I had a nasty case of lateral epicondylitis (tennis elbow) for years. I tried stretching exercises, physiotherapy, massage, etc. It got so bad, I could barely hold a cup of coffee without dropping it and I was seriously considering surgery.
I decided to give exercises one more shot but rather than use the exercises from the physiotherapist, I used exercises that caused the most pain - reverse wrist curls and another exercise holding (pronated) the end of a dumbbell with a plate on one side and lifting to 90 degrees. I did 3 sets of each exercise eod starting with a light weight and increasing over time as strength increased. Sets were done for the maximum "burn" possible - usually 30 - 50 reps and the I concentrated on slow eccentrics (30 seconds) - anything to make it harder and increase the burn. I used NO stretching, ice or massage.
What I first noticed with this protocol was greatly reduced pain the following day which would slowly return until the next exercise day. After about 2 months, the improvement was quite significant and by 6 months it was probably 95% improved. I saw no further improvement beyond the 95% so I stopped the exercises.
The improvement has remained to this day although last winter, I got tendonitis in the other elbow. Maybe it just moved.
I'm not suggesting my experience is the answer but there is evidence eccentric loading is beneficial for tendonitis.
This interesting study came out in 2010. They used eccentric wrist extensor exercises combined with standard therapy and a control group doing only standard physical therapy. They stopped the trial at 2 months because they felt the results were too unfair. The control group had showed little or no improvement. But the treatment group effectively had been cured. (Dr Jim, if you have any comments on this study, I'm interested in hearing them.)
J Shoulder Elbow Surg. 2010 Sep;19(6):917-22.
Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. Addition of isolated wrist extensor ec... [J Shoulder Elbow Surg. 2010] - PubMed - NCBI
Tyler TF, Thomas GC, Nicholas SJ, McHugh MP.
[Link to full article:
http://www.thera-bandacademy.com/elements/clients/docs/Tyler%20et%20al%20JSES%202010__201009DD_123442.pdf]
Abstract
BACKGROUND: Isokinetic eccentric training of the wrist extensors has recently been shown to be effective in treating chronic lateral epicondylosis. However, isokinetic dynamometry is not widely available or practical for daily exercise prescription. Therefore, the objective of this study was to assess the efficacy of a novel eccentric wrist extensor exercise added to standard treatment for chronic lateral epicondylosis.
MATERIALS AND METHODS: Twenty-one patients with chronic unilateral lateral epicondylosis were randomized into an eccentric training group (n = 11, 6 men, 5 women; age 47 +/- 2 yr) and a Standard Treatment Group (n = 10, 4 men, 6 women; age 51 +/- 4 yr). DASH questionnaire, VAS, tenderness measurement, and wrist and middle finger extension were recorded at baseline and after the treatment period.
RESULTS: Groups did not differ in terms of duration of symptoms (Eccentric 6 +/- 2 mo vs Standard 8 +/- 3 mos., P = .7), number of physical therapy visits (9 +/- 2 vs 10 +/- 2, P = .81) or duration of treatment (7.2 +/- 0.8 wk vs 7.0 +/- 0.6 wk, P = .69).
Improvements in all dependent variables were greater for the Eccentric Group versus the Standard Treatment Group (percent improvement reported): DASH 76% vs 13%, P = .01; VAS 81% vs 22%, P = .002, tenderness 71% vs 5%, P = .003; strength (wrist and middle finger extension combined) 79% vs 15%, P = .011.
DISCUSSION:
All outcome measures for chronic lateral epicondylosis were markedly improved with the addition of an eccentric wrist extensor exercise to standard physical therapy. This novel exercise, using an inexpensive rubber bar, provides a practical means of adding isolated eccentric training to the treatment of chronic lateral epicondylosis.
CBS