In this post, I take a look at an article in Medical Xpress, which makes the statement that “Exercise Is The Best Tennis Elbow Treatment” — Is this unequivocally true or does it depend on how and when that exercise is done?
Why Exercise Is The Best Tennis Elbow Treatment — And How To Do It Right — In this article by Michael Brown, of the University of Alberta, Physical Therapy Professor Chris Zarski discusses exercise and the treatment of Tennis and Golfer’s Elbow: Link to full article: “Why Exercise Is The Best Tennis Elbow Treatment”
The article begins with a quote from Chris Zarski, clinical assistant professor of Rehabilitation Medicine at the University of Alberta:
“With tennis or golfer’s elbow, you need to settle it down and rest it but after that, the best research and evidence points to exercise as the most effective treatment for healing,”
This sounds perfectly reasonable, as first glance — except to someone who is already caught in the vicious cycle of Golfer’s or Tennis Elbow!…
Because they already know the trouble with “settling it down and resting,” is that it’s often nearly impossible to rest it — and it’s absolutely notorious for NOT settling down…
Even after weeks or months of “Total Rest” (Or what I like to call “Resting, Hoping And Waiting!”)
Settling it down all-too-often seems to mean “symptom suppression” utilizing all the standard treatments most sufferers stumble through:
- Icing several times a day, being the most common (bad idea)
- Slathering lotions and creams on oneself (not a harmful or useful tactic)
- Gobbling anti-inflammatory pills, being another (worse idea)
- Wearing a brace day and night (not a good idea either)
- And even getting Cortisone Shots (the worst idea of all)
A lot of the efforts of Doctors and other practitioners, including Physical Therapists, still revolve around this symptom-chasing approach (because that’s how Allopathic Medicine operates) with the emphasis on inflammation.
I was encouraged to see recognition by the author that most of these tendon disorders, like Tennis Elbow and Golfer’s Elbow are now recognized NOT to be a form of Tendonitis but, rather, a degenerative type of Tendinopathy…
Degeneration being the key aspect of the injury — The essence of the damage (Read more about what’s called Tendinosis here)
And inflammation (if it’s even present, which is questionable) being a secondary factor (I would classify it as a “Non-factor”)
But it seems the author is still hedging his bets by referencing inflammation as if it were a problem that needs to be addressed and treated.
“once the damage is done and especially if there is acute pain, he said the best thing to do is follow the PRICE protocol—protection, rest, ice, compression and elevation—and maybe take some sort of anti-inflammatory medication or over-the-counter cream.”
Unfortunately, the RICE (or the “PRICE”) Protocol is completely outdated (or never applied in the first place) when it comes to the treatment of chronic tendon disorders, like Tennis and Golfer’s Elbow.
(Except for the protection aspect, in the form of avoiding excessive stress on the area, if possible, and perhaps wearing a brace when one has to perform a strenuous, physical activity.)
The damage, “once the damage is done” is in all likelihood going to be degeneration / Tendinosis…
Which means the rest of that protocol — especially the ice, compression and elevation — is of no use whatsoever in treating that degeneration.
It makes no sense, unless one is suffering from an acute, traumatic injury, which Tennis Elbow is not.
Which brings us back to the key question:
Is rehab exercise the critical factor in treating these Tendinopathies?
Yes and no… From my perspective exercise is without a doubt ‘A’ key factor — But not ‘THE’ key factor — At least not initially.
I would never downplay the importance of rehab exercise when it comes to the treatment of these degenerative Tendinopathies.
It is a critical aspect of the treatment and rehabilitation of all kinds of muscle and tendon injury, including Tennis Elbow and Golfer’s Elbow.
However, I still believe the best approach to these tendon disorders is to defer exercise until one has made significant progress with manual therapy.
…With the goal of releasing ahesions in the muscles involved in the injury, directly stimulating the affected tendon(s) and overall increasing circulation…
BEFORE engaging in significant rehab exercise.
And I was delighted to see this given some emphasis in the Medical Xpress article:
“There would also be some sort of manual or hands-on intervention, such as massage…”
(Even though it was the last line of the article and not given a high priority.)
In my experience, exercise goes so much easier, with less risk of flare ups and setbacks, if one waits until there has been some healing progress.
(My rule of thumb is to wait until the pain is decreased by 75-90% before starting rehab exercises — And NOT down by 75-90% by way of symptom suppression — Rather by way of healing!)
What About The Different Types Of Exercise?
There is evidence that ‘Eccentric Exercise’ or Eccentric-ONLY Exercise is particularly beneficial in the rehab of certain tendon disorders / Tendinopathies.
A fair amount of research has been done around this concept…
However, I don’t really believe it matters as much whether one uses Concentric, Isometric or Eccentric Exercise in the rehab exercise “phase” of healing IF the priority is first placed on achieving some healing with Manual Therapy.
I believe muscles and tendons that have been healing and are less symptomatic are much more responsive and “content” to handle both Concentric and Eccentric contractions.
(Honestly, though, I don’t see the point of doing Isometric-Only Exercise — Or even including any Isometric Exercise in a tendon rehab program, except possibly in the most sensitive, and reactive cases, where little progress is being made otherwise.)
Again, in conclusion, exercise IS essential to achieving full tendon recovery, strength and function — but may be a lot easier and less of a struggle for most sufferers IF it’s begun in the later stages of the healing and rehab process!
(By the way, if you lift weights, here are some exercises you may want to avoid while you’re recovering from your Tennis Elbow.)
Be sure to explore all the other free Tennis and Golfer’s Elbow-related articles I have here for you…
As well as my free video course: Tennis Elbow 101
Learn To Treat And Heal Your Own Tennis Elbow Or Golfer’s Elbow At Home With This Video Program
I’ll be your personal tutor guiding you through step-by-step video lessons, where you’ll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home. (Without any special equipment.)
Tennis Elbow sufferers: Learn more about the program here
Golfer’s Elbow sufferers: Learn more about the program here