Standard Tennis Elbow or Lateral Epicondylar Release Protocol
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Aims:
The aims of the rehabilitation programme are to promote a normal reparative process and tendon healing and to optimise function in the long-term.
General Points:
• Do not push through pain.
• Do not sacrifice quality of movement for range of movement
Post Operative support:
• The patient typically has a wool and crepe bandage applied to the arm following the surgery.
• The wool and crepe dressing is usually removed at approximately 48 hours.
• The wound and Steri-stripsTM should be covered by an occlusive dressing such as a padded OpsiteTM or TegadermTM
• The OpsiteTM or TegadermTM dressing is effectively splash-proof but not water-proof.
• The wound should be kept clean and dry for 2 weeks when it will normally be reviewed in the clinic and the dressings removed.
Post Operative Instructions:
0-6 weeks:
Hand, Wrist and Shoulder maintenance exercises.
Active assisted progressing to active elbow flexion and extension.
Active assisted progressing to active forearm supination and pronation.
Decrease swelling with cryotherapy/ice and elevation as indicated.
From 6 weeks:
Continue eccentric rehabilitation.
Eccentric Thera-BandTM or Resistance band exercises:
Important Notes:
• Avoid releasing the band suddenly.
• You may feel a moderate ache in the elbow at the end of each session.
• As you progress and the exercise gets easier and less uncomfortable, you may wish to shorten the band or change the colour of the band to provide increased resistance.
• If you can repeat a session with a stiff band and no pain the rate of the repetitions can be increased.
• It is important to persist with the programme even if you feel it is not helping.
• It may take 7-10 weeks to notice any improvement.
• The majority of people with tennis elbow should improve with this programme over a 12 week period.
Exercise Session:
1 Sit comfortably. Fix the band firmly under your foot. Hold the other end with your effected hand with the palm towards the floor. Place your elbow as straight as possible over your knee. Let your wrist be pulled bent towards the floor.
2 Use your free hand to pull the effected wrist back away from the floor stretching the band.
3 Gently let go of the supporting hand and slowly, and in a controlled manner, let the wrist bend back towards the floor resisting the pull of the band.
4 Repeat this process (steps 1-3) 15 times.
5 Then rest for a minute and repeat the exercise (steps 1-3) 15 times.
6 Rest for a further minute and repeat the exercise (steps 1-3) 15 times.
You have completed 1 session.
The sessions should be repeated twice per day. This needs to be continued for 12 weeks.
No long lever open chain exercises until 12 weeks.
12 weeks onwards:
Isometric exercises in variable starting positions progressing to
Resisted movements through range and strengthening
Functional Milestones and Activity Time Scales:
Driving See general principles of rehabilitation.
Swimming 12 weeks plus.
Golf 12 weeks plus.
