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Tennis Elbow Exercise



Tennis elbow is a condition which causes pain around the outside bony part of the elbow and down into the forearm. It is also known as lateral epicondylitis or lateral epicondyle tendinopathy in medical terms. It mainly affects people between the ages of 40 and 60. Men and women are equally affected with the most commonly affected arm is the dominant side. Tennis elbow is often an overuse injury primarily due to repetitive strain from tasks and activities that involve loaded and repeated gripping and/or wrist extension.




tennis elbow exercise



Tennis elbow is caused by a variety of activities that involve repetitive use of the forearm muscles through repetitive extension movements of the wrist and hand. This includes gripping and twisting activities that are done in manual jobs or through prolonged use of a computer.


The natural course of tennis elbow is favourable and in 80-90% of cases of tennis elbow people will have a spontaneous recovery. However, symptoms can take up to 12-18 months to resolve.


If your elbow pain is aggravated by certain movements try to avoid these aggravating movements. Often symptoms and flare ups of tennis elbow can be settled by modifying your activity. If certain movements or activities at your work seem to be the biggest issue in aggravating your symptoms you could speak to your occupational health department for an assessment and support.


It is thought smoking could interfere with the circulation to tendons. This means the tendons are at increased risk of injury. If circulation is poor, tendons may take longer to heal or may not heal well. Previous smokers are also at increase risk of tennis elbow due to the previous exposure and effects of tobacco on the vascular system. You can find help to reduce or quit smoking here


If you have a tennis elbow it is important to keep your arm moving. Rest can be helpful for a few days if you have had a flare up of pain but it is important to keep your elbow moving so it does not stiffen up and get weak. Exercises to maintain your elbow range of movement and strength are extremely important.


You may find that these exercises may slightly increase your symptoms initially. However you should find that the exercises themselves will become easier to do. These exercises can take up around 12 weeks for you to notice a great improvement.


Aim to stay in the green or amber boxes. If you are in the red area then you can modify the exercises by trying reducing the amount of movement during an exercise, the number of repetition, reducing the weights, reducing your speed or increasing rest time between sets.


Your pain or other symptoms should return to your pre exercise baseline within 30 minutes of exercising. You should not feel an increase in pain or stiffness that last longer than 60minutes the next morning after your exercises.


This is usually the first phase of tendon rehabilitation where this type of exercise can help to reduce your pain if done correctly. These exercises need to be repeated several times a day and slowly increased to 40second holds to reduce pain, maintain some muscle capacity and tendon load.


To do this exercise position your painful arm resting on a table. Pull your hand back towards you so that your fingers are pointing to the roof. Bring your non-painful hand and gently place at the back of your hand pointing towards the roof. Gently push for 10 seconds. Repeat 5 times and repeat 4 times per day. If this exercise brings on pain then you are pushing too hard so slightly ease off your push.


To do this exercise position your painful arm on a table with your palm facing downwards. Hold a small hand weight (or can or bottle of water) then slowly raise the weight towards the ceiling and then lower back to the starting position. Repeat 15 times as pain allows.


To do this exercise rest your painful arm on a table with your wrist coming over the edge and palm facing downwards. Hold a small hand weight (or can or bottle of water). Slowly raise your painful wrist with your non-painful hand. Then slowly lower back to the starting position. Repeat 15 times.


This exercise can be done in either standing or sitting. Hold a broom handle or walking stick in both hands. Lift your arms to shoulder level. Keep both elbows straight with your palms facing down. Roll the broom handle backwards like your are trying to reel something in. Repeat 15 times twice per day.


To do this exercise, sit in a chair with your arms at shoulder level holding a rolled up towel in both hands. Keep elbows in straight position. Twist the towel - so you are turning the painful wrist towards the floor. Repeat 15 times. Then slowly increase to 3 sets of 15 repetitions as pain allows.


To progress this exercise then twist the towel in opposite directions like your are trying to wring water from the towel. Repeat 15 times and then slowly increase to 3 sets of 15 repetitions as pain allows.


Lateral Epicondylitis, also known as "Tennis Elbow", and lately proposed as Lateral Elbow (or Epicondyle) Tendinopathy (LET) [1] is the most common overuse syndrome in the elbow. As the last description implies, it is a tendinopathy injury involving the extensor muscles of the forearm. These muscles originate on the lateral epicondylar region of the distal humerus. In many cases, the insertion of the extensor carpi radialis brevis is involved.


It should be remembered that only 5% of people suffering from tennis elbow relate the injury to tennis! Contractile overloads that chronically stress the tendon near the attachment on the humerus are the primary cause of LET. It occurs often in repetitive upper extremity activities such as computer use, heavy lifting, forceful forearm pronation and supination, and repetitive vibration. Despite the name, you will also commonly see this chronic condition in other sports such as squash, badminton, baseball, swimming and field throwing events. People with repetitive one-sided movements in their jobs such as electricians, carpenters, gardeners, desk bound jobs also commonly present with this condition.[2][3] [4][5][6]


The elbow joint is made up of three bones: the humerus (upper arm bone), the radius and ulna (two bones in the forearm). At the distal end of the humerus there are two epicondyles, one lateral (on the outside) and one medial (on the inside).


LET is classified as an overuse injury that may result in hyaline degeneration of the origin of the extensor tendon. Overuse of the muscles and tendons of the forearm and elbow together with repetitive contractions or manual tasks can put too much strain on the elbow tendons. These contractions or manual tasks require manipulation of the hand that causes maladaptations in tendon structure that lead to pain over the lateral epicondyle. Mostly, the pain is located anterior and distal from the lateral epicondyle.[4]


Elbow tendinopathy occurs at least five times more often and predominantly occurs on the lateral rather than on the medial aspect of the joint, with a 4:1 to 7:1 ratio. It affects 1-3% of the population, with those 35-50 years old most commonly being affected. [8] If a patient is 50, consider osteoarthritis (OA), referred cervical spine pain. In a study by Nirschl, [9] of 200 tennis players aged >30, 50% had symptoms of LET at some stage.


Furthermore, it is often seen that the flexibility and strength in the wrist extensor and posterior shoulder muscles are deficient. At least patients report weakness in their grip strength or difficulty carrying objects in their hand, especially with the elbow extended. This weakness is due to finger extensor and supinator weakness. Some people have a sense of paralysis but this is rare. [10][19] [20]


During the physical exam, the structure of the elbow and other joints is assessed. Also the nerves, muscles, bones and skin are examined. The diagnosis of LET is substantiated by tenderness over the ECRB or common extensor origin. By the following methods, the therapist or physiotherapist should be able to reproduce the typical pain:


In longstanding cases, plain X-ray (AP and lateral views) of the elbow may be taken to rule out arthritis of the elbow. Calcification along the lateral epicondyle [24], osteochondritis dissecans, degenerative joint changes or evidence of heterotopic calcification are among the common findings.


Exercise therapy is a regimen or plan of physical activities designed and prescribed for specific therapeutic goals. Its purpose is to restore normal musculoskeletal function or to reduce pain caused by diseases or injuries. Strength, stamina and mobility should be improved by exercises once the pain and inflammation are under control. [64][68] Supervised exercise programmes may be the first treatment in managing LET compared to Cyriax physiotherapy. [64]Combinations of exercise/manipulation and exercise/stretching may have a short-term effect, with the latter also having a long-term effect.[2]


Other programs suggest that stretching exercises for the extensor muscles of the wrist and fingers should be performed in the following manner: fully extend the elbow and palmary flex the wrist. Remain in the point of maximum non painful extension for a period of 15 to 25s. this exercises is repeated four to five times a day with two series of ten exercises in each session: the patient should always stop at the first sign of pain. In this phase of therapy, the patient should also perform isotonic exercises, once a day, according to the following plan:[64] 1. Stretching exercises = repeat 10 times (15-25 seconds)2. Isotonic exercises = repeat 15 times (3 series)3. Stretching exercises = repeat 10 times (15-25 seconds)4. Icing = massage the tender area with ice or crushed ice for 10-15 minutes


Theraband Exercise:Theraband exercises (or exercises with a small weight) are performed each day for 3 sets of 10. You fix one side of the theraband under you feet or another place and you take the other side in your hand or you have a small weight in your hand. The patient starts the exercise in wrist flexion, then he/she does a wrist extension and comes back to the start position very slowly. [19] This exercise is an concentric and eccentric exercise for the wrist extensors. Supervised exercise consisting of static stretching and eccentric strengthening for 4 weeks is suggested to have larger effects in reducing pain, strength and function, compared to the Cyriax physiotherapy approach. Once the patients can do this, they can progress to another colour of theraband or you increase the weight. [19] 041b061a72


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