Tennis Elbow Pain

There is moderate evidence for the immediate effects of several manual therapy techniques on pain and grip strength. Many of the techniques we incorporate will cause an immediate reduction in your pain. Most of them require repeated treatments for 2- 3 weeks to keep the pain at bay and transition to a full-fledged exercise program. Manual Therapy is a hands-on technique employed by the practitioner to stretch, mobilize and move tissues while you relax. This may include mobilizations directed at joint, fascial, muscle and nerve.

In patients with chronic tennis elbow pain, exercise has been shown to produce regression of pain. Some of the patients might need to provoke the pain while doing the exercises and others need exercises which do not provoke any pain. Your physical therapist will make the call after examining the stage and severity of your condition.

Some of the exercises aim at relieving the pain while others work towards tendon regeneration and strengthening. All exercise programs must include a global perspective to reactivate whole body link systems. (Kinetic chain exercises)

Sensorimotor palm-slide exercise for retraining of wrist extension

With the forearm resting in on a table, the wrist should be slowly extended by sliding the fingertips along the table and lifting the knuckles. Emphasis is placed on avoiding metacarpophalangeal extension and finger flexion. Return to the starting position and repeat 10 times.

Another form of exercises are graded exercises. In the graded exercises load on the affected muscles will be progressively increased over a period of 4 to 12 weeks.

New understanding of how our brain perceives pain has led to this new treatment approach. In this form of treatment, we rewire the way your brain understands impulses that generate pain. This is particularly effective if your pain is chronic and hurts even without movements. The treatment will be done in three stages.

Stage 1 – Reorganizing brain’s perception of your hand through understanding its spatial orientation.

Research shows people in pain often lose the ability to identify left or right images of their painful body part(s) (i.e. when viewing pictures of body parts they are slower and/or less accurate than somebody without pain at determining whether the image is a Left or Right).

Stage 2 – Mental imagery of movement – Imagined movements can actually be hard work if you are in pain. This is most likely because 25 percent of the neurons in your brain are ‘mirror neurons’ and start firing when you think of moving or even watch someone else move.

Stage 3 – If you put your left hand behind a mirror and right hand in front, you can trick your brain into believing that the reflection of your right hand in the mirror is your left. You are now exercising your left hand in the brain, particularly if you start to move your right hand. Sounds tricky! Mirrors can sometimes be used by themselves but often it is best to do once you have a good ability to discriminate your Lefts from your Rights and imagine movements.