Rehabilitation in epicondylitis lateralis humeri

Etiology
This is an impairment of the beginning of the wrist extensors, mainly: m. extensor carpi radialis brevis, fingers and m. supinator on the radial condyle of the of the humerus. The clinical picture includes pain during exercise (lifting, carrying loads) and when pressing. In acute epicondylitis we find swelling, in chronic rather hypotrophy in the place where the muscles start. The wrist and finger extensors are mostly in hypertonia, we often find reflex changes in the muscle bellies. Resistance tests on m. extensor carpi radialis, finger extensors (mostly 2nd and 3rd finger) and m. supinator are positive, handshake is painful. Springing in the elbow joint is also often limited.

Forms of epicondylitis lateralis humeri

 * Acute form: In general, for the acute form, we focus on rest or short-term immobilization. From physical therapy, you can use cryotherapy or diadynamic currents. We can indicate a gentle massage on the area and support the drainage of swelling with lymphatic drainage. From pharmacology, you can use non-steroidal anti-inflammatory drugs, local anesthetics with corticosteroids.


 * Chronic form: In the chronic form, we also focus on problems caused by chronicity. We try to focus on the therapy of TrPs, hypertonia, restore and maintain joint mobility and improve coordination and muscle work while gradually engaging in muscle activity.


 * Here we use relaxation techniques, e.g. postisometric relaxation (PIR), compression therapy, reciprocal inhibition, soft techniques, and we also focus on maintaining joint mobility. We use mobilization and traction of the joint, it is also possible to use passive movements with a gradual change to active movement. Physiotherapy techniques such as proprioceptive neuromuscular facilitation (PNF), dynamic neuromuscular stabilization or sensorimotor exercises can be used to improve movement patterns.

Physiotherapy

 * Physical therapy: In physical therapy for the diagnosis of tennis elbow, there is a fairly large range of therapy options, which are also confirmed by the studies carried out. Most of them are focused on treatment using ultrasonotherapy, laser, electric current and lately widely used shock wave.


 * Taping: Nowadays, very popular kinesiotaping can be applied as a supportive therapy during treatment. The indication for taping is the prevention of disorders and overloading of the musculoskeletal system. It is also a therapeutic and rehabilitation indication – structural changes (acute conditions, insufficiency of the fibrous apparatus of various etiologies, functional disorders of the locomotor system and disorders of the lymphatic circulation and peripheral blood circulation) (Vrbová, 2009). So it is a possible indication for tennis elbow. It is possible to use two types of taping – elastic, which often refers to the already mentioned kinesiotaping, or so-called fixation, which is made of inelastic material and limits the movement of the given segment.
 * One of the many questions that accompany kinesio tape therapy is whether it has an inhibitory or facilitatory effect on a given muscle. According to several studies, it has been proven that it depends on the application process and its intensity. An inhibitory variant is possible for epicondylitis, where it replaces a possible epicondylar tape with a similar result.


 * Epicondylar tape: Epicondylar tape is a prosthetic device and is part of rehabilitation treatment. Prosthetic equipment improves the biomechanical conditions of the segment, relieves the affected attachment of the relevant muscle or ensures the centered position of the joints. There are many studies that have tried to reveal the principle on which the tape works. Unfortunately, a generally accepted explanation is still lacking; some authors assume that the effect consists in changing the direction of the muscle pulls acting on the radial epicondyle, another theory claims that the tape (or orthosis) creates a counterforce preventing the muscles from fully stretching, thus reducing the strength in the own attachments of these muscles.