In my last post I described the symptoms of tennis elbow and treatment options. Here I will describe the rehabilitation process for this condition.
Epicondylitis often becomes a chronic problem if not cared for properly. For this reason, it must be stressed that the rehabilitation process should not be progressed until you experience little or no pain at the level you are performing. Regaining full strength and flexibility is critical before returning to your previous level of sports activity.
In general, the rehabilitation process can be divided into three phases:
Goals: decrease inflammation and pain, promote tissue healing, and retard muscle atrophy. During the acute stage of your injury, whether the medial or lateral elbow is affected, follow the RICE principle:
1. Rest – this means avoiding further overuse not absence of activity. You should maintain as high an activity level as possible while avoiding activities that aggravate the injury. Absolute rest should be avoided as it encourages muscle atrophy, deconditions tissue, and decreases blood supply to the area, all of which is detrimental to the healing process. Pain is the best guide to determine the appropriate type and level of activity.
2. Ice – is recommended as long as inflammation is present. This may mean throughout the entire rehabilitation process and return to sports. Ice decreases the inflammatory process slows local metabolism and helps relieve pain and muscle spasm.
3. Compress and Elevate if appropriate to assist venous return and minimize swelling.
Goals: Improve flexibility, increase strength and endurance, increase functional activities and return to function.
Gentle stretching exercises should include wrist flexion, extension, rotation and elbow should be kept straight in order for stretch to be performed properly. These stretches should be held for 30 seconds and repeated 5-10 times, at least twice a day. Vigorous stretching should be avoided – do not stretch to the point of pain that reproduces your symptoms.
With the elbow bent and the wrist supported perform the following exercises:
1. Wrist Extension. Place 1 lb. weight in hand with palm facing downward (support forearm at the edge of a table or on your knee so that only your hand can move. Raise wrist/hand up slowly and lower slowly.
2. Wrist Flexion. Place 1 lb. weight in hand with palm facing upward, support forearm at the edge of a table or on your knee so that only your hand can move. Bend wrist up slowly and then lower slowly.
3. Forearm Pronation/Supination. Grasp hammer (wrench, or some similar device) in hand with forearm supported. Rotate hand to palm down position, return to start position (hammer perpendicular to floor), rotate to palm up position, repeat. To increase or decrease resistance, by moving hand farther away or closer towards the head of the hammer.
4. Finger Extension. Place a rubber band around all five finger tips. Spread fingers 10 times, repeat 3 times. If resistance is not enough, add a second rubber band or use a rubber band of greater thickness which will provide more resistance.
5. Ball Squeeze. Place rubber ball or tennis ball in palm of hand, squeeze 10 times, and repeat 3 times. If pain is reproduced squeeze a folded sponge or piece of foam.
When performing exercises use pain as your guide – all exercises should be pain free.
After exercising, massage across the area of tenderness with an ice cube for about 5 minutes. You might also try filling a paper cup half-full with water and freeze; peel back a portion of the paper cup to expose the ice.
When your symptoms are resolved and have regained full range of motion and strength, you may gradually increase your level of playing activity.