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PTupdate.com -> Re: Tennis Elbow (well I guess) (March 31, 2007 2:54:00 PM)
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With the ECRB attaching to the deep fascia, perhaps the anconius or even triceps causes a pull, and thus pain. Plus, it also attaches to the radial collateral ligament, so the movement into extension, and thus the radius moving, may irritate it as well. With the other wrist extensors also attaching at the humerus, perhaps they are attempting to perform some elbow extension as well.
I noted that you are not doing any actual exercise to the tissue itself, nor any modalities. Also, neural mobilizations are not going to help those "traditional" tennis elbow persons, but rather those with issues that are acting like tennis elbow, or precipitating some extensor dysfunction that leads to the tennis elbow.
Considering the fact that you see temporary relief with the radial head mobilizatons, consider trying this muscle energy technique:
1. Apply posterior mobilizations to the radial head for a few minutes
2. Flex elbow to 90 degrees, and then block any more flexion as the person attempts a maximal biceps contraction. Odds are you will feel/hear a loud clunk or crunch like biting into celery
The theory behind this is radial head malposition, perhaps posterior, causes pressure under the extensor origin and the ECRB. This may also explain the lack of elbow extension often seen in this patient population. The repositioning usually really helps my patients, and also facilitates greater elbow extension as well. At that point, I barrage them with my shock-and-awe treatment, and its rare that we do not resolve anybody with this problem
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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