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Tennis Elbow Rehabilitation
Outlined below is a simple treatment and rehabilitation program for tennis elbow. No single treatment is likely to be effective but a combination of methods can be successful.
Aims of rehabilitation
The following guidelines are for information purposes only. The aim of tennis elbow rehabilitation is to:
- Rreduce pain and inflammation
- Identify and address possible causes
- Stretching and strengthening exercises
- A gradual return to activity.
Different people respond differently to various methods so it is important to do everything within your power to maximize the chance of a successful and speedy rehabilitation.
Reduce pain and inflammation
Rest from activity that causes pain. If you are a tennis player then stop playing. It is not just tennis that causes this injury or may aggravate it. Gripping anything tightly or opening heavy doors may make it worse, even .
Cold therapy should be applied in the early stages, in particular the first couple of days to ease pain. Do not apply ice directly to the skin as this may cause ice burns but wrap in a wet tea towel. A number of specialist cold therapy products are useful in applying the right amount of cold therapy in a convenient way.
Electrotherapy treatment such as laser or ultrasound are often administered to help reduce pain although there effectiveness may depend on the intensities and frequencies used.
Wear a tennis elbow brace, support or heat retainer. This will give support and help prevent further injury. A specialist tennis elbow brace works by changing the direction of the forces through the tendon and so reducing the strain and load on the painful parts. Wearing a heat retainer type support after the initial painful acute stage will stimulate blood flow and aid healing.
NSAID's (Non Steroidal Anti-inflammatory Drugs) such as Ibuprofen can help reduce pain and inflammation, especially in the early stages. It is thought they are less helpful later in the rehabilitation process. Always check with a Doctor before taking medication. You should not take Ibuprofen if you have asthma.
This phase will usually take anything from 2 days to 2 weeks depending on how bad the injury is, how long your may have had it and how much rest it is given. It is important that the elbow is pain free before moving onto rehab exercises.
Tennis elbow exercises
A gradual and progressive exercise regime over an either week period should be attempted before considering surgery or injections.
Stretching exercises for tennis elbow should begin as soon as pain allows. They should be performed very gently at first and continue throughout the rehabilitation process and after. Hold stretches initially for 10 - 15 seconds - during the acute stage. Later stretches can be held for up to 40 seconds. Repeat stretches 3 times and aim to stretch at least 3 times a day.
Strengthening exercises should also begin as soon as pain allows. Again this will depend on how bad the injury is and is likely to be a few days after stretching exercises commence. The basic rule is if it hurts doing the exercise then wait!
Start with static exercises and gradually progress. When these can be done comfortably move onto concentric and then eventually eccentric type exercises. It is important that strengthening exercises are done before trying to return to activity. Also apply cold therapy after strengthening exercises to control pain and inflammation.
A professional therapist may use mobilizations with movement in conjunction with strengthening exercises. This involves mobilizing the elbow whilst the therapist applies pressure to the joint in a particular direction which re-aligns the joint and relieves pain.
Identify possible causes
Overuse is the main cause of tennis elbow, whether that be work related or sport related. Identifying and eliminating the causes of tennis elbow is essential if recurrence is to be avoided.
If it is tennis related then consult a suitably qualified tennis coach. Other tips include keeping a training diary so you can look back and identify possible training increases. An poor backhand technique (bent wrist), having the wrong grip size or badly strung rackets can all increase the likelihood of tennis elbow.
Sports massage therapy
If after 8 weeks of exercises there is little improvement then massage may help, although massage should be applied only after the acute stage and very lightly at first, below pain levels. Cross friction techniques are usually applied across the tendon to help stimulate healing.
Massage can also be applied to the muscles of the forearm to help relax them and release any tight knots in the muscles that may increase the strain at the elbow. It is a good idea to apply cold therapy after massage treatment to calm the area down and reduce any residual inflammation. Manual therapy to the neck and upper back may also help.
Other forms of treatment
Corticosteroid injections to treat tennis elbow are thought to offer effective results over the short term which up to 80% of patients claiming success. But over the long term (6 to 12 weeks post injury) it is thought steroid injections may turn out to be less effective, delaying eventual recovery or increasing the chance of recurrence.
Nitric oxide donor therapy involves applying patches with glycerol trinitrate to the painful area. Symptoms are thought to improve over a 3 to 6 month period. However, side effects include skin rash and headaches in approximately 1 in 20 patients.
Botox injections are relatively new for tennis elbow treatment and are thought to be effective in the short term however risks longer term could be a lag in the contraction of the extensor muscles.
Autologous blood injections involves injecting the area with blood which has been centrifuged to concentrate the platelets in the blood which may enhance the inflammatory response and re-initiate the healing process.
Surgery for tennis elbow may be considered if the patient has had severe symptoms for over 18 months. The exact type of surgery performed may vary depending on the particular surgeon but most techniques involve cutting away the diseased or degenerated tissue.
Return to activity
This should be done gradually whether the injury is work related or sport related. Only go back to normal activities when the elbow is pain free and strengthening exercises have been progressed.
If you are a tennis player ensure you have the correct technique. Wearing a brace can help take the strain off the elbow during the return to full fitness. Some coaches may advise practice strokes without a ball to start with then introducing a light foam ball and then a normal tennis ball. Gradually increase power in shots and number of practice shots played over a 6 week period. For example session 1 - 20 strokes at 20% effort. Session 2 - 30 strokes at 30% effort and so on.
If you find you have pain during, after or the next day then take a step back. Throughout this phase it is essential that stretching and strengthening routines are maintained.