stressing the eccentric work phase will probably provide an advantage. 

The following exercises described by Kenas et al. in the year 2015 can be included in a rehab program for lateral Epicondylalgia. We modified them in a way that the concentric portion of the exercise is included as well:

The authors recommend including one exercise for wrist extension and 1 exercise for wrist supination per session with 2 sets of 10 repetitions. Each repetition should be performed in a slow controlled manner. Sessions should be performed 3 times a week with a 24 to 48 hour rest period in between to allow for proper recovery and a positive net synthesis of collagen.

Similar to tendinopathies in other body regions good load management is key to rehabilitation. This means that the patient should temporarily avoid or reduce activities that aggravate the elbow pain. At the same time, the exercise program must be as close as possible to the tendon’s current capacity and progressed in the course of rehab in order to drive adaption. For this reason, we advise starting with a training volume that the patient can just tolerate in a pain-free manner and closely observe the patient’s 24-hour reaction to exercise. If there is no pain aggravation beyond the 24-hour mark after exercise, the training volume can be increased gradually by adding repetitions, sets, or intensity in the form of increased resistance.

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In case you are curious about how to diagnose tennis elbow, check out the following orthopedic tests:

References

Coombes BK, Wiebusch M, Heales L, Stephenson A, Vicenzino B. Isometric exercise above but not below an individual’s pain threshold influences pain perception in people with lateral epicondylalgia. The Clinical journal of pain. 2016 Dec 1;32(12):1069-75.

Kenas A, Masi M, Kuntz C. Eccentric Interventions for Lateral Epicondylalgia. Strength & Conditioning Journal. 2015 Oct 1;37(5):47-52.

Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nature Reviews Rheumatology. 2010 May;6(5):262-8.

Peterson M, Butler S, Eriksson M, Svärdsudd K. A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy). Clinical rehabilitation. 2014 Sep;28(9):862-72.

Peterson M, Butler S, Eriksson M, Svärdsudd K. A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Upsala journal of medical sciences. 2011 Nov 1;116(4):269-79.

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