AC Joint Sprain

Treatments

There are various treatment options for tennis elbow, your physiotherapist will assess and use a combination of treatments depending on what is best suited to you.

Evidence suggests tendons respond best to beginning with eccentric exercises that strengthen the muscle while lengthening it [1] providing a greater reduction in pain and increase in strength compared to concentric exercises [2]. Once pain is controlled and strength increased, exercises can then be progressed on to concentric strengthening and finally functional or sports specific exercises including plyometric type exercises [3]. It is important to strengthen the full kinetic chain when rehabilitating the elbow so shoulder, scapula and core exercises will often be included in treatment [3] [4]. There is some evidence to suggest that stretching the extensor muscles can have a short-term effect on pain, especially when combined with eccentric exercise [1] [4].

Manual therapy such as joint mobilisation and soft tissue release can additionally provide short term pain relief and facilitate exercises [1][5]. Similarly, acupuncture/dry needling can provide short term benefits for 2-8 weeks which may facilitate treatment and improve outcomes [4] [6]. Kineso taping has also been found to reduce pain in tennis elbow, especially when used in combination with exercise [7][5].

Furthermore, intense therapeutic ultrasound can effectively reduce pain and increase function in chronic tendinopathies [8] and it is believed that using a combination of ultrasound and exercise has a better outcome than exercise alone [5].

It is clear from the evidence that a combination of strengthening and additional treatment modalities is the best approach to treat tennis elbow.

Clinics that help

• Upper Back and Neck Clinic
• Arm, Wrist & Hand Clinic

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4482821/ Dimitrios S. Exercise for tendinopathy. World journal of methodology. 2015 Jun 26;5(2):51

2. https://journals.sagepub.com/doi/abs/10.1177/0269215514527595 Peterson, M., Butler, S., Eriksson, M. and Svärdsudd, K., 2014. A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy). Clinical rehabilitation, 28(9), pp.862-872.

3. https://www.jospt.org/doi/full/10.2519/jospt.2015.5841 Coombes, B.K., Bisset, L. and Vicenzino, B., 2015. Management of lateral elbow tendinopathy: one size does not fit all. journal of orthopaedic & sports physical therapy, 45(11), pp.938-949.

4. https://pdfs.semanticscholar.org/b304/822f2ceafde8661388bc4b61e9c4afcdafe8.pdf Schwarzman, G., Watson, J.N. and Hutchinson, M.R., 2017. Lateral Epicondylopathy (Aka. Tennis Elbow): A Review of Current Concepts and Treatment. Ann Sports Med Res, 4(5), p.1117.

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990766/ Dimitrios, S., 2016. Lateral elbow tendinopathy: Evidence of physiotherapy management. World journal of orthopedics, 7(8), p.463.

6. http://jrsr.sums.ac.ir/article_44736.html Etminan, Z., Razeghi, M. and Ghafarinejad, F., 2019. The effect of dry needling of trigger points in forearm’s extensor muscles on the grip force, pain and function of athletes with chronic tennis elbow. Journal of Rehabilitation Sciences & Research, 6(1), pp.27-33.

7. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2118-3 Cho, Y.T., Hsu, W.Y., Lin, L.F. and Lin, Y.N., 2018. Kinesio taping reduces elbow pain during resisted wrist extension in patients with chronic lateral epicondylitis: a randomized, double-blinded, cross-over study. BMC musculoskeletal disorders, 19(1), p.193.

8. https://pdfs.semanticscholar.org/c6a2/8ccbdf8aaca62bff18161f040fa31103d402.pdf Slayton, M.H., Kearney, J.A., Amodei, R.C. and Compton, K.B., 2018. Intense Therapeutic Ultrasound for Chronic Lateral Epicondylitis Pain Reduction. J Sports Med Doping Stud, 8(202), pp.2161-0673.