Physiotherapy Treatment of Tennis Elbow

Treatment of Tennis Elbow

Activity Modification

-In non-athletes, removal of activities that are painful is essential to improvement (eg., repetitive valve opening).

-Treatment for example ice and NSAIDs may decrease the inflammation, but continued repeating the aggravating motion will prolong any recovery.

-Often repetitive pronation-supination motions and lifting household names at work can be modified or eliminated. Activity modifications for example avoidance of grasping in pronation and substituting controlled supination lifting instead may relieve symptoms.

-Lifting ought to be done with the palm up whenever you can, and both upper extremities ought to be used in a manner that reduces forcible elbow extension, supination and wrist extension.

Correction of mechanics

If your late poor backhand is painful, correction of mechanics from the game is warranted.Avoidance of ball impact that lacks a forward body weight transference is stressed.

If typing with unsupported arms exacerbates the pain sensation, placing the elbows on stalked towels for support will help.

Calculation of grip-The distance in the proximal palmar crease to the tip from the middle finger determine the correct grip size.The figure obtained represents the circumference from the racket handle.

Nonsteroidal Anti-inflammatory Drugs

Otherwise contraindicated, we use Cox-2 inhibitors (rofecoxib, celecoxib) for their improved safety profile.

Physiotherapy Treatment of Tennis Elbow
Icing

10-15 minutes of icing, 4 to 6 times a day.

Cortisone Injection

Your physician may suggest an injection of the small dose of steroid towards the affected area. This is not the type of steroid banned for athletes. If tried on the extender can last for up to 3 months, and although it might need to be repeated you seldom require more than two or even three injections.

Stretching

ROM of exercises emphasizing end-range and passive stretching (elbow entirely extension and wrist in flexion with slight ulnar deviation).

Forearm extensor stretch might be performed with the athlete facing the wall.The dorsum from the hand is placed around the wall, and the elbow remains locked. By leaning forward the wrist needs into 90 amount of flexion,stretching the posterior forearm tissues.

Wrist flexion might be combined with a pronation stretch.Keeping the elbow locked, the forearm is maximally pronated and wrist flexed.Overpressure is used by other hand and static stretch is conducted.

The scar tissue is much more pliable when warm. So stretching exercises could be given after some superficial heating modality.

Bracing

Brace can be used only during actual play or aggravating activity. The strain is adjusted to comfort as the muscles are relaxed to ensure that maximal contraction from the finger and wrist extensors is inhibited through the band. The band is positioned 2 finger breadths distal to the painful part of the lateral epicondyle.

Some authors recommend 6-8 weeks utilization of a wrist splint positioned at 45 amount of dorsiflexion.

Range of Motion Exercises

Exercises emphasize end-range and passive stretching (elbow entirely extension and wrist in flexion with slight ulnar deviation).

Soft tissue mobilization- Cross fibre friction massage is performed with and perpendicular towards the tissue involved.

Electrotherapy

TENS for pain alleviation

LASER

Phonophoresis or iontophoresis might be helpful.

Strengthening exercises for tennis elbow

A light strengthening program ought to be used for grip strength, wrist extensors, wrist flexors, biceps, triceps, and rotator cuff strengthening.

However,the acute inflammatory phase should have resolved first, with fourteen days of no pain before initiation of graduated strengthening exercises.Growth and development of symptoms (pain) modifies the exercise progression, having a lower level of intensity and much more icing if pain recurs.

The workout program includes-

Active motion and submaximal isometrics.

Isotonic eccentric hand exercises with graduated weights to not exceed 5 pounds.

Theraband extension is conducted with athlete sitting.One end from the band is placed underneath the foot and the opposite end is gripped.

Wrist curls-Sit using the hand over the knee.With palm up, bend the wrist Ten times holding a 1-2 pound weight.Increase to 2 sets of 10 daily; then boost the weight by 1 pound upto 5-6 pounds. Continue doing this with palm down, but progress to simply 4 pounds.

Forearm strengthening-Hold the arm in front of the body, palm down. The individual clenches the fingers, bends the wrist up, and holds it tight for Ten seconds. Next with the contrary, the patient attempts to push the hand down. Hold for Ten seconds, 5 repetitions, slowly increasing to twenty repetitions 2-3 times each day.

Elbow flexion and extension exercises.

Squeeze a sponge ball repetitively for forearm and hand strength.

Mobilization with movement (MWM)- Within this a sustained mobilization is used to a joint. The mobilization is used at the same time the patient performs an unpleasant action with the affected joint (extension of wrist).

Progress strength, flexibility, and endurance inside a graduated fashion with slow-velocity exercises involving use of gradually increasing resistance. Afterwards upper limb plyometrics, closed chain activities and sport specific activities are carried out.

Surgical treatment of tennis elbow

Operative treatment is needed in less than 2% cases. Extensor tenotomy-Release of ECRB with debridement of chronic inflammatory tissues may be the treatment of the choice.

Guidelines of Surgery-Persistent pain (a lot more than 1 year), pain resting, high activity level, failure of quality rehab program.