A simple cure—the wringing exercise
Chronic tennis elbow (lateral epicondylitis) can be alleviated by a simple wringing exercise using a small hand towel.
Roll up the hand towel.
With the arms extended, grasp the towel with the wrist of the affected side placed in slight flexion.
Then exert maximum wring pressure (Fig. 11.35):
first fully flexing the wrist for 10 seconds
then fully extending the wrist for 10 seconds
alternate flexion and extension between hands.
Grip for ‘wringing exercise’ at the end point of the isometric hold (right wrist in full flexion and the left in extension)
This is an isometric ‘hold’ contraction.
This exercise should be performed only twice a day, initially for 10 seconds in each direction. After each week, increase the time by 5 seconds in each twisting direction until 60 seconds is reached (week 11). This level is maintained indefinitely. Apply ice for 10 minutes after completion, especially last thing at night.
Note: Despite severe initial pain, the patient must persist, using as much force as possible.
Review at 6 weeks (there is usually some relief by 4 to 6 weeks), to ensure that the patient is doing the exercise exactly as instructed.
Stretching and strengthening exercises for the forearm muscles represent the best management for tennis elbow.7,8 The muscles are strengthened by the use of hand-held weights or dumbbells. A suitable starting weight is 0.5 kg, building up gradually (increasing by 0.5 kg) to 5 kg, depending on the patient.
To perform this exercise the patient sits in a chair beside a table.
The arm is rested on the table so that the wrist extends over the edge.
The weight is grasped with the palm facing downwards (Fig. 11.36a).
The weight is slowly raised and lowered by flexing and extending the wrist.
The flexion/extension wrist movement is repeated 10 times, with a rest for 1 minute and the program repeated twice.
Tennis elbow: (a) dumbbell exercise for classical case (palm facing down); (b) dumbbell exercise for medial epicondylitis—forearm tennis elbow, golfer’s elbow (palm facing up)
This exercise should be performed every day until the patient can play tennis, work or use the arm without pain.
For medial epicondylitis (forearm tennis elbow, golfer’s elbow), perform the same exercises but with the palm of the hand facing upward (Fig. 11.36b).
Tip: In colder conditions, keep the elbow warm with a woollen sleeve around it such as two or three modified old socks.