tennis elbow or what’s called lateral
epicondylitis it is basically that the outside area here on your humerus where the
muscles that go down to control all the muscles in your hand and your wrist
where that starts to pull the tendon away from the bone a little bit. That
causes extreme pain where a patient will notice the pain is right in this area
it’ll be very very tender and they might have problems you know grasping things. Might cause very severe pain they’re picking up a book. All sorts of things. So
they can get it from hammering, from playing tennis, you may never have played
tennis in your life and still have tennis elbow. So anyway it’s definitely
something that we can help with in the office but it’s very important that you
take an active role in your care to speed up your recovery and also to make
your recovery lasting. The first level and the first stage of
rehab what we’re going to have you do is just rest the arm and and the treatments
that we’re doing in the office to help it heal. An icepack fantastic a gel pack
taking and just putting that over that region after the treatment and also when
we’re doing exercises anytime we are doing those exercises making sure that
you are icing afterwards to reduce the inflammation that has been created. You
could wrap an ace bandage around this and just keep that there for about ten
to fifteen minutes. These usually don’t get too cold but if you want you can put
a layer of paper towels between the ice and your arm. So we would do that
maybe a couple times a day for 15 minutes and then also using something
like a tennis elbow strap the one that we carry in the office and we recommend
because it seems to be the best from our research is called the BandIt. The
reason we like it is that instead of putting a continuous pressure all the
way around the forearm here which blocks blood and nerve flow blood, very
important for healing of this area, it only is going to push down over these
muscles: your forearm flexors and extensors muscles just there. Leaving
the areas on either side where the blood and nerve flow go unobstructed and not
compressed. And what we do with this is we’ll have her put her
arm through there and then we get this where it is about two or three inches
from the elbow joint down. It needs to be over the muscle portion here so when you
feel your arm here and you have a squishy part and then on the sides it’ll
feel like you can touch the bone kind of. You want to be a muscular portion there
so just like that going to tighten this down just a bit should you know your
hand shouldn’t be turning white or blue or red. And it should just provide a
little bit of support there whenever you’re doing anything that would cause
pain here know that that is re-injuring the area so a strap like this can really
help speed up healing because you’re not re-injuring it during the day as you’re
doing your daily activities. The goal is not to have you wear this for the rest
of your life. This is just during the rehab phase to make it so that you’re
not re-injuring yourself. Excellent device. The first stage of exercises we’re going to do here is a gentle stretching so the first thing we’re going to have you do is bring your
hand out like this and we’re going to stretch the muscles on the opposite side. You’re kind of pulling your fingers back and where you should feel the stretch is
right in here, right? We want to make sure that the elbow is extended. We don’t want
the elbow bent because you won’t get as good as stretch. So the elbow needs to be extended and then we’re doing this stretch. We’d hold this stretch for about
30 seconds just a gentle stretch and then we’re going to do the opposite
we’re going to bring your hand over this way,
perfect, again the elbow is extended and we should feel the stretch on the top
there if this causes intense pain you’re not ready for this stage yet we need to
ice more and help it heal more. These muscles get very tight with typing,
mousing, all the stuff that we do on a daily basis. Pulling back here again the elbow is extended and you’re going to feel the
stretch in this region. You’re going to hold your fingers back just like this
and then we’ll have you do the other one. Again you would hold that for about 30
seconds. We’ll have you do the other one where
you’re bending this way elbow is extended bending at the wrist we should
feel a stretch here in this area. The next thing we’re going to do is help
to strengthen those muscles but the way that we do these exercises is the most
important part. So I’m taking a very small weight here a 3 pound weight we’re
going to start with you could use a soup can. What we’re gonna do here is she’s
gonna take and bring her elbow down on her thigh like this and she’s gonna take
and do extension of the wrist very very slowly. Okay if I was doing it here fully
going down and then fully coming back up the most important thing is that we are
slowly letting it back down. right? It isn’t so much how fast we come up but we
want to let back down very slowly. Maybe down to a count of three. You might
notice that you’re a little ratchety with it on the way back down that just
shows that these have lost their control to decelerate any movements and that’s a
prime reason that people get hurt in that area. So very important for us to
work this and again the deceleration phase the most important. Then we’ll have
her flip her forearm over perfect again resting it on the knee her wrist is
right there at the end of her knee so that it allows it to hinge there but
it’s not hanging over too much like this so right back here and then she’s going
to go down good and then bring it back up as far as you can up and then again
slowly releasing it back down. You might notice that it’s a little shake here
usually people are stronger with their wrist flexors than they are their wrist
extensors and that’s why we see more people with tennis elbow or lateral
epicondylitis than golfer’s elbow. We’re looking at her arm is resting on her
thigh and hinged here we’ll actually have her pull this out just a little bit
and then bring it down as far as you can good and up as far as you can
good. Again being very very slow when we were when we returned it back down
sometimes you’ll notice a little shaky. A two to three pound weight a great size
weight and then to slowly increase that as you as you work work up to that. If
this is causing a lot of pain we need to go back to the stretches this is a
gradiated rehab program and so the first thing is the icing the next thing that
you will get to is the stretching and then after that we’re going to get to
this and one other exercise I’m going to show you with rubber band. We will have you
flip your arm over… the next part of the exercises for tennis elbow that we’re
going to work on you can also use this for medial epicondylitis or golfer’s
elbow is working the finger extensor muscles. Wen you think about it we’re
constantly grabbing things in this world but we’re very infrequently opening our
fingers against any load. So what you’re going to do is take this fancy piece of
rehab equipment this is not a thin rubberband but a little bit bigger one. I
would not use the ones that come on like a broccoli stalk grouping. So this rubber
band here can stretch it a bit and then you’re just going to put it over the
tips of your fingers harder than it looks put over the tips of your fingers
and then we’re just going to extend and close in. Extend and close in. Again
coming back to neutral very very slowly like this and then when we’re done with
that any of the exercise sessions we’re always going to want to be using the ice,
the gel pad or the gel pack of ice there, to reduce any inflammation that we’ve
created by working out those muscles. It’s very important as you are rehabbing
for tennis elbow that you’re not going out and doing any exercises that are
causing significant pain at this area so if I go back and I want to start tennis
I’m kind of ripping those fibers away from the bone before they’ve had a
chance to heal. That will significantly impact your ability to heal and it can
mean that the condition goes on for months or years. So in the healing phase
and the rehab phase we want to focus on these very controlled motions very
controlled activities and not be too hasty to get back to our sport which
and cause a delayed healing.

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Dennis Veasley

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