Tennis Elbow – Tennis elbow or lateral epicondylitis is a condition in which the outer part of the elbow becomes sore and tender. It is commonly caused by non-inflammatory, chronic degenerative changes in the tendons that attaches the forearm muscle extensors to the elbow. It is most prevalent in middle age.
Signs And Symptoms of Tennis Elbow:
Lateral Epicondylitis ( TENNIS ELBOW)
- Common extensor tendon is located distal to the lateral epicondyle
- With extensor tendonitis, microtearing occurs in extensor carpi radialis brevis (ECRB) origin. extensor carpi radialis longus (ECRL) and extensor digitorum may also become involved.
- Tendinitis caused by forceful extension, supination and radial deviation.
- Racquet sports players (backand technique) are prone to injury.
- Pain is local to the lateral epicondyle, specifically at the origin of ECRB.
Grades of Tennis Elbow:
- Grade 1 Tennis Elbow: pain after activity only
- Grade 2 Tennis Elbow: pain at the beginning of activity, disappears with activity, returns afterwards
- Grade 3 Tennis Elbow: pain at the beginning, during, and after activity; pain may restrict activity
- Grade 4 Tennis Elbow: pain with activities of daily living, and to get worse
Acute Tennis Elbow Symptoms:
- Gradual onset, tenderness local to the proximal extensor tendons one or two days after activity. The tenderness progresses into pain during activity as the tendonitis becomes severe.
- Microtearing causes a cycle of inflammation and the formation of adhesions and even crepitus in the area
- Inflammation, heat and swelling at the tendon or sheath
- Decreased range of motion of the wrist extensors, also elbow
Chronic Tennis Elbow Symptoms:
- Pain during and after activity
- Chronic inflammation, adhesions, crepitus and fibrosis present
- Chronic swelling, thickening may be visible if the tendon is superficial
- Decrease in ROM-range of motion and strength of the wrist extensors
- Flare –ups to acute stage may occur with repeated overuse
- ECRB Tendons may degenerate until rupture occurs
Tennis Elbow Special Orthopedic Tests:
- AFROM- usually painless
- PR ROM may have pain when flexing the wrist
- AR ROM painful on wrist flexion ( pain increases with increased resistance)
- Extensor Tendinosis Test ( active) – therapist try to flex, client extending ( contracting extensors). Positive sign- PAIN. Testing for lateral/extensor tendinosis/tennis elbow
- Mill’s Test ( passive) – stretch the affected tendon. Passively flex the wrist to stretch.(+) pain
Tennis Elbow Massage Therapy Treatment:
Acute Tennis Elbow Massage:
- affected arm elevated (if really inflamed), cold hydro applied to the lateral area of the forearm
- MLD ( manual lymphatic drainage) to the affected arm
- Treat proximal arm for hypertonicity
- Ischemic compressions to trigger point referring to the lesion site
- Treat hypertonicity in antagonists of affected muscles, DO NOT flush toward the lateral area of the forearm near the elbow- lesion site (use segmental instead of long strokes)
- Treat hypertonicity of Affected muscles using GTO on the unaffected distal tendons of the wrist extensors
- Muscle squeezing and stroking to distal limb
- Pain free Passive Relaxed ROM on proximal and affected joint to maintain succusive action
- Gentle joint play to affected arm
Chronic Tennis Elbow Massage Therapy Treatment:
- Position for comfort
- Hydro is local deep moist heat ( to soften adhesion and increase circulation)
- If chronic edema remains, begin with fascial work to loosen area, follow with contrast hydro to flush it out
- Proximal arm treated to increase circulation and to decrease hypertonicity and trigger points
- Antagonists treated with skin rolling, long effleurage, pettrisage to increase circulation
- Affected muscle treated, working toward the lesion to increase circulation
- Adhesions may form between tendons and paratendons or at musculocutaneous junctions of the wrist extensor muscles.
- Skin rolling, fascial spreading and muscle stripping used to decrease adhesions before cross fiber friction technique is used
- Follow frictions with passive stretch and ice
- Distal limb may be treated with effleurage and petrissage
- Joint play and Passive ROM to affected arm
- Passive stretch to affected muscles lateral epicondylitis massage, tennis elbow massage, tennis elbow massage relief, tennis elbow massage therapy, tennis elbow massage treatment
Considerations and Contraindications for Tennis Elbow Massage Therapy Treatment:
- NO Frictions on the wrist extensor muscles and tendons when client is taking anti-inflammatories
- If client is taking anti-inflammatories, therapist uses only fascial techniques & muscle stripping to decrease adhesions in the tendons
- Avoid techniques that increase circulation to the lesion site during the acute stage or when inflamed
- Do not flush toward the lesion site during the acute stage or when inflamed lateral epicondylitis massage, tennis elbow massage, tennis elbow massage relief, tennis elbow massage therapy, tennis elbow massage
Self Care for Tennis Elbow: Tennis Elbow Massage
Acute Tennis Elbow: Tennis elbow massage lateral epicondylitis massage
- Relative rest from the cause of the tennis elbow.
- Rest continues until pain and inflammation decreases. This prevents the tennis elbow from becoming chronic.
- Hydrotherapy is ice immediately after activity. 5-20 mins duration.
- Slow pain-free stretch to wrist extensors to increase flexibility
- When pain is gone before, during and after activity, Begin with pain-free isometric exercise, then strengthening of the wrist extensors to regain full strength of the muscles and to prevent reinjury
Chronic Tennis Elbow: Tennis elbow massage treatment lateral epicondylitis massage therapy
- Contrast hydrotherapy to increase tissue health. Ice on the lateral area of the affected arm during flare up
- Self massage to wrist extensors and wrist flexors
- Stretching of the wrist extensors continued from acute stage, & wrist extensor strengthening can be isotonic.
- Eccentric exercise appears to have specific strengthening effect on tendons
- Client should work up to 3 sets of 15 reps of isotonic exercises for the wrist extensors
- Modify sport or occupational activity to reduce repetition & speed
- Exercise routine, including stretching of the wrist extensors