Lateral Epicondyle Tendinopathy Toolkit: Section E - Exercise Prescription: Difference between revisions

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== Introduction ==
== Introduction ==
Exercises for lateral epicondyle tendinopathy (LET) should be chosen according to patient preference, and the clinical evaluation.


== Concentric/Eccentric Home Exercise Program (Peterson et al 2011<ref>Peterson M, Butler S, Eriksson M, Svardsudd K. A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Uppsala Journal of Medical Science. 2011; 116: 269-279.</ref>) ==
There is a large volume of clinical evidence that consistently supports the use of exercise for management of chronic LET. Studies evaluating strength-based exercise have demonstrated improvement in symptoms regardless of the muscle contraction-type (e.g. concentric, eccentric or isometric). Some evidence suggests that eccentric exercises may provide superior pain relief, but providing an exercise that the patient can tolerate (isometric, concentric or eccentric) is the most important consideration.


The summary of interventions suggests ([[Lateral Epicondyle Tendinopathy Toolkit: Section D - Summary of the Evidence|see section D]]) that clinicians strongly consider using local and upper limb kinetic chain exercises to support patients suffering from chronic LET. The following are examples of exercises to consider based upon the available literature
== Concentric/Eccentric Home Exercise Program  ==
[Needs a a summary description of concentric/eccentric exercises].  The exercises below are based on a study by Peterson et al 2011<ref>Peterson M, Butler S, Eriksson M, Svardsudd K. A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Uppsala Journal of Medical Science. 2011; 116: 269-279.</ref>
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''Protocol:''  
''Protocol:''  


*Daily, 3-month program.  
*Daily, 3-month program.
*Forearm supported in pronation with elbow in some flexion.  
*Forearm supported in pronation with elbow in some flexion.
*Resistance 1kg women, 2kg men (1 litre of water = 1kg).  
*Resistance 1kg women, 2kg men (1 litre of water = 1kg).
*3 sets of 15 once daily.  
*3 sets of 15 once daily.
*Increase resistance by 0.1 kg (100ml water) weekly.  
*Increase resistance by 0.1 kg (100ml water) weekly.
*No comment was made regarding pain during exercise.
*No comment was made regarding pain during exercise.


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''Directions:''  
''Directions:''  


*Lift the weight by extending the wrist, then lower.  
*Lift the weight by extending the wrist, then lower.
*The original research used a water container that is unavailable in North America. We have substituted a water bottle in a bag.<br>
*The original research used a water container that is unavailable in North America. We have substituted a water bottle in a bag.<br>


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| width="300" |  
[[Image:LET Appendix C Fig1.png|center|264x230px|Fig 1 of LET App C]]'''&nbsp; &nbsp; Figure 1'''  
[[Image:LET Appendix C Fig1.png|center|264x230px|Fig 1 of LET App C]]'''&nbsp; &nbsp; Figure 1'''


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<br>  
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== Supervised Eccentric Exercise and Stretching Program (Stasinopoulos et al 2006<ref>Stasinopoulos D, Stasinopoulos I. (2006) Comparison of effects of cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (bioptron light) for the treatment of lateral epicondylosis. Clinical Rehabilitation. 2006; 20(1): 12-23.</ref>)  ==
== Supervised Eccentric Exercise and Stretching Program ==
 
[Needs a description of eccentric exercises and stretching.  The exercises below are based on a study by Stasinopoulos et al 2006<ref>Stasinopoulos D, Stasinopoulos I. (2006) Comparison of effects of cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (bioptron light) for the treatment of lateral epicondylosis. Clinical Rehabilitation. 2006; 20(1): 12-23.</ref>
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| width="500" | ''&nbsp; Protocol:''  
| width="500" |''&nbsp; Protocol:''  
*3 times a week, 4 weeks.  
*3 times a week, 4 weeks.
*Forearm supported in pronation with elbow extended.  
*Forearm supported in pronation with elbow extended.
*Wrist extended as high as possible then lowered into flexion slowly counting to 30, return to starting position using the other hand.  
*Wrist extended as high as possible then lowered into flexion slowly counting to 30, return to starting position using the other hand.
*3 sets of 10, 1 minute rest between sets.  
*3 sets of 10, 1 minute rest between sets.
*Resistance, free weights.  
*Resistance, free weights.
*Increase resistance when the exercise is pain-free.  
*Increase resistance when the exercise is pain-free.
*Exercise with mild pain. Stop if pain becomes disabling.  
*Exercise with mild pain. Stop if pain becomes disabling.
*Passive stretching of the extensor carpi radialis brevis tendon (ECRB) done by therapist 3 times before and 3 times after the eccentric exercise. Forearm pronated, elbow extended, wrist flexed and ulnar deviated. Hold 30-45 seconds. 30 second rest between stretches.<br>
*Passive stretching of the extensor carpi radialis brevis tendon (ECRB) done by therapist 3 times before and 3 times after the eccentric exercise. Forearm pronated, elbow extended, wrist flexed and ulnar deviated. Hold 30-45 seconds. 30 second rest between stretches.<br>


<br> ''&nbsp; Directions:''  
<br> ''&nbsp; Directions:''  


*Extend the wrist using the unaffected hand (2A).  
*Extend the wrist using the unaffected hand (2A).
*Allow the wrist to flex (eccentric contraction of wrist extensors) (2B).  
*Allow the wrist to flex (eccentric contraction of wrist extensors) (2B).
*The original research used hand held weights. We have substituted a bag with weights.<br>
*The original research used hand held weights. We have substituted a bag with weights.<br>


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[[Image:LET Appendix C Fig2a.png|center|264x154px|Fig 2a of LET App C]]'''&nbsp; &nbsp; Figure 2A'''  
[[Image:LET Appendix C Fig2a.png|center|264x154px|Fig 2a of LET App C]]'''&nbsp; &nbsp; Figure 2A'''  


<br><br> [[Image:LET Appendix C Fig2b.png|center|264x154px|Fig 2b of LET App C]]'''&nbsp; &nbsp; Figure 2B'''<br>  
<br><br> [[Image:LET Appendix C Fig2b.png|center|264x154px|Fig 2b of LET App C]]'''&nbsp; &nbsp; Figure 2B'''<br>


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== The “Tyler Twist” Eccentric Wrist Extensor Exercise (Tyler et al 2010<ref>Tyler T, Thomas G, Nicholas S, McHugh M. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. Journal Of Shoulder And Elbow Surgery. Sep 2010; 19(6): 917-922.</ref>)   ==
== The “Tyler Twist” Eccentric Wrist Extensor Exercise ==
 
[Needs a description of eccentric wrist externsor exercises]. The exercises below are based on a study  (Tyler et al 2010<ref>Tyler T, Thomas G, Nicholas S, McHugh M. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. Journal Of Shoulder And Elbow Surgery. Sep 2010; 19(6): 917-922.</ref>)
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== Resources ==
== Resources ==

Revision as of 13:51, 10 November 2022

Original Editor - Rishika Babburu for BC Physical Therapy Tendinopathy Task Force:

Dr. Joseph Anthony, Paul Blazey, Dr. Allison Ezzat, Dr. Angela Fearon, Diana Hughes, Carol Kennedy, Dr. Alex Scott, Michael Yates and Alison Hoens


Top Contributors - Evan Thomas, Rishika Babburu, Kim Jackson, Admin, Wanda van Niekerk and Vidya Acharya  


This article is currently under review and may not be up to date. Please come back soon to see the finished work! (10/11/2022)

Introduction[edit | edit source]

Exercises for lateral epicondyle tendinopathy (LET) should be chosen according to patient preference, and the clinical evaluation.

There is a large volume of clinical evidence that consistently supports the use of exercise for management of chronic LET. Studies evaluating strength-based exercise have demonstrated improvement in symptoms regardless of the muscle contraction-type (e.g. concentric, eccentric or isometric). Some evidence suggests that eccentric exercises may provide superior pain relief, but providing an exercise that the patient can tolerate (isometric, concentric or eccentric) is the most important consideration.

The summary of interventions suggests (see section D) that clinicians strongly consider using local and upper limb kinetic chain exercises to support patients suffering from chronic LET. The following are examples of exercises to consider based upon the available literature

Concentric/Eccentric Home Exercise Program[edit | edit source]

[Needs a a summary description of concentric/eccentric exercises]. The exercises below are based on a study by Peterson et al 2011[1]

Protocol:

  • Daily, 3-month program.
  • Forearm supported in pronation with elbow in some flexion.
  • Resistance 1kg women, 2kg men (1 litre of water = 1kg).
  • 3 sets of 15 once daily.
  • Increase resistance by 0.1 kg (100ml water) weekly.
  • No comment was made regarding pain during exercise.


Directions:

  • Lift the weight by extending the wrist, then lower.
  • The original research used a water container that is unavailable in North America. We have substituted a water bottle in a bag.
Fig 1 of LET App C
    Figure 1


Supervised Eccentric Exercise and Stretching Program[edit | edit source]

[Needs a description of eccentric exercises and stretching. The exercises below are based on a study by Stasinopoulos et al 2006[2]

  Protocol:
  • 3 times a week, 4 weeks.
  • Forearm supported in pronation with elbow extended.
  • Wrist extended as high as possible then lowered into flexion slowly counting to 30, return to starting position using the other hand.
  • 3 sets of 10, 1 minute rest between sets.
  • Resistance, free weights.
  • Increase resistance when the exercise is pain-free.
  • Exercise with mild pain. Stop if pain becomes disabling.
  • Passive stretching of the extensor carpi radialis brevis tendon (ECRB) done by therapist 3 times before and 3 times after the eccentric exercise. Forearm pronated, elbow extended, wrist flexed and ulnar deviated. Hold 30-45 seconds. 30 second rest between stretches.


  Directions:

  • Extend the wrist using the unaffected hand (2A).
  • Allow the wrist to flex (eccentric contraction of wrist extensors) (2B).
  • The original research used hand held weights. We have substituted a bag with weights.
Fig 2a of LET App C
    Figure 2A

Fig 2b of LET App C
    Figure 2B


The “Tyler Twist” Eccentric Wrist Extensor Exercise[edit | edit source]

[Needs a description of eccentric wrist externsor exercises]. The exercises below are based on a study (Tyler et al 2010[3])

  Protocol:

  • Daily, approximately 6 weeks.
  • Forearm pronated, elbow and wrist extended.
  • Allow wrist to flex slowly for approximately 4 seconds.
  • 3 sets of 15 once daily. 30 second rest between sets.
  • Increase resistance by using a thicker bar when the exercise is pain-free.


Fig 3a of LET App C
Figure 3A
Fig 3b of LET App C
Figure 3B
Fig 3c of LET App C
Figure 3C
Fig 3d of LET App C
Figure 3D
Fig 3e of LET App C
Figure 3E

  Directions:

  • Hold the bar in the affected hand (3A).
  • Place the unaffected hand as shown (3B).
  • With affected wrist in full extension, twist the bar with the unaffected hand (3C).
  • Stretch both arms out, elbows straight (3D).
  • Slowly allow the affected wrist to bend, i.e. allow an eccentric contraction of wrist extensors (3E).




Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Peterson M, Butler S, Eriksson M, Svardsudd K. A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Uppsala Journal of Medical Science. 2011; 116: 269-279.
  2. ↑ Stasinopoulos D, Stasinopoulos I. (2006) Comparison of effects of cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (bioptron light) for the treatment of lateral epicondylosis. Clinical Rehabilitation. 2006; 20(1): 12-23.
  3. ↑ Tyler T, Thomas G, Nicholas S, McHugh M. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. Journal Of Shoulder And Elbow Surgery. Sep 2010; 19(6): 917-922.
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