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Tennis elbow, more appropriately called lateral elbow tendinopathy (LET) is one of the most common work or sport related arm injuries. To clarify, tennis elbow is caused by a degeneration of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse. Occasionally inflammation may also be present. The tendon usually involved is called the Extensor Carpi Radialis Brevis (ECRB).
Most people who experience LET are between the ages of 30 and 60. However, symptoms tending to be more severe among women. The symptoms of LET develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. You may have no specific injury associated with the LET symptoms. Common signs and symptoms of LET include pain or burning on the outer part of your elbow and weak grip strength
Although LET is a very common injury, there is no ideal treatment. The most common treatment is a physiotherapist lead exercise program. Traditional conservative treatments for LET include cross friction massage, electrical and thermal modalities, bracing, and therapeutic exercise. A systematic review and meta-analysis of interventions for LET noted a lack of evidence to support treatments other than exercise. This would again indicate that LET is more often a degenerative rather than inflammatory condition.
Therapeutic exercises programs have traditionally focused on eccentric loading of the affected tendon. Eccentric strengthening is aimed at strengthening the muscle -tendon complex. In addition, it was proposed that eccentric exercise effectively “lengthened” the muscle-tendon complex. This results in structural remodelling of the tendon with hypertrophy and increased tensile strength of the tendon.
Strengthening programs for tendon related injuries are now starting to move away from eccentric strengthening and focus on isometric and concentric/eccentric loading. Concentric movement describes the shortening of the muscle as it contracts. However, isometric contraction is a sustained contraction of the muscle e.g. gripping. Isometric exercises, have been shown to reduce and manage tendon pain. Since LET pain is often related to forceful gripping activities requiring isometric contraction of wrist extensors and flexors, it is now thought that isometric exercises may be more beneficial and functional that eccentric strengthening exercises.
A recent study by Stasinopoulos et al set out to compare the effectiveness of traditional eccentric training with an eccentric-concentric training program combined with isometric contraction. The effects of these loading programs on pain and function in patients with LET was compared. The improvement in pain and function in those performing a concentric-eccentric loading program combined with isometric contraction was significantly larger than the eccentric training group. It was proposed that this type of loading program should be the first treatment option. This heavy slow resistance program is also recommended in the management of lower limb tendinopathy e.g. achilles and patellar tendinopathy.
If you have been experiencing symptoms related LET or tennis elbow, contact us here. Our physiotherapists are all experienced in the management and treatment of LET and will provide you with a progressive strengthening program, based on latest research into this area.