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Basic rehabilitation program for lateral epicondylalgia (tennis elbow)

Basic rehabilitation program for lateral epicondylalgia (tennis elbow)
Phase I – Acute phase (two weeks to one month; progress to next phase as soon as Phase II exercises can be tolerated)
Goals:
  1. Control pain.
  2. Reduce inflammation.
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):
  1. Wrist extensor stretching – Perform five sets of a 20-second stretch three times per day (stretch only until slight discomfort felt).
  2. Active range of motion – Move wrist through full range of extension and flexion. Perform three sets of 15 repetitions three times per day.
  3. Gentle strengthening as pain allows:
    1. Wrist extension – Perform three sets of 15 repetitions with light weight (0.5 to 1 kg; one to two pounds).
    2. 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).
    3. Grip strength – Grip and release putty, a stress ball, or a foam block. Perform 30 repetitions three times per day.
Phase II – Chronic phase (generally lasts more than one month)
Goals:
  1. Improve strength.
  2. Promote healing.
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):
  1. Wrist extensor stretching – Perform five sets of 20-second stretch three times per day.
  2. Wrist extensor eccentric strength – Perform using an elastic band or dumbbell. Complete three sets of 15 repetitions.
  3. Flexbar eccentric strength – Perform three sets of 15 repetitions.
  4. Cross-friction massage over the common extensor origin at the lateral epicondyle.
  5. Forearm supination-pronation eccentric strength – Holding a hammer or light dumbbell, perform three sets of 15 repetitions.
  6. Shoulder external rotation with retraction – Using an elastic band, perform three sets of 15 repetitions.
  7. Shoulder external rotation – Using an elastic band, perform three sets of 15 repetitions.
  8. 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.
  9. Serve simulations (tennis athletes) – Perform three sets of 15 repetitions holding a light weight (0.5 to 1 kg; one to two pounds).
Phase III – Return to activity
  1. Full strength without pain during resisted wrist extension and during resisted forearm pronation and supination with the elbow in extension.
  2. Full range of elbow and wrist motion without pain.
  3. Pain-free forceful grip.
  4. Pain-free tennis strokes with reduced forearm pronation on forehand and serves and reduced wrist extension on backhand.
  5. Continue Phase II exercises twice weekly.
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