Current evidence-based management of Tennis elbow also known as lateral elbow tendinopathy

A lateral elbow tendinopathy is a compressive injury of the wrist extensors.

What we know based on current science:

Tendons do NOT like internal or external compression!

What you should NOT do:

1) External compression techniques: weird things like tendon rubbing techniques should be avoided at all cost.

Exemple: DTF aka Deep Tendon Friction. Yes we have all learned that in physical therapy school. It has always been a purposeless technique, and wil add external compression forces on the tendon and will consequently add more effusion.

Exemple 2: local massage. Same idea. You are adding more compression on the injury, It makes little sense. It might feel good, but you will worse the condition.

• Wearing compressive elbow braces also increases external compression, thus possibly creates more effusion.

2)

Stop it with the eccentric wrist go up and down physio exercises.

Like we previously mentioned, tendons do NOT like compression especially when injured. Eccentric contraction increases internal compression.

We should think of ECRB (external carpi radialis brevis) as more of a wrist stabiliser than a primary wrist mover. This gives you an idea of what exercises to prescribe to patients.

3)

Knowing all this, stretching the wrist extensors with pronated forearm is therefore a bad idea.

Why? Because stretching adds to the compression again! It gets old huh?

4) The hammer pronation supination exercise. Again, do not do this. because… comp…ression.

In conclusion:

It is possible that everything you’ve learning so far on lateral elbow tendinopathy was based on an expired concept and you are probably worsening your patient’s tendinopathy by doing one compressive exercises.

Fear not, we do have the solution for you! (in our next blog!)

Good luck!

Physio Summum Brossard