The aim of phase 3 is to further increase the load through the tendon in an increased range. It comprises:
- Cold therapy
- Massage
- Bracing
- 1 mobility exercise
- 2 strengthening exercises
Check the Exit Criteria to see when you can progress to phase 4
Treatment
Can be done daily.
Hot & cold therapy
The elbow only needs to be iced after exercise.
Brace
Continue to wear a counterforce brace (not during exercise).
Massage
Deep tissue massage for the muscles of the forearm can release any tight knots, lumps, and bumps that might increase the stress on the tendon attachment point.
Sports massage can be a useful treatment for tennis elbow, particularly more chronic conditions. In particular, cross friction massage of the tendon, but only once the initial inflammation has settled. This is usually after 5 days.
To be done 2 times per week.
Mobility & stretching
At least once a day.
Wrist extensor stretch
Both straight and bent elbows.
Teaching point:
- Place your arm in front with your hand pointing down
- Pull the hand towards your body to feel a stretch at the back of the wrist, forearm, and elbow
- Your forearm can be rotated inwards to increase the stretch. This will be felt more on the outside of the elbow
- The stretch can be held for 30 seconds and repeated up to 3 times
- 1-2 x per day, as comfortable
- 3 sets of 30 seconds (3 to 5 times per day)
Note: Adding the middle finger to the stretch may help.
Strengthening
3 times a week.
Short lever Wrist extension
When the isometric exercises can be completed comfortably without pain then you can move on to dynamic exercises, this may be from 5 days onwards.
Do not rush! If the injury becomes painful, take a step back.
Teaching point:
- In a sitting position move the wrist from flexion to extension
- This exercise can be performed using a lightweight (about 1 to 2 kg)
- This exercise can be performed using a resistance band
- 3 sets of 12 to 15 repetitions
- Alternate days
- Isometrics on off days
Note: As this becomes more comfortable increase the weight and reduce reps to 3 sets of 8 reps.
Long lever wrist extension
When the isometric exercises can be completed comfortably without pain then you can move on to dynamic exercises, this may be from 5 days onwards.
Do not rush! If the injury becomes painful, take a step back.
Teaching point:
- In a sitting position move the wrist from flexion to extension whilst holding the arm out straight
- If this feels hard to do then lower the weight down
- 3 sets of 15 reps
- Alternate days
- Isometrics on off days
Note: As this becomes more comfortable increase the weight and reduce reps to 3 sets of 8 reps.
Move on to phase 4?
Check if you are ready to move on:
Exit criteria
Move onto the next phase when:
- The exercises are pain-free
- No pain 24 hours post-exercise
- Normal daily activities are pain-free
- The stretch is not painful
- The area is not tender to touch