PRACTITIONER PROMPT Tennis elbow rehabilitation Technique factors affecting onset of tennis elbow

● Perception of tennis as upper body sport ● Elbow leading at ball strike ● Trunk rotation too early ● Excessive use of tennis as a conditioning tool

● Sustaining grip throughout stroke ● Allowing ball contact behind line of body ● Moving into position too late to play shot ● Poorly co-ordinated sequential movement of body parts

● Racket head dropped below elbow at ball strike

● Abnormal flexibility/strength in forearm controlling wrist movement

● Single-handed backhand technique

Treatment in the first 48 hours ● ‘Relative rest’ of elbow, maintenance of fitness ● Ice in the first 48 hours to reduce swelling

Treatment after 48 hours ● Deep transverse frictional massage ● Myofascial techniques ● Ultrasound ● Iontophoresis ● Active stretches ● Passive stretches ● Accessory elbow mobilisation

● NSAIDs ● Wrist/forearm splint to offload tendon origin

● Radiohumeral manipulation ● Dry needling and/or acupuncture ● Strengthening exercise ● Isotonic, eccentric exercises ● Injection/surgery

Rehabilitation programme

● Correct faulty technique ● Correct shoulder kinematics ● Improve periscapular activity

● Pilates approach to trunk stability ● Maintain rotator cuff strength ● Strength exercises for forearm to strengthen teno-osseus junction

● Sport specific resistance work Possible equipment modifications to reduce tennis elbow injury

● Try lighter racket ● Increase grip size ● Maybe use string vibration dampers

● Have string tension reduced ● Ensure larger racket head size ● Newer balls to play with ● More flexible shaft needed ● Allow balls to dry out if played in wet weather

● New, softer grip material

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for special- ist medical advice in each individual case. To the extent permissable by law, the publisher, editors and contributors accept no liability for any loss, injury or damage howsoever incurred (including negli- gence) as a consequence, whether directly or indirectly, of the use of any person of the contents of this article.

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