Physical Therapy for Tennis Elbow

Symptoms and Functional Limitations of Lateral Epicondylitis (Tennis Elbow)

Lateral epicondylitis, commonly known as 'tennis elbow', is an overuse injury caused by eccentric overload of the extensor carpi radialis brevis tendon. It is typically induced by activities that involve loaded or repeated gripping, such as tennis, squash, or badminton. Interestingly, despite its name, only 10% of the patient population consists of tennis players. In fact, as many as 15% of workers in highly repetitive jobs report having tennis elbow. The annual incidence of tennis elbow ranges between 1% and 3% in the U.S.^[1][2][3].

Effective Physical Therapy Approaches for Lateral Epicondylitis (Tennis Elbow)

Physical therapy for tennis elbow offers a comprehensive and evidence-based approach to manage and alleviate symptoms. The interventions include:

• Manual Therapy: This encompasses techniques such as soft tissue mobilization, cross-friction massage, and joint mobilization. Soft tissue mobilization focuses on reducing muscle tension and improving tissue extensibility. Cross-friction massage is applied perpendicular to the tendons, aiming to reduce pain and promote collagen fiber realignment. Joint mobilization techniques, like the mobilization of the radioulnar and radiocarpal joints, can help in improving joint mechanics and reducing pain^[4].
• Therapeutic Exercises: Specific exercises are prescribed to strengthen the extensor muscles of the forearm and improve flexibility. Eccentric exercises, where the muscle lengthens under tension, have been particularly effective. Examples include the eccentric wrist extensor exercise, where the patient resists a force while slowly letting the wrist bend forward. Stretching exercises for the wrist extensors and flexors are also beneficial^[6].
• Orthotic Devices: Tennis elbow braces or straps can be beneficial. They work by offloading the stressed extensor tendons, redistributing forces, and preventing further damage. They are typically worn just below the painful area on the forearm^[5].
• Modalities: Physical therapists might also use modalities like dry needling, which can promote blood flow and aid in the healing process. Another modality is electrical stimulation, which can help in pain modulation and muscle stimulation.
• Patient Education: Educating patients about activity modification, ergonomics, and proper techniques can prevent further aggravation of symptoms. This includes advice on avoiding repetitive wrist activities, taking frequent breaks, and using ergonomic tools or equipment.

Economic Value of Physical Therapy for Tennis Elbow

Physical therapy offers a cost-effective solution for treating tennis elbow. While the initial cost of physical therapy might be higher than a corticosteroid injection, in the long run, it proves to be more beneficial. A study showed that patients who underwent physical therapy experienced a better quality of life compared to those who received injections. In fact, the overall benefit of choosing physical therapy over injections is estimated to be $10,739 per episode of care^[7]. This means that investing in physical therapy can provide lasting relief and better outcomes, making it a wise choice for those suffering from tennis elbow.

References:

1. Buchanan (2022)
2. Johnson (2007)
3. Degen (2018)
4. Jones (2009)
5. Lucado (2022)
6. APTA Economic Value Report (2023)
7. Coombes et al. (2015)