Tennis elbow, technically known as lateral epicondylitis (an inflammation of the outside aspect of the elbow) is a commonly presenting complaint to my office. It’s a tendonitis of the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB) muscle tendons. The inflammation of these two tendons, which control wrist extension (think of the movement at your wrist during a tennis backhand) can be a hassle to deal with because they are also used heavily in all kinds of activities outside of tennis! Holding a grocery bag, lifting weights, opening doors and even shaking hands are all examples of common activities that will load the tendon and potentially aggravate the problem. For this reason the condition is easily irritated which slows healing and keeps the injury simmering often much longer than we’d like.
Research consistently shows that a targeted exercise program is an effective intervention for soft tissue injuries like tennis elbow. An exercise program that includes strength training and stretching performed with consistency (emphasise consistency) will load the tendon in an appropriate manner and stimulate the laying down of new fibers that are strong and well arranged to bear the stress of normal future uses! But what should that exercise program look like? A 2005 article published in the British Journal of Sports Medicine outlines a very simple protocol consisting of one stretch and one eccentric strengthening exercise that can be performed with a light weight that I present to you below and in the video shown here:
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Stretch: With your elbow extended (straightened out in front of you) and the forearm pronated (palm facing down), bring the wrist into flexion (wrist bent so that the fingers point toward the floor. You can use the other hand to add a little overpressure to the stretch. If you really want to impress everybody, and I know you do, add a little but of ulnar deviation by angling the wrist toward the pinky side. You should feel the stretch come on into the affected tendons with this last one. Find a place where your stretch pain is at 4-6/10 and hold for 1-2 minutes (that’s right!). Do this stretch three times before and three times after the strengthening exercise described below.
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Strengthening exercise: Extend your elbow across a table as shown in the video so that your wrist is dangling off the edge of the table and the elbow is straightened. Hold a small weight in your hand between 1 and 5 lbs depending on tolerance (start at 1lb). Start with the wrist extended (pointing “up”) Slowly let the weight drop down over the edge of the table until the wrist is in a flexed position (pointing “down”). Use the other hand to help lift the weight back into the extended position and repeat. Do not lift the weight back to the starting position under your own power without assistance from the other hand. Perform 10 repetitions, 3 sets. the video will provide a demonstration for this.
That’s it! Perform this protocol daily for 4 weeks as part of an overall rehabilitation program that includes consultation with your physiotherapist for manual therapy and reassessment of where you are in the healing process. Also be aware that there can be other contributors to tennis elbow type pain not least of which is the very common occurrence of referred pain from nerve dysfunction rooted at the neck. Check with your physiotherapist to see which intervention is right for you!
Some Further reading on this topic (If you really want to dig deep).
Stasinopoulos, D., Stasinopoulou, K., & Johnson, M. (2005). An exercise programme for the management of lateral elbow tendinopathy. British Journal of Sports Medicine, 39(12), 944–947. http://doi.org/10.1136/bjsm.2005.019836
Stasinopoulos, D., Stasinopoulos, I., Pantelis, M., & Stasinopoulou, K. (2010). Comparison of effects of a home exercise programme and a supervised exercise programme for the management of lateral elbow tendinopathy. British journal of sports medicine, 44(8), 579-583.
Dimitrios, S., & Pantelis, M. (2013). Comparing Two Exercise Programmes for the Management of Lateral Elbow Tendinopathy (Tennis Elbow/Lateral Epicondylitis)—A Controlled Clinical Trial. Open Access Journal of Science and Technology, 2(6), 7.
