Treatment of tennis elbow – a case study

The article contains:

• tennis elbow – healing process

Patient characteristics

• Age: 36 years
• Height: 186 cm
• Weight: 90 kg
• Pitch position: coach

Description of the injury

After one of the training units in the Bielsko-Biala arena, the coach reported pain in the area of the lateral epicondyle of the humerus As it turned out later, the symptoms accompanied him for a longer  time, but with varying pain intensity adequate to the training load The pain mainly appeared after the first training unit preceded by a period of two or more days off. The pain initially did not limit function, but over time it began to impede the trainer’s active participation in training.

Functional limitations of the patient prior to treatment

• Pain appeared after the first workout after a two-day break – 6/7 on the VAS scale
• After training, pain of 8 on the VAS scale

Diagnostic examination

Diagnostic tests for tennis elbow were performed prior to therapy.

• Cozen’s test
• Thomson’s test
• Mill’s test

Treatment of tennis elbow

Pharmacological drugs were NOT used as part of the treatment. Shockwave and high-energy laser treatments were performed.

The treatment was divided into two stages. In the first, the extensors and wrist inversors were worked out. In the second, therapy targeted the lateral epicondyle of the humerus.

High-power laser treatment POLARIS HP

pulse/rectangular Impactis M+

Additional rehabilitation treatments

Besides laser and shockwave therapy, an additional treatment was provided:

• manual therapy for forearm extensors
• functional massage of the wrist extensors
• dry needling
• massage of the trapezius muscle, treatment of the scapula and shoulder muscles
• self-massage with the massage gun
• Chinese cup
• Pinotherapy
• cryotherapy
• stretching and strengthening exercises for the forearm muscles
• Kinesiotaping

Tennis elbow treatment summary

The coach did not restrict activity during training sessions. He did, however, ensure adequate recovery time after the procedures performed After each shockwave treatment, it lasted for two days, when he did not assist in training.  The rehabilitation and return to pain-free activity lasted about one and a half months. The discomfort subsided gradually, but was intermingled with worse and better pain sensations

On a day-to-day basis, little mention is made of the assistants, who often train just as hard as the players to ensure that the training and preparation of the volleyball players is adequate The active participation of the coach is usually limited to a lot of repetitive, rapid and specific movements predisposing, as it were, to overload within the exploited muscle groups Thanks to the IMPACTIS M+ and POLARIS HP devices, the treatment process for wrist extensor enthesopathy has gone much smoothly.

Patient opinion

Until recently, I was a player myself My position on the pitch was ‘libero’ This is a rather specific function, as a player in this position does not jump, but also does not place balls As a coach, the specifics of my movements have changed a bit, as the vast majority of my movements are just cleats, plays or other types of strokes, where the movement comes from above the head.  I didn’t have such pains before My pain threshold is rather high, but this ailment forced me to use the services of the club physiotherapist I tried to reduce the initial pain by changing my striking technique, but this gave only short-term relief After shockwave treatments supplemented with high-energy laser, rehabilitation and manual therapy, I was able to deal with the popular ‘tennis elbow’.