This is the second video in our Tennis Elbow series. In the first video we learnt about what tennis elbow is and how to recognise it if you think you have it, and also more importantly how to manage the pain and discomfort in the short term. Take me back to Tennis Elbow everything you need to know – Part 1 .
In this second video we will learn about how to manage it in the longer term using exercise and ultimately get rid of the tennis elbow pain altogether, watch the video below.
Firstly I think it’s important to understand why exercise helps alleviate tennis elbow in the long term. The Tennis Elbow Tendinopathy occurs when you have a degeneration of the collagen protein that forms the tendon at the lateral epicondyle of the elbow. The fibres of the collagen protein form up in a cross hatched pattern causing aggravation of the tendon with repetitive loading due to poor force transmission. A healthy tendon should have nicely aligned collagen fibres which transfer forces through the tendon efficiently.
Exercise and loading is important to build new healthy collagen around the old degenerative tendon, making the tendon thicker, strong and more elastic. This doesn’t happen overnight. Changes in tendon size typically take at least 3 to 6 months to occur.
There are three types of exercise we want to use to overcome Tennis Elbow.
- Isometric Exercise
- Eccentric Exercise
- Isotonic Exercise
1 – Isometric Exercise
Isometric Exercise is useful as it has an analgesic / pain relieving effect on the region. This is helpful in the acute phase when you are experiencing the most pain.
Isometric Exercise is when the muscle is producing a contractile force but is not changing length, in other words the forearm extensors are contracting but the wrist joint is not moving.
During this early painful stage perform 5 repetitions of an isometric contraction for up to 45 seconds. Start with a light contraction, I usually suggest around 25% of your strength. Over time as your symptoms improve and the tendon strengthens you can increase the force of the contractions to up to 90% of your strength.
Once the pain has reduced enough for you to perform Eccentric exercises then you are ready for the next phase of your rehabilitation.
2 – Eccentric Exercise
Eccentric exercises are when the muscle is producing a contractile force and the muscle is lengthening. An example would be going from an extended wrist position to a neutral wrist position.
Eccentric exercises are useful at this stage because our muscles can tolerate greater loads during eccentric movements than otherwise. Eccentric contractions also tend to create more beneficial adaptations for the tendon, so you are more specifically targeting the benefits for the tendon.
During this Eccentric phase of rehabilitation you should perform 3 sets of 10 repetitions. Start with a loading that is tolerable for your tendon and doesn’t create soreness which lasts longer than a few hours.
Once you are able to perform these exercises with minimal or no pain you are ready to progress to Isotonic exercises.
3. Isotonic Exercise
This is the final phase of your rehabilitation. Isotonic exercises are where we perform the concentric and eccentric phases of the movement. Perform 3 sets of 10 reps.
Perform the above exercises daily while the pain persists and you are performing Isometric or Eccentric exercises. Reduce the frequency to 3-4 times weekly once you are performing Isotonic Exercises. Keep performing the exercises even after the pain has completely gone for another 3-6 months. Then you can reduce the exercise frequency to 1-2 times weekly.