In this article, I wanted to highlight a few Tennis Elbow Exercise Mistakes.
If you have been reading my writing over the last 6 years, you know that I love looking to the research for answers and today is no different. Looking at the research allows me to challenge myself to see if what I am doing is right and safe.
Tennis Elbow Exercise Mistake #1 – Ignoring Fascia
I have been beating this drum for a while and it has been highlighted in the Muscle Imbalances Revealed series, fascia is something we need to think about.
I wanted to talk about fascia and tennis elbow.
There has not been much talk about fascia and tennis elbow but it is something that I have been doing for years. For my client’s, they may end up getting some hands-on work done by a therapist or bodyworker but between visits it is important for them to do what they can to continue the work that the therapist or bodyworker has been doing. Very much like flossing between dentist visits. What I encourage my clients to do is self massage. I know self massage may not follow the text book guidelines or follow what is taught in a fascia course but it has benefited my clients.
Lets look at some research that shows the benefit of addressing fascia and tennis elbow.
What they Looked at:
The investigators wanted to see if myofascial release reduced pain and functional disability in a group of computer professionals while the control group received sham ultrasound therapy.
The myofascial release techniques were performed by a certified practitioner where the test group had 12 sessions over 4 weeks.
What the Result was:
The group that got myofascial release done had a 78% decrease in pain and functional disability while the control group had a 7% improvement.
At a 12 week follow up the treatment group had a 63.1% improvement in pain and function.
Comments from Rick:
I mentioned it above, if you are a computer worker and have lateral epicondylitis, myofascial treatment maybe of benefit to you.
If you can not get myofascial treatment, try some self massage as I am sure it will help out with your pain and arm function.
Where to get more information – Ajimsha MS, Chithra S, Thulasyammal RP. (2012). Effectiveness of Myofascial Release in the Management of Lateral Epicondylitis in Computer Professionals. Arch Phys Med Rehabil. 2012 Jan 9. [Epub ahead of print]
Tennis Elbow Exercise Mistake #2 – Your Computer Could Be Holding You Back From Recovering
I am working on this month’s Injury of the Month. It is on tennis elbow. At this time I am digging in the research to see what is new. This was the 15th article that I looked at and I thought it was a good fit for the article I chatted about, above.
What They Looked at:
They wanted to see the factors that lead to successful conservative management of tennis elbow.
They looked at 60 patients with tennis elbow and followed them for 6 months.
What They Found:
- Repetitive work tasks affected arm function and pain level.
- Neck issues affected the outcome of tennis elbow and lead to lower arm function and greater pain.
- They suggest those with tennis elbow look at their work station, posture and behavior.
Comments from Rick
Not sure what more I can add.
The treatment and exercises are important but what is equally important is what you do to help yourself recovery from the injury. This includes looking at what you are doing, looking at your environment and minimizing things that slow down your injury recovery.
Where to get more information – Waugh EJ, Jaglal SB, Davis AM. (2004). Computer use associated with poor long-term prognosis of conservatively managed lateral epicondylalgia. J Orthop Sports Phys Ther. 2004 Dec;34(12):770-80.
Tennis Elbow Exercise Mistake #3 – Little Evidence Supporting Stretching
I know, this is going to anger a few people.
I know you were taught in a course or your instructor at college/university said that you should stretch if you have a client with tennis elbow but the reality is, there is little evidence supporting just doing stretching as the primary activity for tennis elbow.
Looking at the research, there is more research that supports strengthening for tennis elbow than just stretching.
My approach is I use both.
My first preference is to use self massage in the forearm. Then I will use stretching with a focus on addressing the tension in the forearm and the focus on the stretch is very very light. Then I will work on concentric, isometric and eccentric strengthening .
There was one article that looked stretching and strengthening.
What they Looked At:
They had 94 subjects (50 men) with chronic epicondylitis were randomly put into three groups: stretching only, concentric strengthening with stretching and eccentric strengthening with stretching.
Each group performed their set of exercises for 6 weeks. Each group were given instructions on icing, stretching and avoiding aggravating activities. Two of the groups got education on their strengthening protocol.
What they Found:
There was no significant difference in the outcome of any one of the groups when it related to pain-free grips strength and function.
The focus of the paper was on exercise but as we saw in the paper above, the activities that someone does has an effect on the long term outcome of tennis elbow. This probably had a bigger factor in the result than they highlighted in their research.
From personal experience, I find people that manage inflammation of their injury have a better recovery result as well. If you keep doing what hurts, your hurt won’t go away.
If you spend some time on PubMed, you come across a number of articles that just focused on strength and this lead to an improvement in tennis elbow. I talked about one of those papers and tennis elbow exercises a few articles back.
Where to get more information: Martinez-Silvestrini JA, Newcomer KL, Gay RE, Schaefer MP, Kortebein P, Arendt KW. (2005). Chronic lateral epicondylitis: comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening. J Hand Ther. 2005 Oct-Dec;18(4):411-9, quiz 420.
Hey, I hope this helps you out if you have a client that has tennis elbow or if you have tennis elbow.
If you, one of your clients or if you know someone that has tennis elbow, this will help out:
That is it, have a great day.
Rick Kaselj, MS