General info
Summary

Data about the condition

Lateral epicondylitis, also known as “Tennis Elbow”, is the most common overuse syndrome in the elbow. 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 a lot of cases, the insertion of the extensor carpi radialis brevis is involved.

Simptomes

  • Pain and/or stiffness in the dominant armPain and/or stiffness in the dominant arm
  • Pain, burning, or stiffness that gradually worsens over time
  • Pain that increases with activity but improves with rest
  • Pain, burning, and/or stiffness in both elbows and/or forearms
  • Pain originating in the elbow that radiates down the forearm
  • Elbow stiffness and aching in the morning
  • Difficulty gripping or holding items in the hand
  • Elbow and/or wrist that is tender to the touch
  • Difficulty turning or flexing the wrist
  • Pain triggered by squeezing motions
  • Pain during athletic activity

Causes

  • Not warming up before strenuous activity
  • Improper use of sports equipment
  • Playing tennis or other racket sports in inclement weather
  • Direct trauma to the elbow
  • Working in physically repetitive occupations
  • Playing non-racket sports or engaging in other recreational activities that involve repetitive use of the arm and wrists

Treatment

  • Not warming up before strenuous activity
  • Improper use of sports equipment
  • Playing tennis or other racket sports in inclement weather
  • Direct trauma to the elbow
  • Working in physically repetitive occupations
  • Playing non-racket sports or engaging in other recreational activities that involve repetitive use of the arm and wrists

The objectives of the Recovery Program

  • Pain relief
  • Local relaxation
  • Mechanical rearrangement of the joint
  • Restoring the range of motion
  • Increased muscle strength and endurance
  • Gesture restoration of movement

The content of the Recovery Program

Deep Transverse Frictions

Deep transverse friction is a specific type of connective tissue massage applied precisely to the soft tissue structures. The therapist must try to reach an analgesic effect applying the DTF at the point of the lesion for 10 min till a numbing effect has been reached. An interval of 48 hours between two sessions is necessary.

Ice massage (cryotherapy), in which ice is applied with circular pressure directly onto the skin over the affected area. Unlike some other types of ice therapy, ice massage does not place a cloth between the ice and the skin. Patients are advised to limit ice massage/cryotherapy to less than five minutes per session, only once or twice per day to reduce the risk of skin damage.

Exercises

  • Elbow and forearm position: begin with flexed elbow and forearm in supination, then progress by increase elbow extension angle.
  • Fingers flexion vs extension: beginning with fingers in flexion then progressing to extension to load the long extensors.
  • Adding weights: whether by an exercise band or dumbbells
  • Functional training exercises and targeting the whole upper limb.

Methodical Indications

  • Long-term warm-up before physical exertion
  • Avoiding elbow hyperextension
  • Avoiding sudden movements at the elbow

Did you know?

People age 30 and older are at increased risk of developing tennis elbow. The risk accelerates even more after age 40.


You can also read about Hand joints, Carpal Tunnel Syndrome.

  1. Manickaraj N, Bisset LM, Kavanagh JJ. Lateral epicondylalgia exhibits adaptive muscle activation strategies based on wrist posture and levels of grip force: a case-control study. Journal of musculoskeletal & neuronal interactions. 2018 Sep;18(3):323.
  2. Jump up to:0 7.1 Heales LJ, Vicenzino B, MacDonald DA, Hodges PW. Forearm muscle activity is modified bilaterally in unilateral lateral epicondylalgia: A case‐control study. Scandinavian journal of medicine & science in sports. 2016 Dec;26(12):1382-90.
  3. Jump up↑Coombes BK, Bisset L, Vicenzino B. A new integrative model of lateral epicondylalgia. British journal of sports medicine. 2009 Apr 1;43(4):252-8.
  4. Jump up↑Mascaró A, Cos MÀ, Morral A, Roig A, Purdam C, Cook J. Load management in tendinopathy: Clinical progression for Achilles and patellar tendinopathy. Apunts. Medicina de l’Esport. 2018 Jan 1;53(197):19-27.
  5. Jump up↑Arampatzis A, Peper A, Bierbaum S, Albracht K. Plasticity of human Achilles tendon mechanical and morphological properties in response to cyclic strain. Journal of biomechanics. 2010 Dec 1;43(16):3073-9.
  6. Jump up↑Stanish WD, Rubinovich RM, Curwin S. Eccentric exercise in chronic tendinitis. Clin Orthop Relat Res. 1986 Jul;(208):65-8
  7. Jump up↑Ohberg L, Lorentzon R, Alfredson H. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. Br J Sports Med. 2004 Feb;38(1):8-11, discussion :11
  8. Jump up to:0 13.1 Rees JD, Lichtwark GA, Wolman RL, Wilson AM. The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans. Rheumatology. 2008 Jul 22;47(10):1493-7.
  9. Jump up↑Naugle KM, Fillingim RB, Riley III JL. A meta-analytic review of the hypoalgesic effects of exercise. The Journal of pain. 2012 Dec 1;13(12):1139-50.
  10. Jump up↑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.
  11. Jump up↑Manickaraj N, Bisset LM, Ryan M, Kavanagh JJ. Muscle Activity during Rapid Wrist Extension in People with Lateral Epicondylalgia. Medicine and science in sports and exercise. 2016 Apr;48(4):599-606.
  12. Jump up↑Nijs J, Van Houdenhove B, Oostendorp RA. Recognition of central sensitization in patients with musculoskeletal pain: application of pain neurophysiology in manual therapy practice. Manual therapy. 2010 Apr 1;15(2):135-41.
  13. Jump up↑Smith BE, Hendrick P, Bateman M, Holden S, Littlewood C, Smith TO, Logan P. Musculoskeletal pain and exercise—challenging existing paradigms and introducing new. British journal of sports medicine. 2019 Jul 1;53(14):907-12.
  14. Jump up↑Reyhan AC, Sindel D, Dereli EE. The effects of Mulligan’s mobilization with movement technique in patients with lateral epicondylitis. Journal of back and musculoskeletal rehabilitation. 2019 May 10(Preprint):1-9.
  15. Jump up↑Mulligan MWM for tennis elbow. Available from: https://www.youtube.com/watch?v=thUlPbCX4fU
  16. Jump up↑Olaussen M, Holmedal O, Lindbaek M, Brage S, Solvang H. Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review. BMJ open. 2013 Oct 1;3(10):e003564.
  17. Jump up↑Cho YT, Hsu WY, Lin LF, Lin YN. Kinesio taping reduces elbow pain during resisted wrist extension in patients with chronic lateral epicondylitis: a randomized, double-blinded, cross-over study. BMC musculoskeletal disorders. 2018 Dec;19(1):193.
  18. Jump up↑Giray E, Karali‐Bingul D, Akyuz G. The Effectiveness of Kinesiotaping, Sham Taping or Exercises Only in Lateral Epicondylitis Treatment: A Randomized Controlled Study. PM&R. 2019 Jan 4.
  19. https://www.sports-health.com/sports-injuries/elbow-injuries/tennis-elbow-all-about-lateral-epicondylitis
  20. https://www.physio-pedia.com/Lateral_Epicondylitis

Leave a comment