Many people experience Tennis Elbow which is tenderness and pain located on the outside area of the elbow with occasional pain radiating down to the wrist. In this article I will examine the treatment and management this condition. Tennis Elbow involves tendinitis of one and sometimes 2 tendon attachments to the boney lateral epicondyle point on the outside of the elbow joint. These two muscle tendons are called the Extensor Carpi Radialis Brevis muscle and the Extensor Digitorum muscle and they are responsible for bending the wrist backwards. Activities such as constantly using a screwdriver or a hammer, knitting or playing racquet sports can overload these muscle tendons leading to micro tears in the tendon attachment point to the outside aspect of the elbow.
Effective Treatment of Tennis Elbow
There are two methods used to treat Tennis Elbow. The first method comprises of rest, icing the tender elbow and taking anti-inflammatories. This treatment plan reduces pain initially but it is only a temporary measure as it does not repair the long term tensile strength of the tendons. Once the tendon is overloaded by activity, repeat micro trauma tears are the end product. The 2nd method involves the Physical therapist diagnosing that the tendon is stuck in a chronic inflammatory stage that cannot complete its 3-5 day inflammatory cycle without disruptive aggravating movements such as knitting, hammering nails etc. The inflammation stage needs to be ‘jump-started’ so that it can proceed to the fibroblastic stage which involves the laying of collagen tissue at tendon site, thus improving the tensile tendon strength.
This is achieved by the Physical Therapist applying graded manual friction across the tendon coupled with the application of ice. Isometric strengthening Exercises which involve holding the arm constant without stretching the tendon can then be commenced in the early stage. Patients should avoid aggravating the elbow by resting it for a few days (over a weekend period!), so the initial treatment is followed with the patient resting the arm for approximately 3 days. Once improvement has been noted, we can commence graded stretching exercises that gently stretch the Extensor Carpi Radialis Brevis and Extensor Digitorum muscles is a painfree manner. This is performed by the patient before they start manual activities. The Patient can then progress to more strenuous strengthening exercises under the Guidance of the Physical Therapist to fully rehabilitate the condition.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles.
Contact Number: 0504 26672
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