A New, Easy Approach for Treating Tennis Elbow

Chronic lateral epicondylitis is a painful condition that is by no means only caused by playing tennis. Any repeated movement of the wrist extensor muscles (they lift the wrist up) can lead to small tears in the forearm muscles’ tendons, with inflammation and pain starting on the outside of the elbow. Rest, icing, ultrasound, and maybe cortisone injections, spread over months, may be required; even then some patients require surgery.

A new approach to treating and preventing recurrence of tennis elbow was reported at the recent American Orthopedic Society for Sports Medicine Meeting. It involves eccentric exercises with a simple rubber cylinder, the Flexbar®.

Patients with tennis elbow resulting from playing tennis or golf that had lasted at least 6 weeks, and who had not had surgery, were randomly assigned to one of two groups. Both groups did wrist-extensor muscle stretching exercises, had ultrasound treatment, cross-friction massage, and heat and ice therapy. Those in a ‘standard treatment’ group did isotonic wrist-extensor strengthening exercise, while the ‘eccentric therapy’ group performed isolated eccentric wrist-extensor strengthening using the Flexbar. This involved twisting the cylinder using the noninvolved arm so that it was “wound up”, then allowing the injured forearm to release the twist using eccentric wrist-extension. (If this sounds complicated, it is – a video would be useful. Ask the author named in the Medscape article.) They did 3 sets of 15 repetitions daily, with increasing intensity over the treatment period.

The eccentric treatment group was found to have a 76% improvement in scores of disability vs. 12% for the standard group. Pain improvement was 81% with the eccentric exercises vs. 4% with standard treatment, and strength of the wrist and middle finger was also much better with the eccentric approach – 72% vs. 11%.

These impressive results were obtained with simple exercises that can be done at home, using a $10 piece of equipment. If the routine can be adequately demonstrated (maybe on U-Tube?) I see a great future for the Flexbar.