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.

WATCH TWO 100% FREE WEBINARS ON SHOULDER PAIN AND ULNA-SIDE WRIST PAIN

Shoulder and wrist free course

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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    GHADEER
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    Orthopedic Physiotherapy of the Upper and Lower Extremities EXCELLENT BUT MISSING PRINTED VERSION

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    Orthopedic Physiotherapy of the Upper and Lower Extremities ORTHOPAEDIC PHYSIOTHERAPY OF THE UPPER & LOWER EXTREMITIES
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    Orthopedic Physiotherapy of the Upper and Lower Extremities REALLY REALLY GREAT!
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    Orthopedic Physiotherapy of the Upper and Lower Extremities Great course, very nice and clean, full attention to details, great job boys!

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    Orthopedic Physiotherapy of the Upper and Lower Extremities LEERZAAM
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    Orthopedic Physiotherapy of the Upper and Lower Extremities My compliments for this online course! I’m feeling all up to date now! I can see why it is highly accredited with the KNGF. Other than expected I quite enjoyed taking the course! Good structure ,good balance between text en videos and content en quiz. For me the assessment assignments worked great to lock the knowledge in! Quizzes are sufficiantly challenging and force/ motivate to really study the contents, think about it and listen to the questions carefully!
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    One point of attention: I got the feeling that the short quizzes at the end of each unit didn’t always mach the unit’s content or plainly state differently (e.g. Type of SLAP lesions).

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    Orthopedic Physiotherapy of the Upper and Lower Extremities PERFECT INFORMATION
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    Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE
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    Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE FOR REFRESSING YOUR KNOWLEDGE ABOUT THE EXTREMITIES
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    Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE FOR NOT ONLY FIRST YEAR PHYSIOS BUT ALSO EXPERIENCED PHYSIOS.

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    Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE
    Super tevreden met de cursus! Heel veel nuttige informatie die makkelijk toepasbaar is op de dagelijkse fysiotherapeutische praktijk. Naast de diagnostische testen ook veel gehad aan de ‘treatment’ gedeeltes voor in de praktijk.
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    Orthopedic Physiotherapy of the Upper and Lower Extremities This course showed me some new insights that I can use in my own practice.
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    Orthopedic Physiotherapy of the Upper and Lower Extremities As I said, great course. When you take this course, you’re being pushed into improving your assessment skillset.

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    29/07/19

    GREAT ILLUSTRATION OF WHAT ONLINE EDUCATION SHOULD BE! The great course with absolutely new approache to study information online!
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    Great illustration of what online education should be!

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    06/06/19

    GREAT! It was an excellent course! Took me 33 hours and 26 minutes to complete. I liked the cases a lot and the statistics gave me a totally new point of view to assess different tests. This course will make me a better physiotherapist. Thank you!

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    31/05/19

    THE UNIVERSITY OF THE FUTURE Awesome Course!!!, honestly it´s the University of future, you will learn all the commmon pathologies of the body with just 1 click: epidemiology, prognostic factors, course, asessment and treatment, everything from a scientific point of view. Well structured, easy to read, fast navegation, high quality videos. You will be able to answer your patient how long the complaints will last base on the last evidence with proper numbers, giving a fair prognosis which will help you to keep them motivate to the therapy and be patients and constant. There is no a day when I dont use it in the practice to consult a specific test or the sensibility of this one. Even you get you acreditation points, a bunch of them actually in comparison with other courses that you will never use in your daily routine. 100% advisable!!!

    Curso Magnifico!!!, honestamente, es la universidad del futuro, aprenderá todas las patologías comunes del cuerpo con un solo clic: epidemiología, factores pronósticos, curso, evaluación y tratamiento, todo desde un punto de vista científico. Bien estructurado, fácil de leer, navegación rápida, videos de alta calidad. Podrás responder a tu paciente cuánto tiempo durarán sus molestias basado en la última evidencia con los números adecuados, lo que les dará un pronóstico justo que los ayudará a mantenerlos motivados para la terapia y ser pacientes y constantes. No hay un día en el que no lo use en la práctica para consultar una test específico o la sensibilidad de este. Incluso se obtienen puntos de acreditación, un monton ellos en comparación con otros cursos que luego nunca usas en su rutina diaria. 100% recomendable!!

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    28/05/19

    Orthopedic Physiotherapy of the Upper and Lower Extremities A great course for new grads! I have found this course to be very well put together. Firstly the formatting is very user friendly – it’s easy to work through but also very to easy to navigate to specific sections to use as a reference resource. As always with these guys the videos are very high quality. The attention to detail with academic references is also spot on. You can be assured that the info is evidence based. Overall, highly recommended.

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    Stijn
    14/02/19

    GREAT COURSE I thinks this course is great, I find the framework it teaches you very useful in assessing my patients. I like how the different pathologies are very clearly explained from epidemiology to pathophysiology to diagnostics to treatment, all evidence based. The Physiotutors-style videos used to explain the subject matter are really useful for studying too. Finally, the assingments at the end of the chapters are a great way to test and practice your knowledge on the subject you just studied.