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Lateral Epicondylitis (Tennis Elbow)

Feb 10, 2022

Lateral epicondylitis (LE), also known as "Tennis Elbow", is the most common overuse injury 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. 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.


Fact - Only 5% of people who experience tennis elbow associate the injury to tennis.


The main symptom of LE is pain, which can be produced by palpating the origin of the extensor muscles at the lateral epicondyle. The pain can also radiate both upwards along the upper arm and downwards along the outside of the forearm, and in rare cases, into the third and fourth fingers.


A study by Warren suggested there are four stages on the development LE and intensity of symptoms:

  • Faint pain a couple of hours after the provoking activity.
  • Pain at the end of or immediately after the provoking activity.
  • Pain during the provoking activity, which intensifies after ceasing that activity.
  • Constant pain, which prohibits any activity


One of the main treatment methods for LE is exercise-based intervention. The study of Vicenzino et al. found that physical therapy interventions including elbow joint mobilization with movement combined with exercise has been shown to have better results than "Therapeutic Corticosteroid Injection" at 6 weeks and to wait and see at 6 weeks but not 52 weeks. Recent research regarding cervicothoracic joint mobilization in conjunction with local treatment for LE has shown improvements in strength, pain, and tolerance to activity compared to local treatment alone. 


An Accredited Exercise Physiologist prescribed exercise programme has been shown to both reduce symptoms and increase function of the affected limb. Once of the main exercise principles for the management of LE is eccentric exercise. An eccentric contraction is the motion of an active muscle while it is lengthening under load. The initial eccentric exercises for LE include wrist extension, pronation and supination and radial deviation, with the concentric phase of the exercise may be performed passively or with assistance from the un-injured side. Positioning of the injured side with the elbow is in full extension, forearm in pronation and the arm is supported, results in the greatest strengthening result for the extensor tendons. However, should you have moderate/high symptoms completing exercises in this position, flex you elbow to 90 degrees. Optimal dosage of exercise for the best outcomes is still to be determined, however the eccentric exercises should be performed slowly initially, with the speed of movement increased as the rehabilitation protocol progresses.


Other treatments for LE include:

  • Anti-inflammatory medications
  • Counterforce braces
  • Extracorporeal shock-wave therapy
  • Acupuncture
  • Injections: Cortisone, platelet-rich plasma (PRP) and autologous blood injection (ABI)
  • Surgery

 

  Blake Cocking

      Workers Compensation Specialist (AEP, ESSAM)

         Exercise Rehabilitation Services ‑ WA

     



Ma, K. L., & Wang, H. Q. (2020). Management of Lateral Epicondylitis: A Narrative Literature Review. Pain research & management, 2020, 6965381.

Tyler TF, Thomas GC, Nicholas SJ, McHugh MP. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. J. Shoulder Elbow Surg. 2010; 19:917Y22.

Stanish WD, Rubinovich RM, Curwin S. Eccentric exercise in chronic tendinitis. Clinical orthopaedics and related research. 1986 Jul 1;208:65-8.

Bisset, L., Coombes, B., & Vicenzino, B. (2011). Tennis elbow. BMJ clinical evidence, 2011, 1117.

Warren, RF. Tennis elbow (epicondylitis): epidemiology and conservative treatment, in AAOS Symposium and Upper Extremity Injuries in Athletes, Pettrone, F.A., Ed. St. Louis: C.V. Mosby, 1986; 233-243. Level of Evidence: 1B


By Alison Absolute Balance 24 Apr, 2024
The human body is designed to move in a three-dimensional plane divided into the following segments: Sagittal Plane: Cuts the body into left and right halves. Forward and backward movements. Frontal Plane: Cuts the body into front and back halves. Side to side movements. Transverse Plane: Cuts the body into top and bottom halves. Twisting/rotational movements. Too often we get caught training mostly in a sagittal plane, think running, squats, bicep curls etc. While these are all good exercises, in day-to-day life we don’t only move along a sagittal plane. What happens when you need to quickly get out of the way of the e-scooter flying towards you on the foot path or make a quick sidestep to avoid a pothole – these movements are along the frontal plane. While movements such as turning to check your blind spot while driving or turning to talk to the person next to us are in the transverse plane. When it comes to injury prevention and movement efficiency it is important to incorporate exercises from all planes of movement into training programs. Sagittal If a line ran down the middle of the body splitting it from left to right, movements parallel to this line are within the sagittal plane of movement. The sagittal plane is the most common plane of movement and is trained overwhelming more than the frontal and transverse planes of movement. Movements/exercises considered to be in the sagittal plane include running, squats, deadlifts and bicep curls. Now while all these exercises are good, with the way our lives having evolved into many desk sitting roles, driving from place to place etc, to then go to the gym and focus heavily on movements that are predominantly up – down, and forwards – backwards we can end up reinforcing these pathways and becoming somewhat robotic, heavily limiting our natural movements. Frontal If a line ran down the middle of the body splitting it into front and back, movements parallel to this line would be within the frontal plane of movement – essentially any movement that involves moving away from or towards the midline. Often neglected in strength programs, frontal plane exercises include Cossack squats, lateral lunges, and side raises. Transverse If a line split the body in half separating it into top and bottom with the pelvis being the point of division, any movement parallel to this line would be considered to be in the transverse plane of movement. Movement along/through a transverse plane is generally more rotational such as a Russian twist or trunk twist. By focussing largely on sagittal plane movements, we are risking developing muscle imbalances, limited mobility and uncoordinated movements in the neglected planes. Our body is designed to move on a 3-dimensional plane so make sure to train in a way that will allow it to move the way it’s supposed to. Katie McGrath Injury Prevention Specialist Injury Prevention Services
18 Apr, 2024
Stretching and mobility exercises are indispensable components of both injury prevention and recovery strategies. Incorporating dynamic stretches before physical activity can help prepare the body for movement by increasing blood flow to muscles and enhancing joint flexibility. This dynamic warm-up routine primes the muscles and connective tissues, reducing the risk of injury during subsequent activity. Furthermore, static stretches, performed after physical activity, helps alleviate muscle tension and improve flexibility, thereby minimizing the likelihood of strains and tears. In the realm of injury recovery, stretching and mobility exercises play a crucial role in rehabilitation protocols for individuals recuperating from various musculoskeletal injuries. Following an injury, muscles can become tight and weakened due to disuse or trauma. Gentle stretching exercises aid in maintaining or restoring flexibility, preventing muscle atrophy and contractures. Additionally, targeted mobility exercises assist in restoring range of motion and functional movement patterns, allowing individuals to gradually regain strength and flexibility while reducing the risk of re-injury. Moreover, stretching and mobility exercises promote tissue healing by improving circulation to the injured area. Increased blood flow delivers essential nutrients and oxygen to damaged tissues, facilitating the repair process and reducing inflammation. By incorporating a comprehensive stretching and mobility routine into their regimen, individuals not only safeguard themselves against future injuries but also expedite their recovery journey, enabling them to return to their activities with greater resilience and confidence. Mariah Adolphus Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA
05 Apr, 2024
Hey, my name is Blake, and I am an Exercise Physiologist, Workers Compensation Specialist and Clinical Team Leader at Absolute Balance. I graduated from Edith Cowan University in 2015 after completed my Bachelor of Science (Exercise Science and Rehabilitation). I grew up on a farm Northeast of Perth past Gingin with my parents and two brothers, both of which are back working on the farm, which has been in our family for generations. My love for sport and interest in the human body initially prompted me to complete my Bachelors in Exercise and Sports Science, and my initial thoughts on a career were either Physiotherapy or Phys Ed Teacher. However, this quickly changed when I commenced my first Exercise Physiology unit in my Sports Science degree as it opened my eyes to exercise rehabilitation, and how important it was to individuals with injuries. Having experienced multiple injuries personally playing football (AFL), basketball and tennis, I can fully empathise with how much injuries can impact your life. Being an EP and being in a role where I can make a positive and meaningful impact on individual’s lives who have sustained an injury is extremely important to me. This doesn’t only extend to the patients I see, but also the team members I lead within Absolute Balance. I guide a team of five in the Northeast region at Absolute Balance, assisting them with their own patients and leading them to grow as Exercise Physiologists and individuals. Although it has its challenges, leadership is extremely rewarding and has helped me grow both personally and professionally. Whilst I am not at work, I am spending my time at the gym, at football training and games during February-September (or in the car travelling to and from comes with the gig of country football), spending time with my wife and our dog Otis. I spend the other half of my weekend manicuring my lawn and watching good shows and sports. Blake Cocking Workers Compensation Specialist ‑ Team Leader North East (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA
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