Proven Tennis Elbow Exercises: A Comprehensive Guide to Easing Pain

Tennis elbow, also referred to as lateral epicondylitis, is a prevalent condition that leads to discomfort and pain in the outer area of the elbow and forearm. It typically occurs due to excessive use of the muscles and tendons in the forearm, causing small tears and inflammation.

Causes of Tennis Elbow

• Repetitive Movements - playing tennis, using a computer mouse extensively, or performing manual labor.
• Improper Technique - Incorrect swing techniques in tennis or improper form while lifting weights are examples of this.
• Overexertion - increasing the intensity or duration of
• Age and Degeneration – with increasing age individual is more susceptible to injury with repetitive movements.
• Lack of Conditioning - Weak muscles and inadequate conditioning can make the tendons more vulnerable to strain.
• Occupational Factors - plumbing, carpentry, painting, or typing, can increase the risk of developing tennis elbow.
• Sporting Activities - golf, racquetball, and baseball, can also contribute to its development.
• Direct Trauma - a direct blow to the outer part of the elbow can result in inflammation

Clinical Presentation

• Pain and Tenderness - around the bony prominence called the lateral epicondyle.
• Grip Weakness - difficult to perform tasks that involve gripping, lifting, or carrying objects.
• Pain Aggravation - includes actions like shaking hands, turning a doorknob, or lifting objects.
• Morning Stiffness - stiffness and discomfort in the elbow and forearm, particularly in the morning or after periods of rest.

Differential Diagnosis of Tennis Elbow

It's important to differentiate tennis elbow from other conditions that can cause similar symptoms

1. Radial tunnel syndrome
2. Cervical neuropathy

Tests to Diagnose Tennis Elbow

Cozen's Test (Resisted Wrist Extension Test):

Have the patient make a fist, extend their wrist, and resist as you try to push their fist downward. This can provoke pain if tennis elbow is present.

Mill's Test:

With the patient's palm facing down, gently flex their wrist while you press down on their extended middle finger. Pain can indicate lateral epicondylitis.

Palpation:

The therapist palpates (apply pressure) to the lateral epicondyle, the bony prominence on the outer part of your elbow. Tenderness and pain at this point during palpation can be a sign of tennis elbow.

Treatment Plan For Tennis Elbow

Pain Management and Restoring Range of Motion

• Education of patient: Physiotherapist explains the nature of tennis elbow and how treatment plan will work.
• Rest and Ice: Rest is crucial to allow the affected area to heal. I'll guide you on proper rest techniques. Applying ice for 15-20 minutes every few hours can help reduce inflammation and pain.

Stretching Exercise: wrist and forearm stretches to improve flexibility and prevent stiffness.

Exercise Example

• Wrist Extensor Stretch - targets the extensor muscles of the forearm

Follow these steps:

1. Extend your arm in front of you, palm facing down.
2. Use your other hand to gently bend your wrist downwards, feeling a stretch on the outer forearm.
3. Hold the stretch for 15-30 seconds and repeat on the other arm.

Range of Motion Exercises: Gradually reintroduce pain-free movements to maintain joint mobility.

Exercise Example

• Forearm Pronation and Supination - focuses on improving the range of motion and strength of your forearm muscles.

Follow the steps:

1. Sit down with your forearm resting on a table or your thigh, palm facing up.
2. Hold a light object (like a hammer) in your hand and slowly rotate your wrist to turn the object downwards (pronation).
3. Rotate it back to the starting position and then rotate it upwards (supination).
4. Perform 2-3 sets of 10-15 repetitions on each arm.

Electrotherapy:

Ultrasound Therapy:

Ultrasound therapy involves the use of high-frequency sound waves to promote blood circulation, reduce inflammation, and accelerate the healing process in the affected area.

Iontophoresis:

Iontophoresis is a technique where a mild electrical current is used to deliver anti-inflammatory medications through the skin to the affected area. This can help reduce pain and inflammation.

Strengthening and Stabilization Exercises

Isometric Exercises: These involve contracting the forearm muscles without moving the joint. Isometrics help improve muscle strength without putting excessive strain on the tendon.

Eccentric Exercises: These controlled-lengthening exercises have been proven effective for tennis elbow. We'll guide you in performing these exercises to strengthen the tendons.

Exercise Example

Eccentric Wrist Flexor Exercise - involve lengthening a muscle as it contracts.

Follow the steps:

1. Hold a lightweight dumbbell or a household object (like a can of soup) in your hand, palm facing up.
2. Slowly lower the weight by bending your wrist, then use your other hand to lift it back to the starting position.
3. Aim for 3 sets of 15 repetitions, gradually increasing the weight as you become more comfortable.

Wrist Extensor Strengthening: Emphasize strengthening the wrist extensors, which are commonly affected in tennis elbow. We'll use resistance bands or light weights as appropriate.

Forearm Strengthening: Gradually introduce more comprehensive forearm strengthening exercises to improve overall muscle support.

Exercises Example

TheraBand FlexBar Twist:

The TheraBand FlexBar is a versatile tool designed to aid in tennis elbow recovery:

1. Hold the FlexBar vertically in front of you with both hands, your injured arm slightly more extended.
2. Twist the FlexBar by turning your wrist and forearm outward (like wringing a towel).
3. Slowly return to the starting position and repeat for 3 sets of 15 repetitions.

Finger Extension with Thera Band:

This exercise helps strengthen the extensor muscles of the fingers and wrist:

1. Place a rubber band around your fingers, just above the knuckles.
2. Open your fingers against the resistance of the rubber band, then relax.
3. Complete 3 sets of 15 repetitions, gradually increasing the resistance as you progress.

Functional Rehabilitation and Prevention

• Sport-Specific Exercises: As your strength improves, we'll incorporate exercises that mimic the demands of your specific activities, like tennis strokes.
• Technique Correction: I'll assess your technique to identify any contributing factors to your condition and suggest adjustments to prevent future issues.
• Gradual Return to Activities: We'll work together to create a progressive plan for returning to your regular activities while minimizing the risk of re-injury.

Taping and Bracing:

Physiotherapists may apply specialized tape or recommend braces to support the affected area, relieve strain on the tendons, and promote proper healing.

Clinical Scenario of Tennis Elbow

Sarah, a 35-year-old office worker who spends long hours at her computer, typing reports and answering emails. Lately, she's been experiencing discomfort on the outer side of her right elbow. The pain started as a mild ache but has gradually become more noticeable over the past few weeks.

Sarah's symptoms worsen during work hours, especially when she's typing or using the mouse. She also notices that gripping a coffee mug or turning a doorknob causes discomfort. While she's not engaged in sports, she's concerned about the persistent pain affecting her daily life.

She decides to seek help and consults a physiotherapist. During the assessment, the physiotherapist takes a detailed history and performs a physical examination. They notice tenderness and localized pain around the lateral epicondyle of Sarah's right elbow. Sarah also reports weakness when gripping objects.

Based on the assessment, the physiotherapist diagnoses Sarah with tennis elbow, or lateral epicondylitis. They explain that this condition can result from repetitive movements and strain on the tendons that attach to the outer part of the elbow. Sarah's prolonged typing and mouse usage have likely contributed to the issue.

The physiotherapist designs a personalized treatment plan for Sarah:

1. Pain Management: The physiotherapist recommends icing the affected area to reduce inflammation and suggests over-the-counter anti-inflammatory medication if necessary.
2. Rest and Modification: Sarah is advised to take breaks during work, perform gentle stretches, and avoid activities that exacerbate her symptoms.
3. Strengthening Exercises: The physiotherapist guides Sarah through specific exercises to strengthen her forearm muscles, with a focus on eccentric movements.
4. Stretching Routine: Sarah is taught stretches to improve flexibility and relieve tension in the forearm muscles.
5. Ergonomic Modifications: The physiotherapist assesses Sarah's workstation and suggests adjustments to her desk, chair, and computer setup to promote better posture and reduce strain.
6. Home Exercise Program: Sarah is provided with a home exercise program to continue her rehabilitation between physiotherapy sessions.

Over several weeks of consistent physiotherapy sessions and diligent home exercises, Sarah experiences gradual improvement. Her pain decreases, grip strength improves, and she can perform her office tasks with less discomfort. The physiotherapist monitors her progress and adjusts the treatment plan as needed.

By addressing the issue early and following the physiotherapist's guidance, Sarah is able to overcome her tennis elbow and return to her work routine and daily activities without persistent pain.