Skip to main content
PMC home page
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2005 Dec;39(12):944–947. doi: 10.1136/bjsm.2005.019836

An exercise programme for the management of lateral elbow tendinopathy

D Stasinopoulos 1, K Stasinopoulou 1, M Johnson 1
PMCID: PMC1725102  PMID: 16306504

Abstract

Background: Home exercise programmes and exercise programmes carried out in a clinical setting are commonly advocated for the treatment of lateral elbow tendinopathy (LET), a very common lesion of the arm with a well-defined clinical presentation. The aim of this study is to describe the use and effects of strengthening and stretching exercise programmes in the treatment of LET.

Eccentric exercises: Slow progressive eccentric exercises for LET should be performed with the elbow in extension, forearm in pronation, and wrist in extended position (as high as possible). However, it is unclear how the injured tendon, which is loaded eccentrically, returns to the starting position without experiencing concentric loading and how the "slowness" of eccentric exercises should be defined. Nor has the treatment regimen of the eccentric exercises of a supervised exercise programme been defined.

Stretching exercises: Static stretching is defined as passively stretching a given muscle-tendon unit by slowly placing and maintaining it in a maximal position of stretch. We recommend the position should be held for 30–45 s, three times before and three times after eccentric exercises during each treatment session with a 30 s rest interval between each procedure. The treatment region of static stretching exercises when a supervised exercise programme is performed is unknown.

Discussion: A well designed trial is needed to study the effectiveness of a supervised exercise programme for LET consisting of eccentric and static stretching exercises. The issues relating to the supervised exercise programme should be defined so that therapists can replicate the programme.

Full Text

The Full Text of this article is available as a PDF (62.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alfredson H., Pietilä T., Jonsson P., Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998 May-Jun;26(3):360–366. doi: 10.1177/03635465980260030301. [DOI] [PubMed] [Google Scholar]
  2. Allander E. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. Scand J Rheumatol. 1974;3(3):145–153. doi: 10.3109/03009747409097141. [DOI] [PubMed] [Google Scholar]
  3. Bandy W. D., Irion J. M., Briggler M. The effect of time and frequency of static stretching on flexibility of the hamstring muscles. Phys Ther. 1997 Oct;77(10):1090–1096. doi: 10.1093/ptj/77.10.1090. [DOI] [PubMed] [Google Scholar]
  4. Fyfe I., Stanish W. D. The use of eccentric training and stretching in the treatment and prevention of tendon injuries. Clin Sports Med. 1992 Jul;11(3):601–624. [PubMed] [Google Scholar]
  5. Khan K. M., Cook J. L., Kannus P., Maffulli N., Bonar S. F. Time to abandon the "tendinitis" myth. BMJ. 2002 Mar 16;324(7338):626–627. doi: 10.1136/bmj.324.7338.626. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kraushaar B. S., Nirschl R. P. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. 1999 Feb;81(2):259–278. [PubMed] [Google Scholar]
  7. Mafi N., Lorentzon R., Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2001;9(1):42–47. doi: 10.1007/s001670000148. [DOI] [PubMed] [Google Scholar]
  8. Noteboom T., Cruver R., Keller J., Kellogg B., Nitz A. J. Tennis elbow: a review. J Orthop Sports Phys Ther. 1994 Jun;19(6):357–366. doi: 10.2519/jospt.1994.19.6.357. [DOI] [PubMed] [Google Scholar]
  9. Ohberg L., Lorentzon R., Alfredson H. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. Br J Sports Med. 2004 Feb;38(1):8–11. doi: 10.1136/bjsm.2001.000284. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ohberg L., Lorentzon R., Alfredson H. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Knee Surg Sports Traumatol Arthrosc. 2001 Jul;9(4):233–238. doi: 10.1007/s001670000189. [DOI] [PubMed] [Google Scholar]
  11. Purdam C. R., Jonsson P., Alfredson H., Lorentzon R., Cook J. L., Khan K. M. A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy. Br J Sports Med. 2004 Aug;38(4):395–397. doi: 10.1136/bjsm.2003.000053. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Roos Ewa M., Engström Mikael, Lagerquist Annika, Söderberg Bengt. Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy -- a randomized trial with 1-year follow-up. Scand J Med Sci Sports. 2004 Oct;14(5):286–295. doi: 10.1111/j.1600-0838.2004.378.x. [DOI] [PubMed] [Google Scholar]
  13. Sady S. P., Wortman M., Blanke D. Flexibility training: ballistic, static or proprioceptive neuromuscular facilitation? Arch Phys Med Rehabil. 1982 Jun;63(6):261–263. [PubMed] [Google Scholar]
  14. Sevier T. L., Wilson J. K. Treating lateral epicondylitis. Sports Med. 1999 Nov;28(5):375–380. doi: 10.2165/00007256-199928050-00006. [DOI] [PubMed] [Google Scholar]
  15. Silbernagel K. G., Thomeé R., Thomeé P., Karlsson J. Eccentric overload training for patients with chronic Achilles tendon pain--a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports. 2001 Aug;11(4):197–206. doi: 10.1034/j.1600-0838.2001.110402.x. [DOI] [PubMed] [Google Scholar]
  16. Smidt Nynke, Assendelft Willem J. J., Arola Heikki, Malmivaara Antti, Greens Sally, Buchbinder Rachelle, van der Windt Daniëlle A. W. M., Bouter Lex M. Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Ann Med. 2003;35(1):51–62. doi: 10.1080/07853890310004138. [DOI] [PubMed] [Google Scholar]
  17. Smidt Nynke, van der Windt Daniëlle A. W. M., Assendelft Willem J. J., Devillé Walter L. J. M., Korthals-de Bos Ingeborg B. C., Bouter Lex M. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002 Feb 23;359(9307):657–662. doi: 10.1016/S0140-6736(02)07811-X. [DOI] [PubMed] [Google Scholar]
  18. Smith C. A. The warm-up procedure: to stretch or not to stretch. A brief review. J Orthop Sports Phys Ther. 1994 Jan;19(1):12–17. doi: 10.2519/jospt.1994.19.1.12. [DOI] [PubMed] [Google Scholar]
  19. Stanish W. D., Rubinovich R. M., Curwin S. Eccentric exercise in chronic tendinitis. Clin Orthop Relat Res. 1986 Jul;(208):65–68. [PubMed] [Google Scholar]
  20. Stasinopoulos D., Johnson M. I. Cyriax physiotherapy for tennis elbow/lateral epicondylitis. Br J Sports Med. 2004 Dec;38(6):675–677. doi: 10.1136/bjsm.2004.013573. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Stasinopoulos D., Johnson M. I. Effectiveness of extracorporeal shock wave therapy for tennis elbow (lateral epicondylitis). Br J Sports Med. 2005 Mar;39(3):132–136. doi: 10.1136/bjsm.2004.015545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Stasinopoulos Dimitrios, Stasinopoulos Ioannis. Comparison of effects of exercise programme, pulsed ultrasound and transverse friction in the treatment of chronic patellar tendinopathy. Clin Rehabil. 2004 Jun;18(4):347–352. doi: 10.1191/0269215504cr757oa. [DOI] [PubMed] [Google Scholar]
  23. Struijs P. A. A., Kerkhoffs G. M. M. J., Assendelft W. J. J., Van Dijk C. N. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both-a randomized clinical trial. Am J Sports Med. 2004 Mar;32(2):462–469. doi: 10.1177/0095399703258714. [DOI] [PubMed] [Google Scholar]
  24. Struijs Peter A. A., Damen Pieter-Jan, Bakker Eric W. P., Blankevoort Leendert, Assendelft Willem J. J., van Dijk C. Niek. Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study. Phys Ther. 2003 Jul;83(7):608–616. [PubMed] [Google Scholar]
  25. Svernlöv B., Adolfsson L. Non-operative treatment regime including eccentric training for lateral humeral epicondylalgia. Scand J Med Sci Sports. 2001 Dec;11(6):328–334. doi: 10.1034/j.1600-0838.2001.110603.x. [DOI] [PubMed] [Google Scholar]
  26. Taylor D. C., Dalton J. D., Jr, Seaber A. V., Garrett W. E., Jr Viscoelastic properties of muscle-tendon units. The biomechanical effects of stretching. Am J Sports Med. 1990 May-Jun;18(3):300–309. doi: 10.1177/036354659001800314. [DOI] [PubMed] [Google Scholar]
  27. Trinh K. V., Phillips S-D, Ho E., Damsma K. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. Rheumatology (Oxford) 2004 Jun 22;43(9):1085–1090. doi: 10.1093/rheumatology/keh247. [DOI] [PubMed] [Google Scholar]
  28. Trudel Daniel, Duley Jennifer, Zastrow Ingrid, Kerr Erin W., Davidson Robyn, MacDermid Joy C. Rehabilitation for patients with lateral epicondylitis: a systematic review. J Hand Ther. 2004 Apr-Jun;17(2):243–266. doi: 10.1197/j.jht.2004.02.011. [DOI] [PubMed] [Google Scholar]
  29. Verhaar J. A. Tennis elbow. Anatomical, epidemiological and therapeutic aspects. Int Orthop. 1994 Oct;18(5):263–267. doi: 10.1007/BF00180221. [DOI] [PubMed] [Google Scholar]
  30. Vilarta R., Vidal B. de C. Anisotropic and biomechanical properties of tendons modified by exercise and denervation: aggregation and macromolecular order in collagen bundles. Matrix. 1989 Jan;9(1):55–61. doi: 10.1016/s0934-8832(89)80019-8. [DOI] [PubMed] [Google Scholar]
  31. Waugh Esther J., Jaglal Susan B., Davis Aileen M., Tomlinson George, Verrier Molly C. Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy. Arch Phys Med Rehabil. 2004 Feb;85(2):308–318. doi: 10.1016/s0003-9993(03)00480-5. [DOI] [PubMed] [Google Scholar]
  32. Webright W. G., Randolph B. J., Perrin D. H. Comparison of nonballistic active knee extension in neural slump position and static stretch techniques on hamstring flexibility. J Orthop Sports Phys Ther. 1997 Jul;26(1):7–13. doi: 10.2519/jospt.1997.26.1.7. [DOI] [PubMed] [Google Scholar]
  33. el Hawary R., Stanish W. D., Curwin S. L. Rehabilitation of tendon injuries in sport. Sports Med. 1997 Nov;24(5):347–358. doi: 10.2165/00007256-199724050-00006. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES