Epicondylitis



Phase 1-Acute Phase

Goals:
Decrease inflammation/pain
Promote tissue healing
Retard muscular atrophy

Cryotherapy- cold packs
Whirlpool
Stretching to increase flexibility
Wrist extension/flexion
Elbow extension/flexion
Forearm supination/pronation
Isometrics
Wrist extension/flexion
Elbow extension/flexion
Forearm supination/pronation
Phonophoresis
Friction massage
Iontophoresis (with an antiinflamatory such as dexamethasone)
Avoid painful movements (such as gripping)

Phase 2-Subacute Phase

Goals:
Improve flexibility
Increase muscular strength and endurance
Increase functional activities and return to function

Emphasize
concentric/eccentric strengthening
Concentrate on involved muscle group (s)
Wrist extension/flexion (see Fig. 2-6, A)
Forearm pronation/supination
Elbow flexion/extension
Initiate shoulder strengthening (if deficiencies are noted)
Continue flexibility exercises
May use counterforce brace
Continue flexibility exercises
May use cryotherapy after exercise or function
Initiate gradual return to stressful activities
Gradually reinitiate previously painful movements

Phase 3-Chronic Phase

Goals:
Improve muscular strength and endurance
Maintain/enhance flexibility
Gradually return to sport/high level activities

Continue strengthening exercises (emphasize eccentric/concentric)
Continue to emphasize deficiencies in shoulder and elbow strength
Continue flexibility exercises
Gradually diminish use of counterforce brace
Use cryotherapy as needed
Initiate gradual return to sport activity
Equipment modifications (grip size, string tension, playing surface)
Emphasize maintenance program