Management of Tennis Elbow: A Practical Therapeutic Plan
- The following suggestions are the result of intensive research, and have worked for me.
- There is however no absolute guarantee of success! Expect a time to recovery
in the order of weeks to months. Also, you will have to do some maintenance work from time to
time, because the part will always be a little bit weak.
- As always, these management guidelines are not intended to replace the specific
advice of a trained professional.
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OBP provides a boost to all tennis elbow remedies!
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- While at rest:
- (e.g. sleeping standing, sitting, holding the steering wheel on a straight road).
Keep the wrist in "OBP":-
- The middle range of "twist" (i.e. supination/pronation).
- The middle range of sideways bend (i.e. lateral flex/medial flex).
- The OBP range of wrist flexion and extension (i.e. -15 degrees to +45 degrees of flexion).
- Above all, do not let your wrist drift into that extended position, which
constitutes the major DSM associated with tennis elbow!
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Apply tickle massage through your shirt, using the tips of your finger nails:-
Apply gentle circular massage with your finger tips to stimulate blood supply:-
- While in use:-
- Keep the wrist in "OBP":-
- The middle range of "twist" (i.e. supination/pronation).
For example:-
- When using a screw driver, fix your wrist in the middle of its twist range,
and let the rest of your body (especially the shoulder joint) do the twisting.
- When planting a ski pole, make sure that your elbow is pointing slightly outside
of downward rather than directly out to the side.
- The middle range of sideways bend (i.e. lateral flex/medial flex).
For example:-
- When hammering or chopping, "fix" the wrist at the middle of sideways bend, and
make sure that the forearm and elbow, and indeed the whole body
moves instead of the wrist.
- The OBP range of wrist flexion and extension (i.e. -15 degrees to +45 degrees of flexion).
For example:-
- When back hand hitting with the tennis racket, "fix" the wrist at the middle of
OBP, and let the whole body from your elbow to your feet move to hit the ball.
(Note here that "fix" does not mean absolute rigidity, but rather locating with
a degree of firmness around the OBP of the wrist). Consult your tennis coach for
precise technique!
- When using a broom, scrubbing the floor, touch typing, and especially
while using the computer mouse, keep your wrist at OBP!
- Above all, do not let your wrist drift into that extended position, which
constitutes the major DSM associated with tennis elbow!
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- Specific Exercises and Treatments
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(1) Eccentric Contraction of the ECRB Muscle (see references 6 and 7):-
- Start Position:-
Make a fist, and extend the wrist to about 40 degrees short of full extension
(see picture).
- Action:-
While pushing down on the back of the wrist with the other hand, slowly flex the wrist
back into OBP, and onward to about 40 degrees short of full flexion. (See picture).
- Comments:-
This will cause mild pain to the tennis elbow (ECRB) muscle, and the pain may take an hour or so to
appear. Please start gently, with say 10 repeats twice daily, and increase gradually to
perhaps 40 repeats twice daily, with increased pressure from the other hand. When you are really confident,
increase the range of movement. After each work out, give the sore spot a massage (see above for details)!
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| (2) Balanced Wrist Extension (See ref. 4):-
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- Start Position:-
Gently flexed wrist and fingers (see picture):-
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- Action:-
Straighten fingers and wrist in co-ordinated fashion (see picture):-
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- Comments:-
Please avoid the following faulty pattern (see picture), with the wrist and finger flexors failing to release as the
wrist extends. Five to ten repeats; do it whenever you have a spare moment through the day.
Continue until you are confident that your wrist has learned the correct movement pattern:-
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Putting OBP into Perspective
OBP does not replace the existing "tools" in the chiropractor or physiotherapists
"tool kit". Other therapeutic tools include stretching, strengthening, various
massage techniques, mobilisation and manipulation, ultrasound, and (by no means least
in the therapeutic tool kit), diet and psychological counselling. OBP does however
complement and enhance these other therapeutic modalities, and also brings a framework
of understanding to aid the wise application of said modalities. Thank you for taking
the time to read this article! And may your tennis elbow never bother you again!
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You can purchase this full article in pdf format for binding into a book!
A great reference for explaining why standard tennis elbow remedies are sometimes only partially effective!
P.S. Recommended Reading:-
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For standard physiotherapeutic advice, refer to
http://www.nismat.org/ptcor/tennis_elbow/
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notes on this article:-
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The description under "Mechanisms of Injury" is very good. It is quoted here:-
"Commonly experienced by the amateur [tennis]player, this injury is often a result
of (1) a one-handed backhand with poor technique (the ball is hit with the front of
the shoulder up and power generated from the forearm muscles), (2) a late forehand
swing preparation with resulting wrist snap to bring the racquet head perpendicular
to the ball, or (3) while serving, the ball is hit with full power and speed with
wrist pronation (palm turned downward) and wrist snap which increases the stress
on the already taught extensor tendons".
Items (1) and (2) in the above list describe jarring while in the DSM which
I have described as "over-extended wrist", while Item (3) describes the similar DSM of
"over-extended wrist with pronation".
- When performing the recommended Nismat Physiotherapy exercises:-
- Avoid doing the exercises outside of wrist OBP.
- Emphasise Eccentric Contraction of the extensor muscles of the forearm.
(Already described in this article).
- Wear a protective arm band over the upper belly of the forearm muscles,
not over the elbow. The armband must be firm enough to stay in place, but not uncomfortably tight.
See pictures below.
The correct armband positioning:-
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The incorrect armband positioning:-
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- Do not perform the Monkey wrench exercise illustrated under "Forearm Pronation/Supination".
A better alternative is the "Fixed Forearm Screwdriver" exercise described in this article.
With these few exceptions, it is an extremely well written article. Please do read it.
References:-
- KL Moore, AF Dalley: Clinically Orientated Anatomy, Fourth Edition
- D Hertling and RM Kessler: Management of Common Musculoskeletal Disorders, Third Edition
- P Brukner, K Khan: Clinical Sports Medicine, Revised Second Edition.
- Shirley A Sahrman: "Movement Impairment Syndromes" Publ. Mosby, 2002 ISBN 0-8016-7205-8
- "The Official Body Control Pilates Manual", Available through
http://www.bodycontrol.co.uk/
- Professor Jill Cook quoted in Fitness Life Magazine Article:
"By Achilles!", published 08/08/2003 02:28 PM online at:-
http://www.xtramsn.co.nz/sport/0,,9352-2564231,00.html
- Hakan Alfredson, Tom Pietila, Per Jonsson, Ronny Lorentzon.
Heavy-load eccentric calf muscle training for the treatment of chronic Achilles
tendinosis. The American Journal of Sports Medicine May-June 1998 v26 n3 p360(7)
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OBP tennis elbow remedies
© Bruce Thomson, EasyVigour Project
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