Oct Tennis elbow is a common afflication amongst tennis and golf players, but any person practicing an activity involving wrist and arm motions can also be affected. If you are or have been affected by a tennis elbow injury, then you know how hard it is to get rid of it! Luckily, there is a tool that can help recover from this injury. The Theraband FlexBar is a portable, efficient and affordable product designed to help with the recovery. The Theraband Flexbar targets and stimulate muscles and tendons in a way that t he muscle lengthen and contract simultaneously, making it easier to perform bending, twisting or oscillating exercises.
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Eccentric exercise has been effectively used in the management of tendinopathies in multiple regions of the body. A novel exercise was developed for home-based eccentric exercise that has shown promise for use with patients with lateral epicondylosis. Clinicians should be aware of this exercise and consider it as an evidence-based intervention.
While not usually associated with actually playing tennis, LE is a relatively common condition that can affect persons who perform repetitive upper body activities such as carpenters, musicians, and computer programmers. There is evidence that eccentric exercise may be effective in reducing the symptoms associated with LE. Studies have shown that the ECR in particular is subject to increased stress during activities requiring power from the wrist.
Traditional conservative treatments for LE include cross friction massage, electrical and thermal modalities, bracing, and therapeutic exercise. Interestingly, a systematic review and meta-analysis of interventions for LE noted a lack of evidence to support treatments other than exercise. Therapeutic eccentric exercise TEE has been found to be an effective intervention for a variety of tendinopathies including Achilles tendinosis, 13 shoulder impingement, 14 and patellar tendinopathy.
Eccentric exercise may also provide neuromuscular benefits through central adaptation of both agonist and antagonist muscles 17 ; therefore, TEE may provide both a structural and functional benefit during tendinopathy rehabilitation.
Interestingly, some patients with LE exhibit lowered pain pressure thresholds PPT and larger referred pain patterns than would occur solely due to the presence of trigger points, suggesting a central nervous system mediation of pain. In a recent systematic review, Woodley et al 19 noted a lack of high-quality studies comparing the effectiveness of eccentric exercise to standard management of tendinopathies.
The researchers noted the previously described efficacy of eccentric training in LE patients using an isokinetic dynamomter in a study by Croisier et al 1 , but wanted to develop an effective, cost-effective home-based eccentric exercise for their patients.
Instructions for the 5 Steps of the Exercise: A. Standard PT included stretching, cross-friction massage, ultrasound, heat and ice. The authors reported on the reliability of their strength and tenderness assessments, noting lower reliability of middle finger extension strength. Each repetition took 4 seconds to complete, and there was a 30 second rest between each set of 15 repetitions. The exercise was performed both during clinic visits and at home.
The treatment continued until the patient had a resolution of symptoms, which occurred at an average of 7 weeks of treatment with 10 clinic visits. This clinical suggestion presents an excellent example of clinical practice leading to the creation of an evidence-driven novel exercise technique.
This clinical suggestion promotes an emphasis on home-based, inexpensive treatment as compared to clinically-based use of more expensive isokinetic devices. Tyler et al 2 utilized the scientific inquiry process in order to answer the question of efficacy of this novel exercise intervention in a clinical setting. There were some limitations to the Tyler et al 2 study such as a small sample size. Only 21 of the 30 subjects needed for sufficient power completed the study.
The researchers who performed that study noted significant improvements in the experimental group and therefore decided to terminate the random group allocation due to the ethical possiblitiy that an effective treatment may have been withheld from the control subjects. The Tyler et al 2 study only examined and reported short-term improvements; longer-term outcomes would help determine if the positive results were sustained over longer time periods.
Nonetheless, the amount and variety of short-term improvement in symptoms described in the study seem to offer positive clinical benefits.
In today's world of the Internet and social media, there were some interesting phenomena that resulted from this study. After presenting the abstract at the American Orthopaedic Society for Sports Medicine's Annual Meeting, a press release was issued by the society.
The New York Times, among other media outlets, posted blog articles about the results of the study, resulting in numerous replies from consumers. Patients provided impressive testimonials about their successes with the exercise.
By understanding the evidence and applying experience within a clinical environment, clinicians can develop effective, novel interventions. It also supports the scientific process used in clinical practice: developing a hypothesis based on a clinical need and testing it in a real-world, clinical situation, with real patients. Finally, today's Internet-based society will continue to challenge rehabilitation providers to support and participate in evidence-based practice as patients learn about successful treatments and look to their physical therapists to provide them.
National Center for Biotechnology Information , U. Author information Copyright and License information Disclaimer. Disclosure: Dr. This article has been cited by other articles in PMC. Abstract Eccentric exercise has been effectively used in the management of tendinopathies in multiple regions of the body.
Open in a separate window. Figure 1. Croisier J. Br J Sports Med. Tyler T. J Shoulder Elbow Surg. Briggs C. Elliott B. A review of structures associated with tennis elbow. Anat Clin. Bauer J. Murray R. J Electromyogr Kinesiol. Finsen L. Muscle Nerve. Morris M. Am J Sports Med. Alizadehkhaiyat O. Rojas M. Nirschl R. Ashman E. Clin Sports Med. Stasinopoulos D.
Johnson M. Med Hypotheses. Bisset L. Kraushaar B. Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. Alfredson H. Jonsson P. Knee Surg Sports Traumatol Arthrosc. Purdam C. Stanish W. Rubinovich R. Curwin S. Clin Orthop Relat Res. Pensini M. Martin A. Maffiuletti N. Int J Sports Med. Fernandez-Carnero J. Clin J Pain. Woodley B. Newsham-West R. Baxter G. Support Center Support Center.
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