Tennis elbow is a blanket term for any condition affecting the lateral compartment of the elbow; however, there is general agreement among health professionals that it is usually lesions of the common extensor origin at the lateral epicondyle of the humerus. Tennis elbow is not restricted to tennis players nor general athletes; it can affect anyone doing a repetitive forearm action. Tennis elbow may be acute or chronic injuries or an acute on chronic condition. Correct diagnosis is essential for optimum recovery. Therefore, the client should be assessed by a health professional before commencing any exercise program.
Tennis elbow or Lateral Epiconylitis is an example of an overuse injury, which is where the demands placed on the body are greater than the body’s ability to heal. Repetitive actions such as the backhand in tennis place increased load on the wrist extensor muscles, which have a relatively small origin at the lateral humeral epicondyle. The repetitive contraction of these muscles pulls at their muscle/bone junction and causes continual microtrauma that builds up until it reaches a point of failure.
Signs and Symptoms
- Local pain and tenderness at lateral elbow
- Pain on gripping
- Pain on wrist extension
- Elbow stiffness
- Postural re-education
- Stretching exercises
- Strength exercises
- Evaluation of equipment and technique
- Graduated return to sport
As with all acute injuries, RICER is the initial treatment regime. The last R refers to the Referral to a health professional for diagnosis and treatment. Once an accurate diagnosis is achieved, the personal trainer can supervise the rehabilitation program as outlined by the physiotherapist. In this article, we will look at the muscle stretching and strengthening exercises in the injured athlete's rehabilitation.
Stretches to Rehabilitate Tennis Elbow
Once the acute phase has settled, an active exercise program of stretches and strength exercises is commenced. For ease of presentation, the stretches and their progressions are presented first and then the strength exercises and their progressions. The general format of stretch-strength-stretch is commonly used; however, follow the program as outlined by the physiotherapist.
Wrist Extensor Muscle Stretch 1 (Figure 1)
The arm is held in full elbow extension, full forearm pronation. Add wrist and finger flexion until a stretch is felt at the lateral aspect of the elbow or along the muscles. There should be no pain just strain felt on the stretch. Hold for 20 seconds and then repeat four to five times.
Wrist Extensor Muscle Stretch 2 (Figure 2)
The same position as for stretch 1; however, a progression can be achieved by adding overpressure with the other hand.
Wrist Flexor Muscle Stretch 1 (Figure 3)
The arm is held in full elbow extension, full wrist supination then add wrist and finger extension until a stretch is felt at the medial aspect of the elbow or along the muscles. Hold for 20 seconds and then repeat four to five times.
Wrist Flexor Muscle Stretch 2 (Figure 4)
The same position as for stretch 1; however, a progression can be achieved by leaning the wrist on a bench to apply more pressure to wrist extension.
Wrist Strengthening Exercises
Wrist Extensor Muscle Strength Exercise 1 (Figure 5)
Flex the elbow to 90 degrees. The hand of the uninjured arm holds the supinated wrist of the injured arm in neutral. A painfree isometric muscle contraction is then performed by the wrist extensor muscles and held for five to 10 seconds. The dosage is dependent on the severity of the symptoms.
Wrist Extensor Muscle Strength Exercise 2 (Figure 6)
Bicep curls holding a weight and the wrist held in supination. This can be progressed to starting in pronation.
Wrist Extensor Muscle Strength Exercise 3 (Figure 7)
Rest the pronated forearm on a bench with the elbow flexed to 90 degrees. Hang the hand over the edge of the bench, holding a light weight. Slowly extend the wrist to lift the weight up, hold for five seconds and then slowly lower. Repeat 10 to 15 times until the muscle is starting to feel tired. Rest then repeat.
Wrist Flexor Muscle Strength Exercises (Figure 8)
It is important to also exercise the wrist flexors as a major risk factor in developing Tennis elbow is a muscle imbalance between wrist flexors and extensors.
Rest the supinated forearm on a bench with the elbow flexed to 90 degrees. Hang the hand over the edge of the bench holding a light weight. Slowly flex the wrist to lift the weight up, hold for five seconds and then slowly lower. Repeat 10 to 15 times until the muscle is starting to feel tired. Rest then repeat.
As the condition resolves, the athlete is gradually re-introduced to the specific sport with close supervision to assess the recovery and prevent a recurrence of the injury.
- Zulaga, M. et. al., (1995) Sports Physiotherapy. Churchill Livingstone.
- Norkin, C.C. & Levangie, P.K. (1983) Joint Structure and Function. A comprehensive analysis. F.A. Davis, Philadelphia.