Phase I – Acute phase (two weeks to one month; progress to next phase as soon as Phase II exercises can be tolerated) |
Goals: - Control pain.
- Reduce inflammation.
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Protection – Avoid activity that reproduces pain. |
Ice – Apply cold pack to the affected area for 10 to 15 minutes, two to three times per day and after exercise as needed. |
Bracing – Counterforce brace or elbow compression sleeve may be used to improve ability to perform work duties and daily activities. |
Therapeutic exercise (okay to continue with pain ≤3/10): - Wrist extensor stretching – Perform five sets of a 20-second stretch three times per day (stretch only until slight discomfort felt).
- Active range of motion – Move wrist through full range of extension and flexion. Perform three sets of 15 repetitions three times per day.
- Gentle strengthening as pain allows:
- Wrist extension – Perform three sets of 15 repetitions with light weight (0.5 to 1 kg; one to two pounds).
- Forearm supination-pronation – While holding a hammer or the bottom of a hand weight, perform three sets of 15 repetitions. Use light weight (0.5 to 1 kg; one to two pounds).
- Grip strength – Grip and release putty, a stress ball, or a foam block. Perform 30 repetitions three times per day.
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Phase II – Chronic phase (generally lasts more than one month) |
Goals: - Improve strength.
- Promote healing.
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Protection – Avoid activity that causes pain >3/10. Avoid sporting activity that reproduces symptoms. Strengthening should cause only mild pain and soreness (pain ≤3/10). |
Ice – May use if needed. Apply cold pack 10 to 15 minutes or perform ice massage three to five minutes. Perform up to three times per day. |
Bracing/equipment modification – May use counterforce brace if necessary for performance of work duties or daily activities. |
Tennis athletes – Reduce string tension, confirm proper grip size and cushion, use string dampener. |
Occupational workers – Use cushioned grips. |
Therapeutic exercises (may perform with pain <3/10): - Wrist extensor stretching – Perform five sets of 20-second stretch three times per day.
- Wrist extensor eccentric strength – Perform using an elastic band or dumbbell. Complete three sets of 15 repetitions.
- Flexbar eccentric strength – Perform three sets of 15 repetitions.
- Cross-friction massage over the common extensor origin at the lateral epicondyle.
- Forearm supination-pronation eccentric strength – Holding a hammer or light dumbbell, perform three sets of 15 repetitions.
- Shoulder external rotation with retraction – Using an elastic band, perform three sets of 15 repetitions.
- Shoulder external rotation – Using an elastic band, perform three sets of 15 repetitions.
- Elastic band backhands (tennis athletes) – Using an elastic band, perform backhand motion. Complete three sets of 15 repetitions. Concentrate on decelerating through the shoulder blade.
- Serve simulations (tennis athletes) – Perform three sets of 15 repetitions holding a light weight (0.5 to 1 kg; one to two pounds).
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Phase III – Return to activity |
- Full strength without pain during resisted wrist extension and during resisted forearm pronation and supination with the elbow in extension.
- Full range of elbow and wrist motion without pain.
- Pain-free forceful grip.
- Pain-free tennis strokes with reduced forearm pronation on forehand and serves and reduced wrist extension on backhand.
- Continue Phase II exercises twice weekly.
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