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Strengthening of supinator in Lateral Elbow Tendinopathy management
... 17 The exercise program in LET should include exercises not only for extensor carpi radialis brevis (ECRB) strengthening, the most commonly affected structure, but also for supinator, rotator cuff, and scapular muscle strengthening. 18,19 Moreover, patients with LET have also reduced proprioception. 20 Techniques to improve reduced proprioception are also recommended. ...
... In LET not only the ECRB (injured tendon) but also the supinator may be involved 1 . The exercise program should include exercises not only for ECRB strengthening but also for supinator strengthening 18 . In addition, rotator cuff and scapular muscles strengthening is also needed 19 . ...
... Functional impingement of the supinator, rotator cuff and scapular muscles due to altered joint mechanism and muscle imbalance can impair the stabilization of the elbow resulting in overcompensation of the ECRB. This may lead to micro trauma of the soft tissue structures present at the lateral epicondyle thus causing symptoms of LET 18,19 . It is reasonable that enhancements with gripping might have happened from a blend of enhanced motor control and upgraded muscular power of the supinator, rotator cuff and scapular muscles. ...
... 1 Το πρόγραμμα άσκησης θα πρέπει να περιλαμβάνει ασκήσεις όχι μόνο για την ενίσχυση του βΚΕΚ, αλλά και για την ενίσχυση του υπτιαστή. 21 Επί πλέον, απαιτείται η ενδυνάμωση του πετάλου των στροφέων και των μυών της ωμοπλάτης. 22 βασισμένο κυρίως στην κλινική εμπειρία, η αδυναμία του υπτιαστή, των μυών του πετάλου των στροφέων και των μυών της ωμοπλάτης στους ασθενείς με LET εμφανίζεται συνήθως ως αυξανόμενος πόνος με μειωμένη λειτουργική ικανότητα και ικανότητα σύλληψης στο χέρι. ...
... άυτό μπορεί να οδηγήσει σε μικροτραυματισμό των μαλακών μορίων που υπάρχουν στην περιοχή του έξω επικονδύλου, προκαλώντας έτσι τα συμπτώματα της LET. 21,22 Είναι λογικό ότι οι βελτιώσεις με τη σύλληψη θα μπορούσαν να συμβούν με ένα μείγμα βελτιωμένου κινητικού ελέγχου και αναβαθμισμένης μυϊκής δύναμης του υπτιαστή, των μυών του πετάλου των στροφέων και των μυών της ωμοπλάτης. Οι αλλαγές στον υπτιαστή, στους μυς του πετάλου των στροφέων και στους μυς της ωμοπλάτης μπορεί να οδηγήσουν σε τροποποιημένες και αντισταθμιστικές αλλαγές στον βΚΕΚ που ενδέχεται να τον επιβαρύνουν κατά τη διάρκεια επαναλαμβανόμενων κινήσεων, προκαλώντας έτσι τα συμπτώματα της LET. ...
... Οι αλλαγές στον υπτιαστή, στους μυς του πετάλου των στροφέων και στους μυς της ωμοπλάτης μπορεί να οδηγήσουν σε τροποποιημένες και αντισταθμιστικές αλλαγές στον βΚΕΚ που ενδέχεται να τον επιβαρύνουν κατά τη διάρκεια επαναλαμβανόμενων κινήσεων, προκαλώντας έτσι τα συμπτώματα της LET. 21,22 Χρησιμοποιώντας ασκήσεις ενδυνάμωσης του υπτιαστή, του πετάλου των στροφέων και των μυών της ωμοπλάτης σε ασθενείς με LET ο πόνος μειώνεται, ενώ η λειτουργικότητα και η δύναμη σύλληψης επιστρέφουν στα επίπεδα που υπήρχαν πριν από τον τραυματισμό. ...
Eccentric training is the most common therapeutic approach for the management of lateral elbow tendinopathy, but it is not the only exercise option. Isometric, concentric-eccentric, stretching-eccentric and isolated eccentric loading may be indicated, and the management of lateral elbow tendinopathy should be based on progressive loading of the distal extremity (kinetic chain), the muscle-tendon unit, and the tendon itself.
... Functional impingement of the supinator due to altered joint mechanism and muscle imbalance can impair the stabilization of the elbow resulting in overcompensation of the ECRB. 52 this may lead to micro trauma of the soft tissue structures present at the lateral epicondyle thus causing symptoms of LET. It is reasonable that enhancements with gripping might have happened from a blend of enhanced motor control and upgraded muscular power of the supinator. ...
... It is reasonable that enhancements with gripping might have happened from a blend of enhanced motor control and upgraded muscular power of the supinator. 52 Changes in the supinator may lead to altered and compensatory changes in the ECRB that may overload the ECRB during repetitive movements, thus causing symptoms of LET. Using supinator strengthening loading, usual motion might have been returned, resulting in resolution of pain with actions and a return to painless gripping for the patient. ...
... Using supinator strengthening loading, usual motion might have been returned, resulting in resolution of pain with actions and a return to painless gripping for the patient. 52 Static stretching is defined as passively stretching a given muscle-tendon unit by slowly placing it in a maximal position of stretch and sustaining it there for an extended Period of time. 53,54 this maximal stretching position is determined by the moderate discomfort or pain that the patient experiences. ...
Introduction. Lateral epicondylitis or tennis elbow is a disease of common extensor muscles origin of elbow presenting with pain over the lateral epicondyle or pain of wrist extensor muscles. Tennis elbow is a very common overuse injury. It may be seen in sports population and also in normal individuals. Occurs commonly between the age group of 35-55years. Objectives. This study is intended to find and compare the effectiveness of eccentric-concentric training of wrist extensors with static stretching and an eccentric-concentric training combined with supinator strengthening in the lateral epicondylitis in reducing pain and increasing grip strength in lateral epicondylitis. Design. A randomized control study. Materials and Methods. 68 subjects both male and females with lateral epicondylitis belonging to Age group ranging from 35 to 55years who fulfilled the inclusion and exclusion criteria were selected for the study and were randomly assigned into the two groups i.e. group A and B. Group A was treated with eccentric-concentric training of wrist extensors with static stretching and Group B was treated with eccentric-concentric training combined with supinator strengthening. Outcome was measured in terms of VAS scale for pain, Hand Held Dynamometer for grip strength evaluation and Patient-Rated Tennis Elbow Evaluation Questionnaire (PRTEE) scale for functional disability on baseline, 1st month, 2nd month, 3rd month and 6th month. Results. In the present study intra group comparison result showed that pain relief, improved grip strength, and reduced functional disability was statistically significant in both the group. Whereas inter group comparison results revealed that group B eccentric-concentric training combined with supinator strengthening showed highly significant difference (P<0.0001) as compared to group A eccentric-concentric training of wrist extensors with static stretching. Conclusion. Study findings concluded that group B eccentric-concentric training combined with supinator strengthening gave better response and is more effective than eccentric-concentric training of wrist extensors with static stretching in reducing pain and increasing grip strength in lateral epicondylitis. Authorship Credit.
... This means that the causes of LET may not be limited to the ECRB. Functional impingement of the supinator due to altered joint mechanism and muscle imbalance can impair the stabilization of the elbow resulting in overcompensation of the ECRB [23]. This may lead to micro trauma of the soft tissue structures present at the lateral epicondyle thus causing symptoms of LET. ...
... This may lead to micro trauma of the soft tissue structures present at the lateral epicondyle thus causing symptoms of LET. It is reasonable that enhancements with gripping might have happened from a blend of enhanced motor control and upgraded muscular power of the supinator [23]. Changes in the supinator may lead to altered and compensatory changes in the ECRB that may overload the ECRB during repetitive movements, thus causing symptoms of LET. ...
... Changes in the supinator may lead to altered and compensatory changes in the ECRB that may overload the ECRB during repetitive movements, thus causing symptoms of LET. Using supinator strengthening loading, usual motion might have been returned, resulting in resolution of pain with actions and a return to painless gripping for the patient [23]. ...
... In LET not only the ECRB but also the supinator may be involved [1]. The exercise program should include exercises not only for ECRB strengthening but also for supinator strengthening [5]. In addition, rotator cuff and scapular muscle strengthening is also needed [6]. ...
... Functional impingement of the supinator, rotator cuff and scapular muscles due to altered joint mechanism and muscle imbalance can impair the stabilization of the elbow resulting in overcompensation of the ECRB. This may lead to micro trauma of the soft tissue structures present at the lateral epicondyle thus causing symptoms of LET [5,6]. It is reasonable that enhancements with gripping might have happened from a blend of enhanced motor control and upgraded muscular power of the supinator, rotator cuff and scapular muscles. ...
... It is reasonable that enhancements with gripping might have happened from a blend of enhanced motor control and upgraded muscular power of the supinator, rotator cuff and scapular muscles. Changes in the supinator, rotator cuff and scapular muscles may lead to altered and compensatory changes in the ECRB that may overload the ECRB during repetitive movements, thus causing symptoms of LET [5,6]. Using supinator, rotator cuff and scapular muscles strengthening loading, usual motion might have been returned, resulting in resolution of pain with actions and a return to painless gripping for the patient. ...
... The results obtained from a randomized clinical trial showed that the eccentric -concentric training combined with isometric contraction produced the largest effect at the end of treatment and at the follow up [14]. The exercise program in LET should include exercises not only for ECRB strengthening but also for rotator cuff, scapular and supinator muscle strengthening [17,30]. Using rotator cuff, scapular and supinator muscles strengthening loading, simple motion might have been restored, resulting in resolution of pain with actions and a return to painless gripping for the patient. ...
The purpose of the case study was to find out the effect of a supervised exercise program combined with Transverse Friction (TF) and Mulligan Mobilization With Movement (MMWM) on disability and pain in a patient experiencing chronic Lateral Elbow tendinopathy (LET). A patient with unilateral LET for 6 months was included in the present study. The patient followed the exercise program five times per week for 4 weeks. The programme was individualized on the basis of the patient’s description of pain experienced during the procedure. TF and MMWM were applied 3 times per weeks for 4 weeks, 12 sessions totally. Outcome measures were function using the Patient-Rated Tennis Elbow Evaluation, a visual analogue scale and the pain-free grip strength and pain using a visual analogue scale. The patient was evaluated at baseline (week 0), at week 4 (end of treatment), at week 8 (1 month after the end of the treatment) and at week 32 (six months after the end of treatment). At the end of the treatment and at the follow – up there was a rise in function and a decline in pain. The findings of the case report suggest that a physiotherapy approach as described in the present case report can produce significant improvements in terms of disability and pain in a patient with chronic LET
... The exercise training in LET should include progressive strengthening exercises not only for ECRB but also for supinator, rotator cuff and scapular muscles [21,22] Using supinator, rotator cuff and scapular muscles progressive strengthening loading, LET patients will carry out painless activities such as gripping, increasing the function of the arm. ...
The most common tendinopathy in the elbow area is the Lateral elbow tendinopathy (LET) [...]
... Recently, isometric exercises have been recommended to manage and reduce tendon pain improving the strength at the angle of contraction without producing inflammatory signs [37]. The exercise program in LET should include strengthening exercises for supinator, rotator cuff and scapular muscles [38,39]. Moreover, proprioception is also reduced in LET patients [40]. ...
Background: One of the two most common tendinopathies of the upper limb is
Lateral elbow Tendinopathy (LET). An exercise programme consisting of static stretching
exercises of wrist extensors, isometric of wrist extensors, concentric – eccentric
training of wrist extensors, Tendon Neuroplastic Training (TNT) of wrist extensors,
and strengthening of rotator cuff, scapula muscles exercises and supinator has been
recommended for the management of LET. Radial Extracorporeal shockwave therapy
(RESWT) is usually used as a supplement to exercise programme. The purpose of the
present article will be to make a comparison of the effects of an exercise programme
consisting of TNT of wrist extensors, static stretching exercises of wrist extensors,
isometric of wrist extensors, concentric – eccentric training of wrist extensors and
strengthening of supinator, rotator cuff and scapula muscles exercises and RESWT
in the painful point and an exercise programme consisting of TNT of wrist extensors,
static stretching exercises of wrist extensors, isometric of wrist extensors, concentric
– eccentric training of wrist extensors and strengthening of supinator, rotator cuff and
scapula muscles exercises and RESWT, scanning and painful (sensitive) point for the
treatment of LET.
Methods/Design: LET patients will participate in this randomized clinical trial
(RCT). Patients will be allocated to two groups randomly. Group A will be treated with
TNT of wrist extensors, static stretching exercises of wrist extensors, isometric of
wrist extensors, concentric – eccentric training of wrist extensors and strengthening of
supinator, rotator cuff and scapula muscles exercises and RESWT in the painful point
and group B will be treated with TNT of wrist extensors, static stretching exercises of
wrist extensors, isometric of wrist extensors, concentric – eccentric training of wrist
extensors and strengthening of supinator, rotator cuff and scapula muscles exercises
and RESWT, scanning the relative area and painful (sensitive) point. All patients will
receive 20 treatments totally of exercise programme (5 treatments / week for 4 weeks).
RESWT will be administered without anaesthesia in 3 treatment sessions held at weekly
intervals (2000 shocks for painful site and 4000 shocks for scanning the relative area
and painful (sensitive) point; 8 Hz; 2,5 bars). Pain (visual analogue scale; Patient-Rated
Tennis Elbow Evaluation), function (visual analogue scale; Patient-Rated Tennis ElbowEvaluation) and pain-free grip strength will be evaluated at the end of treatment, at 3
months follow-up and at 6 months follow up. The independent t test will be used to
determine the differences between groups. A paired t test will be used to determine
the difference within groups. The level for statistical significance will be 5% level of
probability. SPSS 21.00 will be used for the statistical analysis.
Discussion: The present RCT will be evaluate the effectiveness of two different
applications of RESWT as a supplement to exercise programme in patients with LET.
Trial Registration: The Ethics Committee of the University of West Attica will
approve the study.
... Recently, isometric exercises have been recommended to reduce and manage tendon pain increasing the strength at the angle of contraction without producing inflammatory signs [9]. The exercise program in LET should include exercises not only for ECRB strengthening but also for supinator, rotator cuff and scapular muscles strengthening [10,11]. Moreover, LET patients have also reduced proprioception [12]. ...
... Recently, isometric exercises have been recommended to reduce and manage tendon pain, increasing the strength at the angle of contraction without producing inflammatory signs [5]. The exercise program in LET should include exercises not only for extensor carpi radialis brevis (ECRB) strengthening, the most commonly affected structure, but also for supinator, rotator cuff, and scapular muscle strengthening [6,7]. Moreover, patients with LET have also reduced proprioception [8]. ...
... Recently, isometric exercises have been recommended to manage and reduce tendon pain improving the strength at the angle of contraction without producing inflammatory signs [32]. The exercise program in LET should include strengthening exercises for supinator, rotator cuff and scapular muscles [33,34]. ...
... 32 The addition of supinator strengthening was proposed. 33 Sterigioulas et al. suggested that a combination of PBMT and plyometric exercises was more effective than placebo PBMT. 1 We included strength training in both our study groups, because LE affects not only handgrip strength but also wrist, elbow, and shoulder muscle strengths. Similarly, it has been reported in a recent study that rotator cuff and scapular muscles strengthening is also needed. ...
Objective: To compare the effects of photobiomodulation therapy (PBMT) and extracorporeal shock wave therapy (ESWT) on lateral epicondylitis (LE). Background: Although several authors have investigated the effects of PBMT and ESWT on LE, only one study to date has compared ESWT with PBMT. Ours is also the first study assessing patient satisfaction levels and quality of life in addition to comparing the two methods. Methods: Forty-three patients were randomly divided into two groups: 23 (mean age: 48.2 ± 9.4; 17 female, 6 male) were included in the PBMT group and 20 (mean age: 48.0 ± 9.9; 15 female, 5 male) in the ESWT group. PBMT was applied three times a week for 4 weeks, and ESWT once a week for 4 weeks. Stretching and eccentric strengthening exercises were also given to both groups as a home program. The Mayo Elbow Performance Score and disabilities of the arm, shoulder, and hand (DASH) were used for evaluating upper extremity functions. Pain intensity was evaluated using a visual analog scale (VAS), and muscle strengths were also assessed using a hand-held dynamometer. The 12-Item Short Form (SF-12) Survey Physical and Mental Component Scales were used to evaluate quality of life, and the global rating of change scale to evaluate patient satisfaction. Patients were assessed before treatment and at 12-week follow-up. Results: Improvements for elbow extension and shoulder flexion strength and for VAS movement were observed only in the PBMT group, whereas improvement of handgrip strength was present in both groups (p < 0.05). However, handgrip strength was superior in the PBMT group than in the ESWT group (p = 0.02). Conclusions: Both PBMT and ESWT are useful and can be used in the treatment of LE.
... One program consisted of isometric Exercises Of Extensor Carpi Radial's Brevis (ECRB), the most common site injury of LET, as well as isotonic (concentric and eccentric mainly ) and static stretching exercises of ECRB is usually recommended [1]. The exercise program should include exercises not only for ECRB strengthening but also for supinator strengthening [2]. In addition, rotator cuff and scapular muscles strengthening is also needed [3]. ...
... One program consisted of isometric exercises of extensor carpi radialis brevis (ECRB), the most common site injury of LET, as well as isotonic (concentric and ecc entric mainly) and static stretching exercises of ECRB is usually recommended [1] . The exercise program should include exercises not only for ECRB strengthening but also for supinator strengthening [2] . In addition, rotator cuff and scapular muscles strengthening is also needed [3] . ...
Synopsis
Clear guidelines for the clinical management of individuals with lateral elbow tendinopathy (LET) are hampered by many proposed interventions and the condition's prognosis, ranging from immediate resolution of symptoms following simple advice in some patients to long-lasting problems, regardless of treatment, in others. This is compounded by our lack of understanding of the complexity of the underlying pathophysiology of LET. In this article, we collate evidence and expert opinion on the pathophysiology, clinical presentation, and differential diagnosis of LET. Factors that might provide prognostic value or direction for physical rehabilitation, such as the presence of neck pain, tendon tears, or central sensitization, are canvassed. Clinical recommendations for physical rehabilitation are provided, including the prescription of exercise and adjunctive physical therapy and pharmacotherapy. A preliminary algorithm, including targeted interventions, for the management of subgroups of patients with LET based on identified prognostic factors is proposed. Further research is needed to evaluate whether such an approach may lead to improved outcomes and more efficient resource allocation. J Orthop Sports Phys Ther 2015;45(11):938–949. Epub 17 Sep 2015. doi:10.2519/jospt.2015.5841
[Bisset LM, Vicenzino B (2015) Physiotherapy management of lateral epicondylalgia.Journal of PhysiotherapyXX: XX-XX].
A plethora of terms that have been used to describe lateral epicondylitis including tennis elbow (TE), epicondylalgia, tendonitis, tendinosis and tendinopathy. These terms usually have the prefix extensor or lateral elbow. Lateral elbow tendinopathy seems to be the most appropriate term to use in clinical practice because other terms make reference to inappropriate aetiological, anatomical and pathophysiological terms. The correct diagnostic term is important for the right treatment. (c) 2006 Elsevier Ltd. All rights reserved.