Massage & Bodywork

SEPTEMBER | OCTOBER 2019

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TREATMENT There is no gold standard treatment for lateral epicondylitis. As noted earlier, the wide variability in treatment effectiveness may be more about the stage of tendon dysfunction than the actual success or failure of a particular treatment approach across the board. The most common traditional medical treatments for LE are various conservative treatment strategies. Symptoms generally resolve with these conservative treatments within a few months to around a year in some resistant cases. The most common strategies employed include physical therapy, nonsteroidal anti- inflammatory drugs (NSAID), shockwave therapy, kinesiology taping, biologics, or corticosteroid injections. Biologics is a general term used to refer to several new treatment techniques, such as autologous blood transfusion (the collection of blood from the patient and re-transfusion of that same blood back into the patient). Platelet-rich plasma (PRP) injection therapy is another approach in this category. PRP injections use a method where platelets, which play a major role in tissue repair, are extracted from the individual and reinjected to stimulate tissue repair processes. It is also surprising that corticosteroid injections are still used as a treatment strategy even though their potential danger and damage of tendon tissue has been well documented for decades. They aren't used anywhere near as often as they used to be, but they are still used in some cases. For determining the most effective treatments, the tendon dysfunction continuum model mentioned earlier is divided into two main categories. Reactive tendinopathy and early tendon disrepair is the first stage. The second stage is Because the wrist extensor muscles are involved, it seems likely that any motions of active wrist extension should reproduce the pain. However, simply moving the wrist in extension with no additional resistance often does not reproduce any pain. Just lifting the wrist is only minimal resistance, so very little load is on the tendon in active motion with no additional resistance. If, however, there is resistance throughout the range, reproduction of the client's pain is more likely. Pain at the lateral elbow region is also common with resisted wrist extension. The pain is likely to be even greater if the various extensor tendons are palpated just distal to their attachment site during the resisted wrist extension. Palpating the tendon during resisted wrist extension is called the tennis elbow test (Image 3). 96 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 9 with very little pain. In other cases, there is only a minor degree of damage and a great deal of pain. It is feasible that chronic overuse tendon pain may have more to do with certain biochemical processes in the tissue that irritate nociceptors than a measure of dysfunctional load on the tissues. ASSESSMENT Identifying lateral epicondylitis is usually pretty easy. The tissues are superficial, and the indicators that lead to this are often clearly identified within the client history. Initial intake usually reveals some history of repetitive motion or constant isometric load affecting the wrist extensor group. The client may also complain of grip strength loss. Their pain is usually around the lateral aspect of the elbow but may also extend down into the forearm. The pain is commonly described as a dull aching sensation. Palpating the involved tendons usually increases the pain significantly. The tennis elbow test. 3

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