lateral epicondylitis (Full Version)

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lorirpt -> lateral epicondylitis (August 31, 2007 6:51:03 AM)

Help! I am sufferring from a chronic, 6 month case of lateral epicondylitis. I was injected after about a month with no relief. I have work a wrist imobilizer at night for several months, and did wear it during the day for a while. It is extremely difficult to perform my job wearing the splint. I have used ultrasound, massage, stretching, ice, heat. Writing is the worst offender and in home health, there is plenty of that! Does anyone have advice?



MS_PT -> RE: lateral epicondylitis (August 31, 2007 8:01:41 AM)

Could be a more central problem, ie, cervical spine, may need radial head manip, could be a tendinosis problem and not inflammatory. Elbow may be victim and not culprit in that there may be muscle imbalance issue in shoulder etc.



dscouras -> RE: lateral epicondylitis (September 25, 2007 1:17:22 AM)

I accidently manip'd a radial head joint with great results.
Client resolved much of his lat. epic. pain and lack of supination...
My concern/question is - what is the proper direction, hand hold etc for a radial head manip
Thanks D



MPT -> RE: lateral epicondylitis (September 25, 2007 8:13:51 AM)

Check out autologous blood injections and eccentric wrist extension exercises.



bonez -> RE: lateral epicondylitis (September 25, 2007 2:26:54 PM)

a lot depends on what you are trying to accomplish with the treatment, scar tissue disruption, loss of joint play and which direction is lost.



spaniard -> RE: lateral epicondylitis (September 27, 2007 1:05:50 PM)

The manual therapy community is talking more about epicondylalgia and epicondylosis; epicondylitis is becoming a very uncertain and updated term because it does not describe accurately the histological changes ocurring in the cECRL and ECRB.  My best results come from manipulation/mobilization of C5-6, radial glides as described by Butler, radial head mobilization and/or manipulation, MWMS and A/P wrist mobilization. If treating distal does not offer relief then go proximal. There is evidence to supports this: check out the article on the Journal of Manual and Manipulative Therapy by Vicenzino et al (JMMT Vol 15, No1, 2007).  Despite all this some cases go south and there is no other solution than and injection. Best of lucks!!



steve -> RE: lateral epicondylitis (September 27, 2007 2:17:55 PM)

Its interesting how many different treatments there are for this condition and how variable the success rate is with treatment; these people frequently become over medicalized. I think the best thing I have added to my treatment toolbox for this condition is to educate the patient on the fact it is a self limiting condition and no harm will come from using the arm.

Steve



clydesdale6 -> RE: lateral epicondylitis (October 26, 2007 8:39:30 AM)

If it is epicondylitis then I have found that eccentric strengthening throughout the day helped tremendously.  I had this condition myself 2 years ago.  I have a certification in Mckenzie, had a clear mechanism of injury, and was very confident that it was not my neck.  I was still bombarded with people who thought it was a neck problem and wanted me to mobilize my spine.  [8|]  Keep it simple at first.  If you are confident in what it is and it is chronic, go for the eccentrics.  It worked fantastically and I have had great results with it.  I learned it on this forum.  If it is chronic lat epi., this stuff works.  Good luck.



VagusX -> RE: lateral epicondylitis (October 26, 2007 8:51:40 AM)

Clydesdale6

Care to share your eccentric training program in more detail?  



clydesdale6 -> RE: lateral epicondylitis (October 26, 2007 9:22:08 AM)

No problem, but I can't take credit for it.  I learned it here, and the damn thing flat out works.  I work with 9 therapists who most now use it, and our results have improved remarkably.  But it looks like it works with chronic cases, which most are by the time they get to us.

warm up-  dumbell wrist extension, focusing on the eccentric, in 90 flexion, 45 and then full ext.  I do one set of 10 in each.  I then do 3 more sets at full ext only.  I then give them a weighted softball sized theraball and have them repeat the full ext 3 sets.  This will bring finger ext into it and increase the intesity.  I then will often give them a simple grip exercise.  I take a dynomometer reading before and after and often they are stronger right after.  I believe that is because it decreases their pain, they certainly didn't get stronger in 20 minutes.  For HEP, I have them do 1 set of 10 at full ext every other hour. 

I did this myself and was absolutely blown away how well it worked.  I had already tried regular strengthening and modalities.  The above is what helped.  It works wonders on chronic problems.  I believe in simple treatments and concepts.  This works.



VagusX -> RE: lateral epicondylitis (October 26, 2007 11:32:55 AM)

When you say "focus on eccentrics," do you mean that you are doing a superslow 4 -10 second decent?  Are you assisting the wrist concentrically into extension then letting it go?  What is the usual start point to weight on the dumbell?  And what is your opinion on pain with the activity?

Thanks

Dan



clydesdale6 -> RE: lateral epicondylitis (October 26, 2007 4:56:26 PM)

No, problem all good questions.  Yep, slow on the way down, about 4-6 seconds and then 2 seconds on the way up.  Pain will be there.  Normally, in the past, I would have used 2-4lb dumbells.  Now we are talking about 4-8lb or higher.  There will be some pain.  Apparently, there has to be inorder to remodel the tissue and sort of micro tear it again and reintroduce blood flow and healing.  Excuse me for not being able to more elloquently describe the physiology.  But this absolutely works.  Don't forget to get before and after dynomometer readings.  Nothing motivates them more than to actually see that they are getting stronger.



bonez -> RE: lateral epicondylitis (October 26, 2007 11:47:09 PM)

Clydesdale have you found any change when the eccentric exercise is not performed daily. The physiology is correct I believe wrt. remodeling. When we look at eccentric exercise and it's role for the sport population the periodization people always seem to limit the frequency of eccentrics and plyos because of their claim that overload in this fashion can be inflammatory.
While likely outdated(1995) A text "Eccentric Muscle Training in Sports and Orthopedics" by Mark Albert  Churchill Livingstone 0-443-08987-6 covered much on this topic



clydesdale6 -> RE: lateral epicondylitis (October 29, 2007 3:53:53 PM)

It seems to work best when the exercises are performed daily and several times a day.  When I had it, I did one set every couple of hours or so.



smithcove -> RE: lateral epicondylitis (November 8, 2007 3:07:12 PM)

I DON'T GET IT, IF S&S ARE POINTING TO LAT EPI WHY MOB THE C5-C6?



smithcove -> RE: lateral epicondylitis (November 8, 2007 3:09:37 PM)

quote:

ORIGINAL: clydesdale6

No, problem all good questions.  Yep, slow on the way down, about 4-6 seconds and then 2 seconds on the way up.  Pain will be there.  Normally, in the past, I would have used 2-4lb dumbells.  Now we are talking about 4-8lb or higher.  There will be some pain.  Apparently, there has to be inorder to remodel the tissue and sort of micro tear it again and reintroduce blood flow and healing.  Excuse me for not being able to more elloquently describe the physiology.  But this absolutely works.  Don't forget to get before and after dynomometer readings.  Nothing motivates them more than to actually see that they are getting stronger.


I FEEL THIS WILL BE WONDERFUL POST A CORTISONE INJECTION, BUT IF SOMEONE IS ACUTE, YOU WON'T SEE THEM PAST THE SECOND VISIT.



buckeye -> RE: lateral epicondylitis (November 8, 2007 5:34:42 PM)

Great information in this thread. I think the mention of going proximal is important for all of the lateral epicondylitis patients. Treating for improved muscle performance at the shoulder girdle and trunk is important. Proximal stability should reduce distal muscle energy needs. Even though the shoulder girdle may not be technically part of the core, this would be sort of like core training for epicondylitis.

smithcove - If you read many threads in this forum, you will realize there are many therapists here who believe there can be a spinal component to distal symptoms. Also, even though the eccentric program can be painful, it is possible to talk to the patient about expected pain and perhaps still treat with passive modalities to control symptoms. There is an eccentric exercise program for Achilles tendonitis that is painful but usually gives great results.     -- And your posts will be much easier to read if you do not use all upper case letters.



jlharris -> RE: lateral epicondylitis (November 8, 2007 7:52:21 PM)

Eccentrics are not for acute tendinitis.  The research is on chronic tendinosis.  So, no worries about getting someone back for a second visit.



proud -> RE: lateral epicondylitis (November 8, 2007 8:03:10 PM)

quote:

ORIGINAL: smithcove

I DON'T GET IT, IF S&S ARE POINTING TO LAT EPI WHY MOB THE C5-C6?


Is this a serious post? If so...It helps explain the "massage" thread on the open forum.



buckeye -> RE: lateral epicondylitis (November 8, 2007 9:00:45 PM)

jlharris - I realize the eccentrics for the Achilles is for tendinosis - I apologize for the mistake and sincerely appreciate you pointing to it.
My point was more that the painful exercise should not discourage the patient from coming back if applied correctly, education for the patient (and referral source), etc. The thread started about a chronic condition - probably something that is not an '-itis.' So the use of eccentrics for the person who started the thread is likely OK.



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