Tennis Elbow and Exercise Protocol

Tennis Elbow

Background
It is also called as lateral epicondylitis. It is defined as a pathlogic condition of wrist extensor muscles at their origin on lateral humeral epicondyle.
The tendinous region of extensor carpi radialis (ERCB) is the area of most pathologic changes

Risk factors

• Most patients are 30 to 50 years
• 95% occurs in tennis players
• Active in sports activities
• Poorly conditioned muscles

Symptoms

• pain or tenderness on the outer side of the elbow bony prominence
• pain when you straighten or raise your wrist and hand
• pain made worse by lifting a heavy object
• pain when you make a fist, grip an object, shake hands, or turn door handles
• pain that shoots from the elbow down into the forearm or up into the upper arm

Physical Examination

• Point of tenderness is examined
• Muscle strength
• Range of motion- Active and passive
• Resisted isometric movements
• Special test : Cozen's test, Mill's test - will be discussed below
• Neck- pain of elbow may be referred to the neck as well

Special test for Tennis elbow

Cozen's test

The examiner stabilizes the elbow with a thumb over the lateral epicondyle. Pain in the lateral epicondyle is seen with patient making a fist, pronating the forearm, radially deviating and extending the wrist against resistance by the examiner. Passive extension of the elbow with forced flexion of the wrist may precipitate pain at the lateral epicondyle

You can view the video on how the test is done

http://www.youtube.com/watch?v=4LK4PTGGg4s&feature=related

Mills test

With this test, pain occurs over the lateral epicondyle when the wrist and fingers are completely flexed.There's a video on how the test is done

http://www.youtube.com/watch?v=sL-W5aeDsHI&feature=player_embedded

Positive signs of Examination

• point of tenderness typically occuring at ERCB origin at lateral epicondyle
• the tenderness will be generalized over the common extensor wad insertion at the lateral epicondyle
• pain often gets worst by wrist extension against resistance with forearm pronated (palm down)
• elbow extension is limited
• neck pain and stiffness
• bursitis
• cozen's test,mills test : positive

Physiotherapy Treatment

Phase 1

Tennis elbow is a soft tissue injury of the muscles and tendons around the elbow joint, and thereforer should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain,the R.I.C.E regime should be employed. This involves

Rest

Ice

Compression

Elevation

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy

techniques. The application of heat and massage is one of the most effective treatments for removing
scar tissue and speeding up the healing process of the muscles and tendons.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your

treatment. The aim of this phase it to regain the strength, power, endurance and flexibility of the muscle
and tendons that have been injured.

Phase 2 : Rehabilitation

Gentle stretching exercise

Gentle stretching exercises including wrist

flexion (bending the wrist down), extension
(bending the wrist up). The elbow should
be fully straightened. These stretches
should be held for 20-30 seconds and
repeated 5-10 times, at least twice a day.
Vigorous stretching should be avoided - do
not stretch to the point of pain that
reproduces your symptoms

Strengthening exercise

With the elbow bent and the wrist supported perform the following exercises:


Wrist Extension. Place 1 lb. weight in hand with palm facing downward; support
forearm at the edge of a table or on your knee so that only your hand can move.
Raise wrist/hand up slowly, and lower slowly.

Wrist Flexion. Place 1 lb. weight in hand with palm facing upward; support
forearm at the edge of a table or on your knee so that only your hand can move.
Bend wrist up slowly, and then lower slowly

Forearm Rotation. Grasp dumbell (wrench, or some similar device) in hand with

forearm supported. Rotate hand to palm down position, return to start position (dumbell

perpendicular to floor), rotate to palm up position, repeat. To increase or decrease

resistance, by move hand farther away or closer towards the head of the dumbell

Theraband exercise for tennis elbow

Begin this elbow strengthening exercise with a resistance band around your hand as demonstrated at the figure above. Your elbow should be at your side and bent to 90 degrees. Slowly rotate your forearm against the resistance band so your palm faces up. Perform 3 sets of 10 repetitions as far as possible and comfortable without pain.

Begin this elbow strengthening exercise with a resistance band around your hand as demonstrated at the figure above. Your elbow should be at your side and bent to 90 degrees. Slowly rotate your forearm against the resistance band so your palm faces down. Perform 3 sets of 10 repetitions as far as possible and comfortable without pain

Biceps Curl 

Begin this elbow strengthening exercise with a resistance band under your feet and around your hands as demonstrated as the figure above. Your back and elbows should be straight. Slowly bend your elbows against the resistance band tightening your biceps. Perform 3 sets of 10 repetitions as far as possible and comfortable without pain.

Advanced exercises

Biceps Preacher Curl


Begin this elbow strengthening exercise kneeling over a Swiss ball and holding a light weight as demonstrated as above. Your back and elbows should be straight. Slowly bend your elbow tightening your biceps. Perform 3 sets of 10 repetitions as far as possible and comfortable without pain.


I hope all this information had helped you all. :)

Below is the link to the video on the exercises for tennis elbow.Feel free to watch it
http://www.youtube.com/watch?v=ayTzSzYFUxM&feature=fvst

By, Anusha Sehgal

Referrence

• S brent brotzman, Kevin E.Wilk : Clinical Orthopaedic Rehabiltation 2nd edition 1996
• http://www.sportsinjuryclinic.net/
• http://www.medicine.net.com/