Tennis Elbow Rehab (Education | Myths | Stretching & Strengthening Exercises)

do you have elbow pain with lifting gripping twisting typing or playing sports in this video I'm going to discuss tennis elbow dispel the most common myths associated with the diagnosis and teach you everything you need to know about managing the condition to best understand tennis elbow it's important to briefly review some basic elbow anatomy the two bones of the forearm are known as the radius and ulna while the arm bone is known as the humerus together these three bones form the humeral radial and humeral ulnar joints which make up the elbow if you feel the

bony prominence on the inside of your elbow this is a part of your humerus known as the medial epicondyle the medial epicondyle is the location of pain for people who experience golfer's elbow if you feel a similar bony prominence on the outside of your elbow this is a part of your humerus known as the lateral epicondyle the lateral epicondyle as you might guess is the area of pain relevant to tennis elbow many of the muscles that control the movements of your forearm wrist and fingers attached to the medial and lateral epicondyles via their tendons because

tendons attach muscles to bones the muscles that attach to the lateral epicondyle have three primary actions wrist extension finger extension and supination which involves turning your palm up toward the ceiling if you squeeze your hand into a fist or extend your wrist you should be able to see and feel these muscles contract there are a lot of names used to describe this outer elbow pain lateral epicondylitis lateral epicondylalga tennis elbow Etc this can be confusing lateral epicondylitis refers to inflammation of the lateral epicondyle or more specifically inflammation of the tendons that attach to the lateral

epicondyle however lateral epicondylitis has fallen out of favor as a diagnosis because current research suggests that local inflammation is likely not the primary driver of the condition this is not to say that inflammation can never be a contributing factor but it likely doesn't need to be the focus of management this is important to know because most people associate inflammation with the need for complete rest ice and anti-inflammatory medication which are not going to be the main recommendations in this video since lateral epicondylitis is inaccurate the term epicondylalgia was introduced to replace epicondylitis however lateral epicondylalgia

just means that the lateral epicondyle is painful which is not very helpful we also shouldn't call it tennis elbow because it doesn't only occur in tennis players in fact it's most common in manual workers who use their dominant arm for repetitive movements or forceful activities on a regular basis and as some of you watching may be aware golfers also get tennis elbow so what should we call it according to Scott at all in 2020 lateral elbow tendinopathy is the preferred term for persistent tendon pain and loss of function related to Mechanical loading of the lateral

elbow tendons mechanical loading refers to any movements or activities that load the lateral elbow tendons such as working with your hands lifting weights and playing sports the diagnosis is typically given when someone's pain is reproduced with pinpoint pressure to the tendons stretching of the tendons or loading of the tendons such as with resisted wrist extension resisted middle finger extension or gripping the tendon most often involved is believed to be the extensor carpi radialis brevis based on this information lateral elbow tendinopathy is generally considered a clinical diagnosis meaning that Imaging such as X-rays and MRIs are

not indicated unless there is suspicion of something like a fracture dislocation or instability but why did you get lateral elbow tendinopathy think of it like this you load your lateral elbow tendons every day when you're working lifting playing sports Etc however if the intensity frequency and volume of that loading exceeds your capacity to recover and adapt from those loads appropriately lateral elbow tendinopathy may occur oftentimes it comes down to doing too much too soon here are three examples one you decided you wanted to get in better shape so you started lifting weights every day without

any prior experience two you're a new tennis player who wanted to get good fast so you joined a club to play after work each day three you took a week off of work to take care of a few projects around the house in these examples you likely loaded your lateral elbow tendons more than what they're used to therefore the goal of rehab is pretty simple it's to initially reduce those loads to a tolerable amount and then make sure that your capacity is greater than or equal to the various loads you're going to be experiencing on

a day-to-day and week-to-week basis based on this information my first recommendation for Rehab is to modify aggravating activities if you're a gym goer who can't tolerate your current training program you need to temporarily scale back by doing less sets per day or throughout the entire week reducing the amount of weight you're lifting or making other adjustments to your routine here are five examples if upper body exercises that require a significant gripping like pull-ups pull downs and rows are provocative an easy modification is to use lifting straps if leg exercises with weights in your hands are

uncomfortable like dumbbell lunges or split squats use lifting straps try a barbell or perform a machine based exercise instead if heavy deadlift variations are problematic even with lifting straps pick a different exercise that train similar muscle groups without placing any Demand on your grip such as single leg hip extension on a Roman chair if you have pain with dumbbell lateral raises you can put a cuff around your rest and do them using the cable column if a certain position of your form is problematic whether it's pronated supinated or neutral try a different position you can

also try equipment or handles that provide you with more movement variability there are a lot of options if you're a tennis player or any other athlete reduce how often you play the total time you play each session or the intensity at which you play this could actually be a good time to focus on your Technique compared to your legs trunk and shoulder your elbow should only be contributing a fraction of your overall power when you're hitting the ball in tennis working with a coach might help you discover errors in your Technique that are contributing to

excessive loading of your elbow this is true for tennis golf and other sports that may be contributing to your symptoms if you're an office worker who spends a lot of time at your computer you might have to adjust your workstation and incorporate periodic walking breaks set a timer on your phone or place a sticky note on your monitor as a reminder I understand that modifying aggravating activities may be more challenging for some individuals than others for example if your job requires repetitive bending and twisting of your elbow and wrist you might need to get creative

if you work for yourself or request modified duty if you're employed by someone else I also want to highlight that most of these changes are meant to be temporary the idea is that you're taking one step back so you can eventually take two steps forward wearing elbow or wrist support is an optional method for potentially decreasing symptoms during aggravating activities but it's not a long-term solution or a substitution for the recommendations I just provided there are typically three types a wrist brace an elbow sleeve and a counter Force strap a counter for strap which wraps

around your forearm or elbow sleeve is usually preferred because a wrist brace is purposely restrictive of your movement if you decide to wear one pick the option that provides you with the most release belief and is most suitable for your situation another fundamental component of rehab is understanding and monitoring pain you have to avoid pain during exercise or is it safe to push into a little pain many people are concerned that exercising into pain means that they're damaging their tendons or making their condition worse but that's not the case remember we're not thinking about lateral

elbow tendinopathy like a predominantly inflammatory condition and the goal of rehab is building Your Capacity by improving your tolerance to various forms of loading and gradually restoring your function plus research demonstrates that the severity of tendon changes on Imaging is poorly associated with symptoms and these tendon changes are prevalent in people and elbows without any symptoms I'm not suggesting to take a no pain no gain approach but it's actually acceptable to have some discomfort during exercise as it doesn't necessarily mean that you're hindering progress or damaging your tendons most tendinopathy research involves exercising within a

tolerable level of pain tolerable is unique to you there's not necessarily a right or wrong way to go about it but there are some strategies that you can use to help find what works best for you you're not only going to monitor symptoms during exercise but immediately after and the following day ask yourself three questions one is my pain tolerable during exercise if it's helpful for you you can rate your pain on a scale from 0 to 10 and determine the highest acceptable number for you some physical therapists might recommend staying at a two to

three out of 10 pain or less While others might suggest a four to five out of 10 pain or less ultimately you get to decide two is my pain better worse or the same after exercise lateral elbow tendinopathy May exhibit a warm-up phenomenon so it's possible that you feel better after short bouts of exercise three is my pain better worse or the same the day after exercise says this is the most important question because it gives you an understanding of how you're responding to the current dosage of exercise if you feel fine during and immediately

after exercise but you have a significant worsening of symptoms the next day that's an indication that you're doing too much and need to back off of it you can assess your next day symptoms with your normal functional activities or use a specific assessment such as squeezing a ball for example you rate your pain on day one with squeezing a ball as a 2 out of 10 pain you then perform your exercise routine with intolerance go about your day and go to bed without any major issues the next morning you squeeze the ball again but this

time you rate your pain as a 5 out of 10. this means that even though your symptoms were tolerable during exercise you might have done more than what you can currently recover from you didn't do any harm but decreasing the volume or intensity of exercise would be recommended so do you have to avoid pain during exercise not necessarily is it safe to push into a low pane yes however you're going to have to find what works best for you how long does it take to get better although the recovery can vary between weeks months and

years a systematic review and meta-analysis by eikening it all in 2022 reported this as one of their key findings we found that approximately 90 of patients who received no active treatment for tennis elbow had either completely recovered or were much improved by one year and they had little remaining Pain and Disability by that point this means that if you stopped watching this video right now and do nothing else there's a very good chance that you'll naturally get better within the next year if not sooner so why would you choose to do exercise well you don't

have to but it's an option and probably the reason you're watching this video plus a systematic review and meta-analysis by karanasios at all in 2021 found that exercise does lead to better outcomes although the effect is small research also demonstrates that individuals with lateral elbow tendinopathy have weakness of their hand forearm elbow and shoulder muscles this is a chicken or egg scenario because it's possible that the weakness is secondary to pain and deconditioning from disuse as opposed to being the reason for the development of symptoms in the first place regardless this still ties into the

goal of improving your tolerance to various forms of loading and gradually restoring your function the first recommended exercise is resisted wrist extension because wrist extension is one of the primary actions of the lateral elbow tendons if you're also experiencing golfer's elbow or just want to be a little more comprehensive you can include wrist flexion strengthening as well you can superset two to three sets of 8 to 15 repetitions of each exercise three times per week ideally you'll be seated with your forearm supported on a table bench or your thigh you can use a dumbbell a

band with or without a handle or whatever household objects you have laying around if the full range of motion is uncomfortable you can shorten the range of motion or just perform an ISO a metric which involves a static hold or 30 to 60 Seconds the second recommended exercise involves supination strengthening because supination is also one of the primary actions of the lateral elbow tendons for Simplicity you'll likely include pronation strengthening as well for both your elbow should be bent with your arm tucked by your side forearm supported or unsupported and you can be sitting or

standing hold on to the end of a dumbbell dowel hammer or another household object the closer you grab to the center of that object the easier pronation and supination become make the movements Harder by grabbing lower using something that's heavier or adding resistance in the form of a cuff weight you can also use a band but you'll have to train each Direction individually pronation would be optional in that scenario once again aim for two to three sets of 8 to 15 repetitions three times per week the last recommended exercise is geared toward grip strength and

endurance there's no shortage of options if you want to keep it simple you can periodically squeeze a lacrosse ball tennis ball towel or one of those grippers throughout the day if you want to do gym based movements aim for two to three sets of farmers carries or suitcase carries with dumbbells or kettlebells you can grab the wide portion of either like the hex part of a dumbbell or the bottom of a small kettlebell for a different challenge you can also do plate pinches with a larger bumper plate or with two smaller plates held together aim

for two to three sets of 30 to 60 seconds of total work three times per week the first group of optional exercises involve shoulder strengthening there are two possible reasons you might choose to perform these exercises one you play a sport that would benefit from improving your shoulder strength such as golf tennis or baseball two you also experience shoulder stiffness weakness or discomfort research demonstrates an association between lateral elbow tendinopathy and shoulder related symptoms so these exercises may help with both issues there are an infinite number of options so here are five to choose from

option one sideline external rotation place your top arm at your side with your elbow bent to 90 degrees while holding a weight in your hand rotate your arm outward as far as you can while keeping your arm at your side lower back to your stomach and repeat option two external rotation with elbow on knee sit with your elbow supported on your knee and a weight in your hand slowly lower the weight rotating your arm inward as far as possible without letting your shoulder roll forward then rotate back to the starting position option three banded external

rotation look your elbows bent to 90 degrees and pinned at your side think about pulling the band apart if you're using a loop band you can put it around your wrists so you don't have to worry about gripping it if you're using a ribbon band you can rotate your arm straight out or think about creating a w if you want to progress these exercises you can perform them in what's known as a 90-90 position while standing or lying on your stomach option four scaption with thumbs pointing up raise your arms to about shoulder height or

slightly higher you are not raising your arms directly to the side or in front of you but an angle in between you can use a band or dumbbells option 5 prone Angel progression if you have access to minimal equipment you can lie on your stomach and progress from performing prone A's to prone T's to prone y's to prone angels if you decide to incorporate these optional shoulder strengthening exercises aim for two to three sets of 10 to 15 repetitions or 30 to 60 seconds of total work three times per week the second group of optional

exercises involves thoracic Mobility there are three possible reasons you might choose to perform these exercises one you want to use them as a way to break up repetitive tasks I'll provide options that require no equipment and can be done anywhere two you play a sport that would benefit from improving your thoracic Mobility such as golf tennis or baseball three you also experience neck and or upper back stiffness and discomfort research demonstrates an association between lateral elbow tendinopathy and neck related symptoms so these exercise may help with both issues here are four options option one sideline

thoracic rotation lie on your side with your hips and knees bent and head supported rotate your top shoulder and arm toward the floor behind you or as far as you can comfortably go option two seated thoracic rotation with your arms out in front of you reach one hand toward the wall behind you return to the starting position and then repeat on the other side you can also Lean Forward grab the opposite knee and reach up toward the ceiling option three half kneeling thoracic rotation set up in half kneeling against a wall with your arms out

in front of you rotate your shoulder and arm toward the wall behind you or as far as you can comfortably go you can make this more challenging by turning the movement into more of a windmill option four deep lunge with thoracic rotation step back Place one hand on the floor reach up toward the ceiling with the other hand lower back down repeat and then switch sides if you decide to incorporate any of these optional thoracic Mobility exercises aim for one to two sets of six to eight repetitions per side as part of your workout or

periodically throughout your day I'll put an example program together in the summary of this video But please understand that these are guidelines not hard and fast rules I can't provide suggestions that will account for every person's unique goals preferences circumstances Etc find what works best for you let me also quickly answer questions that I anticipate receiving about why I excluded certain exercises why didn't I include an exercise for finger extension one research demonstrates that lateral elbow tendinopathy is not associated with the weakness of the finger extensors two the finger extensors are typically loaded with gripping

because they contract to counteract the finger flexors whenever you grip an object like the exercises I discussed both your finger flexors and extensors are engaged why didn't I include an exercise for radial deviation one there is a lack of research associated with radial deviation two the extensor carpi radialis brevis the muscle believes to be most involved in lateral elbow tendinopathy isn't the primary radial deviator of the wrist three radial deviation will be indirectly strengthened with other exercises that I provided why didn't I include stretching any benefits from stretching should be achieved through the exercises I've

given when performed slowly and through a full range of motion you certainly can stretch if it feels good doesn't exacerbate symptoms and doesn't detract from the other exercises why didn't I include exercises for biceps and triceps strengthening I don't think strengthening of the biceps and triceps is always an essential component of rehab for lateral elbow tendinopathy once again individualize this program in a way that works best for you if you want to incorporate isolated finger extension strengthening radial deviation strengthening or biceps and tricep strengthening you're welcome to do two to three sets of 10 to

15 repetitions two to three times per week just keep in mind that more isn't necessarily better especially when you first start two other questions one why didn't I discuss eccentric wrist extension which involves assistance from your other hand so you're just doing the lowering portion of the exercise eccentric exercises were traditionally believed to be the best approach for lateral elbow tendinopathy but the systematic review and meta-analysis by karenasios at all in 2021 found no difference between concentric eccentric and eccentric exercise alone just perform every exercise slowly and with control two is there anything else you

can do yes there is a growing body of literature including research related to lateral elbow tendinopathy that tendinopathies are often associated with other lifestyle and metabolic factors such as cardiovascular disease diabetes smoking Etc this is not to say that they are the cause of your symptoms or even a contributing factor but if you've been meaning to positively influence your General Health and well-being by changing your exercise nutrition and or sleeping habits this might be a good time to kick start your journey one of the easiest methods for improving health is simply walking more something is

always better than nothing and short walks throughout the day can be a great way to help break up any repetitive tasks that you're doing with your wrist or elbow what about surgery injections and other adjunct treatments since the goal of rehab isn't to reduce inflammation or change tendon structure many of these interventions don't make irrational sense and they're not well supported by research a systematic review by Bateman at all in 2019 stated that the findings of this systematic review suggest that surgical interventions for tennis elbow are no more effective than non-surgical and Sham interventions and

this is regardless of symptom duration the systematic review and meta-analysis by eikenin at all in 2022 reported the following we found that longer durations of symptoms were not associated with poorer prognosis which suggest that persistent symptoms are no justification to recommend surgical interventions that have questionable efficacy profiles and known risks such as surgery for tennis elbow their research related to corticosteroid injections has been clear-cut for the past 20 years yet recommendations and implementation haven't changed these injections can provide short-term relief but they lead to worse outcomes in the long term compared to exercise or doing

nothing at all as for PRP injections a Cochrane systematic review in 2021 concluded data in this review do not support the use of autologous blood or PRP injection for treatment of lateral elbow pain with no evidence of benefit the costs and risks are not justified what about massage icing or whatever else you can think of if it's low cost and low risk you can pretty much try out anything however these things aren't the focus of rehab and shouldn't take away from the goal of progressively improving function in summary lateral elbow tendinopathy is the preferred term

for persistent tendon pain and loss of function related to Mechanical loading of the lateral elbow tendons mechanical loading refers to any movements or activities that load the lateral elbow tendons such as working with your hands lifting weights and playing sports we shouldn't call it tennis elbow because it doesn't only occur in tennis players in fact it's most common in manual workers who use their dominant arm for repetitive movements or forceful activities on a regular basis golfers and other athletes also experience these symptoms lateral elbow tendinopathy is thought to occur when the intensity frequency and volume

of loading exceeds your capacity to recover and adapt appropriately therefore the goal of rehab is pretty simple it's to initially reduce those loads to a tolerable amount and then make sure that your capacity is greater than or equal to the various loads you're going to be experiencing on a day-to-day and week-to-week basis if you plan incorporating exercise and just want to focus on the local function of the lateral elbow tendons these are the three things you want to do one wrist extension strengthening for two to three sets of 8 to 15 repetitions three times per

week as an optional add-on you can pair this with wrist flexion strengthening two supination and pronation strengthening with a weight or household object for two to three sets of eight to Fifteen repetitions three times per week if you're using a band strengthening of the pronators is optional three grip strength and endurance aiming for two to three sets of 30 to 60 seconds of total work three times per week if you also wanted to focus on your shoulder neck and thoracic spine because you play sports or have other symptoms associated with those areas two optional exercise

categories include shoulder strengthening and thoracic Mobility their shoulder strengthening exercises can be performed for two to three sets of 10 to 15 repetitions or 30 to 60 seconds of total work three times per week prior to the wrist and forearm exercises the thoracic Mobility exercises can be performed for one to two sets of six to eight repetitions per side as part of your workout or periodically throughout your day since your overall health and well-being can have an effect on your lateral elbow symptoms and function taking steps to a healthier lifestyle can be a beneficial component

of recovery you can incorporate adjunct treatments that alleviate pain but they're not the focus of rehab especially if they're high cost or high risk regardless of what you decide to do it's important to tailor the plan to your individual goals and needs there is no quick fix for lateral elbow tendinopathy so it's helpful to set realistic expectations and plan for the process to take a minimum of three months if you want all of this information neatly packaged into a program with detailed instructional videos check out the link in the description otherwise thank you so much

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