HANDI
Making non-drug
interventions easier
to find and use
Physiotherapy: lateral epicondylitis
Intervention A physiotherapy program that includes exercise, elbow manipulation (manual therapy)
and self-manipulation.
Progressive exercise of the wrist extensor muscles may also be used alone, without
elbow manipulation.
Indication Lateral epicondylitis (LE), commonly known as ‘tennis elbow’, where pain persists for 6
weeks or more; however, earlier institution of exercise might also confer benefit.
Tennis elbow affects 1–3%
of the population; risk factors
include smoking, obesity, being LE is a chronic degenerative process stemming from microtrauma (rather than an acute
aged 45–54 and two or more inflammatory process). Hence, the term lateral epicondylalgia is also used.
hours of repetitive movement
per day.
In most cases, symptoms of LE are self-limiting and usually resolve within 12 months.
However, physiotherapy may reduce the time taken to improve pain (i.e. provide
short-term benefit) and reduce the recurrence and delayed recovery associated with
alternative interventions such as corticosteroid injection (i.e. provide improved long-term
outcomes).
When compared with a wait-and-see approach or corticosteroid injection, a
physiotherapy program involving exercise is associated with a greater reduction in
severity and greater success in both the short and long term.
Significant differences between study arms at six and 12 weeks: †corticosteroid injection v wait and see;
‡physiotherapy v wait and see; §corticosteroid injection v physiotherapy. *Significant differences between
groups (P<0.01)
Source: Bisset L, Beller E, Jull G et al. Mobilisation with movement and exercise, corticosteroid injection,
or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939.
www.racgp.org.au/handi
First published: January 2016 Reprinted with permission from The Royal Australian College of General Practitioners.
, HANDI
Making non-drug
interventions easier
to find and use
Availability A physiotherapy program will typically involve eight 30-minute sessions with a
physiotherapist. To find a physiotherapist, go to The Australian Physiotherapy
Association’s Find a Physio webpage.
A low-cost alternative is a home-based exercise program using rubber resistance
bands, which may be demonstrated in a general practice consultation.
Description A physiotherapy program will typically combine exercise and elbow manipulation
(manual therapy). Various techniques may be used, including those described here.
Exercise
Figures 1(a) and 1(b) below demonstrate a forearm muscle exercise for the wrist
extensor muscles. The exercise involves the application of load while the muscle
gradually contracts and moves the wrist from flexion to extension and back to flexion.
Figure 1(a). Starting and ending flexed position – do not go to end of range. Note elbow
is flexed and forearm is supported. The other end of the elastic band is fixed by the
patient’s foot or other hand.
www.racgp.org.au/handi
First published: January 2016 Reprinted with permission from The Royal Australian College of General Practitioners.
Making non-drug
interventions easier
to find and use
Physiotherapy: lateral epicondylitis
Intervention A physiotherapy program that includes exercise, elbow manipulation (manual therapy)
and self-manipulation.
Progressive exercise of the wrist extensor muscles may also be used alone, without
elbow manipulation.
Indication Lateral epicondylitis (LE), commonly known as ‘tennis elbow’, where pain persists for 6
weeks or more; however, earlier institution of exercise might also confer benefit.
Tennis elbow affects 1–3%
of the population; risk factors
include smoking, obesity, being LE is a chronic degenerative process stemming from microtrauma (rather than an acute
aged 45–54 and two or more inflammatory process). Hence, the term lateral epicondylalgia is also used.
hours of repetitive movement
per day.
In most cases, symptoms of LE are self-limiting and usually resolve within 12 months.
However, physiotherapy may reduce the time taken to improve pain (i.e. provide
short-term benefit) and reduce the recurrence and delayed recovery associated with
alternative interventions such as corticosteroid injection (i.e. provide improved long-term
outcomes).
When compared with a wait-and-see approach or corticosteroid injection, a
physiotherapy program involving exercise is associated with a greater reduction in
severity and greater success in both the short and long term.
Significant differences between study arms at six and 12 weeks: †corticosteroid injection v wait and see;
‡physiotherapy v wait and see; §corticosteroid injection v physiotherapy. *Significant differences between
groups (P<0.01)
Source: Bisset L, Beller E, Jull G et al. Mobilisation with movement and exercise, corticosteroid injection,
or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939.
www.racgp.org.au/handi
First published: January 2016 Reprinted with permission from The Royal Australian College of General Practitioners.
, HANDI
Making non-drug
interventions easier
to find and use
Availability A physiotherapy program will typically involve eight 30-minute sessions with a
physiotherapist. To find a physiotherapist, go to The Australian Physiotherapy
Association’s Find a Physio webpage.
A low-cost alternative is a home-based exercise program using rubber resistance
bands, which may be demonstrated in a general practice consultation.
Description A physiotherapy program will typically combine exercise and elbow manipulation
(manual therapy). Various techniques may be used, including those described here.
Exercise
Figures 1(a) and 1(b) below demonstrate a forearm muscle exercise for the wrist
extensor muscles. The exercise involves the application of load while the muscle
gradually contracts and moves the wrist from flexion to extension and back to flexion.
Figure 1(a). Starting and ending flexed position – do not go to end of range. Note elbow
is flexed and forearm is supported. The other end of the elastic band is fixed by the
patient’s foot or other hand.
www.racgp.org.au/handi
First published: January 2016 Reprinted with permission from The Royal Australian College of General Practitioners.
