Lateral Epicondylitis – Why can it linger, and what is the best rehab for it?

Lateral Epicondylitis, commonly known as Tennis Elbow, is a very common chronic inflammatory condition of the elbow that is normally placed into the category of an ‘Occupational Overuse Syndrome’ (OOS). Lateral Epicondylitis is caused by repetitive loading with twisting activities of the forearm and wrist, it can also be caused by activities such as repetitive typing, keyboard, and mouse usage. The lateral epicondyle is the Common Extensor Tendon Origin (CETO); there are five key tendons that attached at this point including the Extensor Carpi Radialis Brevis (ECRB) and Longus (ECRL), Extensor Digitorum (ED), Extensor Digiti Minimi (EDM) and Extensor Carpi Ulnaris (ECU); all of which form the Common Extensor Tendon (CET).  The ECRB is frequently the main cause of symptoms and makes up the largest component of the CET, and often becomes the main focus of a rehabilitation programme, however, the smaller tendons may often be overlooked and may become the underlying culprits causing an extended recovery from the injury. We quite often hear from our patients that they have had multiple failed attempts at conservative rehabilitation with the focus being solely on the ECRB, and when provided rehabilitation exercises that target the smaller muscles and tendons we regularly see a great response and significant improvements in their symptoms.

When assessing function of the hand wrist and forearm for a client with LE, it is important to assess ALL functions of the fingers, hand, wrist, and forearm which are associated with the CET. I also find it helpful to assess functions including pronation and supination of the forearm with the elbow in a fixed position to determine if there are any biomechanical discrepancies outside of the normal range and function of the elbow. Covering all your bases in the assessment will assist in finding any functional gaps that can be worked on throughout the rehabilitation programme. It is promoted and supported by the literature that LE is treated conservatively, with interventions including activity modification and exercise (Bisset, 2006). A good exercise rehabilitation should combine range of motion and stretching exercises, concentric and eccentric strengthening exercises, and fine/gross motor control and grip strengthening exercises. A systematic review conducted by Menta et. Al, 2015, concluded that clinic-based strengthening exercises were effective for short-term improvements in pain reduction and have a better longer-term outcome for patients with persistent LE.

If you or a patient are struggling with an ongoing and painful elbow injury, a referral to an Accredited Exercise Physiologist may be the appropriate next step in the treatment timeline to attain a positive outcome. Absolute Balance have a caring team of skilled Accredited Exercise Physiologists’ that can help get your rehabilitation back on track, with comprehensive assessments and exercise programming designed with the goal of attaining full pain-free function front of mind. If you would like further information on this topic, or would like to contact the team you can email info@absolutebalance.com.au or visit our website www.absolutebalance.com.au

Alixe Marion (B.Sc. Exercise Physiology)

Senior Accredited Exercise Physiologist – Complex Claims Specialist

 

References:

Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B BMJ 2006 Nov 4;333(7575):939

Menta R, Randhawa K, Côté P, Wong JJ, Yu H, Sutton D, Varatharajan S, Southerst D, D’Angelo K, Cox J, Brown C, Dion S, Mior S, Stupar M, Shearer HM, Lindsay GM, Jacobs C, Taylor-Vaisey A J Manipulative Physiol Ther 2015 Sep;38(7):507-20