Are there any specific weight training exercises that can be done to help reduce the strain on the forearm extensors of someone who has extensive tennis elbow syndrome? I have a couple of male clients who are middle age and looking for help in dealing with this problem. The tennis elbow is very advanced, with one client having undergone three cortisone shots in the past year. Thanks for any info you can supply.
From a personal training standpoint tennis elbow, or lateral epicondylitis, is a tough one because there are some ethical issues involved. Under no circumstances should a trainer “treat” tennis elbow (unless you are an injury rehab specialist and are insured as such). First and foremost refer!
If your client’s sports med professional agrees to confer, these are the suggestions I would make:
I am assuming that both of these cases of tennis elbow are the result of either repetitive stress, sustained contraction, or degenerative wear and tear due to aging. Regardless, the injury is not getting better because the tendon is never quite healing and the scar tissue isn’t developing completely (angiofibroblastic degeneration). A decreased blood flow to the injured tissues is also a contributing factor to the ongoing discomfort.
REFER to someone who can prescribe an anti-inflammatory so that some blood flow, and therefore repair, can resume. A tennis strap can be extremely helpful for taking pressure off of the tendon but again you will need to refer so that someone can make that recommendation. Medical referral is necessary for both of these treatments.
As a trainer, you can follow a 3-step approach to your client’s recovery:
1) Stretch the forearm extensors several times daily.
Have your client extend their arm straight down by their side with the palm facing up. The client uses their opposite hand to interlock their fingers and pull up. Have your client rotate medially at the shoulder. This will help to take tension off of the tendon by making the muscle more supple.
2) Isometrically contract the forearm extensors.
Have your client rest their hand, palm down, on a table. The opposite hand holds the fingers down. The client tries to “lift” the fingers that are being held down. Putting this small load on the muscle before going to full range will get the muscle and tendon functioning properly again.
3) Finally, forearm extension exercises with a dumbbell.
The client rests his forearm on his leg or on a table while holding a small dumbbell. The hand should be hanging over the edge of the table or the knee. They let the hand drop down to a relaxed position and then come into extension.
There are some new approaches out there but these remain the best exercises for the job. (Keep It Super Simple)
It generally takes a minimum of 3 months for lateral epicondylitis to repair enough to resume normal activity but will more likely take upwards of 6 months. Keep your client motivated during this time by focusing on other goals that they might have. In the interim have your client rest the injury and ice it as much as possible. During your client’s recovery period make sure you stay away from dumbbells (except for their forearm extension exercises). Generally this rule applies to medial epicondylitis but it works for lateral as well. Stick to barbells and machines and find creative ways for them to get in a good, hard, workout. Medicine ball workouts might just be the way to go for a while.
I hope that all of this has helped you!