Lateral Epicondylitis
Principles: Slow, controlled, progressive heavy load exercise is the basic principle for improving function and decreasing pain in most cases of tendinopathy (this includes, Achilles, patellar, and lateral and medial epicondyle tendinopathy. Eccentric strengthening exercises involve the careful application of a load to a lengthening muscle. The type and amount of loading should be individually tailored to the patient. The progression needs to be gradual and carefully monitored.
The strain from exercising with large tensile loads, moved in a slow, controlled manner, likely stimulates tissue remodeling and some normalization of tendon structure. These exercises may be uncomfortable, but should not cause severe pain or worsening of symptoms. During rehabilitative exercise, discomfort should be kept within moderate levels that do not suggest further injury.
The therapist must ensure that exercise technique is biomechanically sound, and the intensity and frequency of the program are appropriate to the patient and clinical circumstance
Phase One – week 1:
- Gentle strengthening exercises with active motion and sub maximal isometrics.
- Edema and inflammation control: Continue to ice application 20 minutes two to three times a day.
Phase 2: Weeks 2-3
- Advanced strengthening as tolerated to include weights or theraband. Focus should be on endurance training of wrist extensors (i.e. light weights, higher repetitions per set).
- Edema and inflammation control with ice application for 20 minutes after activity.
- Modified activities in preparation for beginning functional training.
- Gentle massage along and against fiber orientation.
- Counterforce bracing to common extensor tendon of forearm. (Including education on proper use to avoid nerve compression.)
Phase 4: Weeks 3-discharge
- Continue counterforce bracing if needed for patient to complete ADLs and/or strengthening activity pain-free.
- Begin task-specific functional training.
- Return to higher-level work / recreational activities.