Tennis elbow, characterized by pain, weakness and inflammation or degeneration of the wrist-extensor tendon that connects to the elbow, is one of those intractable overuse injures that, until recently, yielded very reluctantly to treatment.
Tennis players are not the only people who might suffer from tennis elbow. Golfers, plumbers, and even people who lug around heavy briefcases can get it.
Treatments range from acupuncture to corticosteroids to surgery, usually with limited — if any — long-term success.
Muscles and ligaments work in two possible ways. Concentric contractions are when the fibers tighten and get shorter, like doing a bicep curl. Eccentric movements are in the other direction, when the muscle fibers are lengthening. A new technique was developed which focused on eccentric exercises.
“We couldn’t believe” how fast and well the therapy worked, says Timothy Tyler, PT, ATC, a clinical research associate at the Nicholas Institute and one of the authors of the study. “We were seeing improvements in five weeks, even three. It was crazy.”
Here’s the treatment exercise they developed:
He and his colleagues realized that a single, unhurried exercise using a tensile bar that looks like an oversized licorice stick could create an eccentric contraction all along the forearm. In the exercise, a person holds the bar upright at his or her side using the hand connected to the sore elbow, then grasps it near the top with the good hand. The top hand twists as the bar is brought around in front of the body and positioned perpendicular to the ground; the sore hand then takes over, slowly untwisting the bar by flexing the wrist. “Afterward, you should be sore,” Tyler says. “That’s how we know it’s effective.”
Dr. Tyler goes on to explain precisely why eccentric movements work better:
Eccentric contractions require the muscle to work against a force, in this case the coiled bar. “You can load a tendon so much more eccentrically” than with concentric exercises, Tyler says. “So we think the process may be remodeling the tendon.” Ultrasound studies by other researchers, including the group in Belgium, have shown that damaged tendons typically become less thick, indicating they are less damaged, after a course of strenuous eccentric exercise.
The rubber bar used by Dr. Tyler to treat tennis elbow, the Thera-Band Flexbar, is available for under $20. Yes, this is one of those unique cases where “cheap” and “effective” can be combined together in a legitimate way. Although it shouldn’t take too long to perform this exercise, its effectiveness depends on the commitment level of the patient.
“It’s not a difficult exercise but it is unique, so I would advise people to be taught by a physical therapist, if possible,” Tyler says. If not, proceed on your own — after, of course, an examination by a doctor; elbow pain can have many causes, not just tennis elbow. “In my opinion, you’re not going to hurt yourself,” Tyler continues, although you should be prepared for a commitment. His patients did three sets of fifteen repetitions every day. Beginners should start with three sets of five repetitions, adding more as the repetitions get easier, Tyler says.
Images demonstrating the technique are available at the source.