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Physiotherapy Management of Tennis Elbow................Article(2)

Physiotherapy Management of Tennis Elbow................Article(2)

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Published by Rupika Sodhi

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Published by: Rupika Sodhi on Mar 08, 2012
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07/20/2013

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Physiotherapy Management of Tennis ElbowIntoduction:
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 primarilyby a tear between the tendinous
 
origin
of 
the extensor carpi radialis brevis and the periosteum
 
on theanterior 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 swinginghammer again and again.
Physiotherapy Management Includes
:
 
There are several treatment options for tennis elbow. Your physiotherapist may employ acombination of the following physiotherapy treatment interventionsCold 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
.
 
R
est - this means avoiding further overuse not absence of activity. You should maintain as highan activity level as possible while avoiding activities that aggravate the injury. Absolute restshould be avoided as it encourages muscle atrophy, deconditions tissue, and decreases bloodsupply to the area, all of which is detrimental to the healing process. Pain is the best guide todetermine the appropriate type and level of activity.
 
I
ce - is recommended as long as inflammation is present. This may mean throughout the entirerehabilitation process and return to sports. Ice decreases the inflammatory process slows localmetabolism and helps relieve pain and muscle spasm.
 
C
ompress and
E
levate if appropriate to assist venous return and minimize swelling.
Phase 2
….
 
Goals:
Improve flexibility,increase strength and endurance,increase functional activities andreturn to function.
Stretching
 
Gentle stretching exercises including wrist flexion, extension and rotation. The elbowshould beextended and not flexed to increase the amount of stretch as required. These stretches shouldbe held for 20-30 seconds and repeated 5-10 times, at least twice a day. Vigorous stretchingshould 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 atthe 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 forearmat 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, repeat3 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. Rotatehand to palm down position, return to start position (hammer perpendicular to floor), rotate topalm up position, repeat. To increase or decrease resistance, by move hand farther away orcloser towards the head of the hammer.
Phase 3
 
Goals:
Improve muscular strength and endurance, maintain and improve flexibilityand graduallyreturn to prior level of sport or high level activity
 
The stretching and strengthening exercises emphasizing the eccentric contractions of wristflexion and extension. lower the weight in a controlled fashion
 
With the combined wristflexion/extension exercise, work on increasing speed when rolling up the string with theattached 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 andpronation
 
2. Ask the patient to relax, then a sustained lateral glide mobilization is applied to the proximalforearm 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 seconds…frequently the patient will report that this time the grip is pain
-free. Thetechnique 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 armextended 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, asadditional support is provided by the second hand.
Support: Brace
- the brace constrains full muscle expansion when the muscle contracts, diminishesmuscle 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..

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