Physiotherapy Management of Tennis Elbow Intoduction:Tennis elbow is a condition characterized by pain and tenderness on the lateral side of

the elbow usually related to the common extensor tendons of the forearm.It is being caused primarily by a tear between the tendinous origin of the extensor carpi radialis brevis and the periosteum on the anterior surface of the lateral epicondyle. Key Words:Tennis Elbow,Extensor carpi radialis brevis,Overuse injury

Aetiology of tennis elbow are:Overuse activity like squeezing clothes, Unaccustomed carpentry,
Unaccustomed gardening, Excessive typing,Excessive use of screwdriver,Can also occur due to swinging hammer again and again. Physiotherapy Management Includes : There are several treatment options for tennis elbow. Your physiotherapist may employ a combination of the following physiotherapy treatment interventions Cold therapy or Cryotherapy Ultrasound Massage Manual muscle stretching Joint mobilization Range of motion exercises Active range of motion (AROM) exercises Active resistive range of motion (ARROM) exercises

Flexibility exercises General conditioning exercises Strengthening exercises Patient education About tennis elbow Precautions Activity modification Self-care of symptoms

Injury prevention

Recommend proper equipment Recommend brace if necessary Work or sport-specific rehab program

Phase 1 Goals:Decrease inflammation ,Decrease pain,promote tissue healing,retard muscle atrophy .

Rest - this means avoiding further overuse not absence of activity. You should maintain as high an activity level as possible while avoiding activities that aggravate the injury. Absolute rest should be avoided as it encourages muscle atrophy, deconditions tissue, and decreases blood supply to the area, all of which is detrimental to the healing process. Pain is the best guide to determine the appropriate type and level of activity. Ice - is recommended as long as inflammation is present. This may mean throughout the entire rehabilitation process and return to sports. Ice decreases the inflammatory process slows local metabolism and helps relieve pain and muscle spasm. Compress and Elevate if appropriate to assist venous return and minimize swelling. Phase 2. Goals:Improve flexibility,increase strength and endurance,increase functional activities and return to function. Stretching Gentle stretching exercises including wrist flexion, extension and rotation. The elbowshould be extended and not flexed to increase the amount of stretch as required. 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 With the elbow bent and the wrist supported perform the following exercises:Wrist Extension. Place 1 lb. weight in hand with palm facing downward (pronated); support forearm at the edge of a table or on your knee so that only your hand can move. Raise wrist/hand up slowly (concentric contraction), and lower slowly (eccentric contraction). Wrist Flexion. Place 1 lb. weight in hand with palm facing upward (supinated); support forearm at the edge of a table or on your knee so that only your hand can move. Bend wrist up slowly (concentric), and then lower slowly (eccentric)(similar to exercise above).

Finger Extension. Place a rubber band around all five finger tips. Spread fingers 25 times, repeat 3 times. Ball Squeeze. Place rubber ball or tennis ball in palm of hand, squeeze 25 times, repeat 3 times. If pain is reproduced squeeze a folded sponge or piece of foam. Forearm Pronation/Supination. Grasp hammer (wrench) in hand with forearm supported. Rotate hand to palm down position, return to start position (hammer 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 hammer. Phase 3 Goals: Improve muscular strength and endurance, maintain and improve flexibilityand gradually return to prior level of sport or high level activity

The stretching and strengthening exercises emphasizing the eccentric contractions of wrist flexion and extension. lower the weight in a controlled fashion With the combined wrist flexion/extension exercise, work on increasing speed when rolling up the string with the attached weight as this will improve endurance.. . Mobilisation Technique

Ask the patient to grip in the position that produces their symptom e.g. in elbow extension and pronation 2. Ask the patient to relax, then a sustained lateral glide mobilization is applied to the proximal forearm either with a belt or with the hands. 3. While the lateral glide is maintained, the patient is asked to form a grip again and hold for approx. 3 secondsfrequently the patient will report that this time the grip is pain-free. The technique must be pain-free; never continue if the patient reports of pain

Some points for regular tennis players to avoid tennis elbow. Firstly, strengthen your forearm muscles by squeezing a ball 40 or 50 times with your arm extended horizontally in front of you. During a stroke your grip should be firm and your elbow should be almost fully extended. Beginner players can use both the hands for a backhand stroke to avoid tennis elbow, as additional support is provided by the second hand.

Support: Brace- the brace constrains full muscle expansion when the muscle contracts, diminishes muscle activity, and therefore the force generated by the muscle. Grip size - A grip too large or too small lessens control and promotes excessive wrist movement..

Equipment Modifications: Ball The type of ball used to avoid tennis elbow should be as bouncy.. Racquet :Big Racquets can aggravate tennis elbow, so go in for a midsize racquet, which absorbs vibration, gives more power and plays softer. Strings Gut strings give more resilience and less vibration than nylon ones.

References:
John Ebnezer,Essentials of Orthopaedics for physiotherapists , 1st ed,Jaypee Brothers 2003,Chapter 16,232-233 Signs and symptoms of athletic injuries. Gallaspy, James; Douglas may, J copyright 1996.

Fundamentals of sports injury management. Anderson, Marcia; Hall, Susan copyright 1997. Tennis elbow. Buchbinder, Rachelle; Green, sally; Struijs, peter. American family physician. March 2007. Lateral Epicondylosis: A case study of conservative care utilizing ART and rehabilitation. Howitt, Scott. Journal of Canadian chiropractic association. 2006. Lateral Epicondylitis: review and current concepts. Faro, Frances; Moriatis wolf, Jennifer. Journal of hand surgery. Oct. 2007.