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Joseph M. Day, Robert Barry Dale and Elizabeth Kennedy

to Guide Search Strategy • P atient/Client group: lateral elbow tendinopathy, tennis elbow, lateral epicondylitis, lateral epicondylalgia • I ntervention: therapy, physical rehabilitation • C omparison: home exercise program • O utcome(s): pain, disability Sources of Evidence Searched • SPORTDiscus

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Bassam A. Nabil, Mariam A. Ameer, Azza M. Abdelmohsen, Abeer F. Hanafy, Ahmed S. Yamani, Naglaa M. Elhafez and Salam M. Elhafez

authors of this study, no previous research has evaluated the effect of tennis elbow and golfer’s elbow on isokinetic shoulder external rotators and abductors strength among athletes. Thus, the authors in this study tried to integrate this knowledge and provide a key element to conduct a proper physical

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Thomas W. Kaminski, Michael E. Powers and Bernadette Buckley

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Tom A. Ranger, Wendy M. Braybon, Craig R. Purdam and Jill L. Cook

Context:

Lateral epicondylalgia, pain at the lateral elbow, is commonly associated with extensor carpi radialis brevis tendinopathy. The radial head, which abuts the extensor tendons and is elliptical in shape, may affect the extensor tendons during pronation of the forearm. Cadaverous studies have shown that the radial head may act as a cam in pronation, to offer a mechanical advantage to the common extensor tendon and to mitigate load on the origin of the extensor carpi radialis brevis tendon.

Objective:

To determine the effect of radial-head position on the wrist-extensor tendons in vivo.

Design:

Repeated-measures design.

Setting:

Laboratory.

Participants:

22 participants (12 male, 2 left-handed).

Main Outcome Measures:

Distance (mm) from subcutaneous fascia to radial head measured by ultrasound.

Results:

The radial head in supination was significantly deeper than either pronation or midprone, indicating a smaller cam effect in supination.

Conclusion:

The authors recommend that the effect of radial-head position and its relationship to the area of tendon pathology be considered clinically in the rehabilitation of patients suffering from lateral epicondylalgia.

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Blanca de la Cruz Torres

–52)  Function subscale: usual activities 22.15 (6.48) (11–36) Abbreviations: F, females; L, left; M, males; R, right; VAS, visual analog scale; PRTEE, Patient-Rated Tennis Elbow Evaluation. Note: Data are presented as mean (SD) (min–max) or as ratio. The University of Seville ethics committee approved the study

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Duane V. Knudson

This study examined the pattern of forces and peak loads on the hands of six advanced and six intermediate level male tennis players as they performed one-handed backhand drives. Two miniature load cells were mounted on a midsized graphite racket. The force on the thenar and hypothenar eminences of the hand were sampled at 1000 Hz. Forces on the thenar eminence in preparation for impact were significantly larger and less variable for the advanced subjects. Postimpact peak forces did not differ across skill level and were smaller than the loads reported for forehand drives. The significantly lower thenar forces the intermediate subjects used in preparation for impact may provide less resistance to the acceleration of the racket created by ball impact. A large impact acceleration may be related to a rapid stretch of the wrist extensors, which has been hypothesized to be the cause of tennis elbow.

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Wendy I. Drechsler, John F. Knarr and Lynn Snyder-Mackler

Eighteen subjects participated in a randomized controlled clinical trial to compare the effectiveness of two physical therapy treatments for tennis elbow. The subjects were divided into two groups: In the neural tension group (NTG), the head of the radius was mobilized and specific physical therapy mobilizations were used to address hypomobility of the radial nerve. The standard treatment group (STG) received ultrasound, transverse friction massage, and stretching and strengthening exercises for the extensors of the wrist. All subjects were treated twice weekly for 6 to 8 weeks. Follow-up data were obtained at 3 months post-treatment. Subjects who received radial head mobilization improved over time (p < .05), while those who did not receive radial head mobilization did not improve. Results of the NTG treatment were linked to the radial head treatment, and isolated effects of the NTG treatment could not be determined. There were no long-term positive results in the STG.

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Scott Gallant

Sports medicine assessment and treatment techniques are ever developing and becoming more holistic. Traditional musculoskeletal assessment is changing to incorporate neural tissue pathology. Neural tension tests assess the mobility of neural tissue in the extremities and spinal canal. Positive adverse neural tension tests suggest poor mobility of neural tissue. Athletes with adverse neural tension often present with pain and decreased range of motion. These disorders can occur individually or can be associated with sports injuries. Ankle sprains, hamstring strains, tennis elbow, and thoracic outlet syndrome are some conditions that respond well to treatment of adverse neural tension. Reports of improved treatment outcomes following neural tension assessment and treatment suggest that adverse neural tension should be considered as a possible source of pain and dysfunction. This paper outlines concepts necessary to understand adverse neural tension including neuroanatomy, pathology, assessment techniques, and common sports injuries that may have an adverse neural tension component.

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Behzat B. Kentel, Mark A. King and Sean R. Mitchell

A torque-driven, subject-specific 3-D computer simulation model of the impact phase of one-handed tennis backhand strokes was evaluated by comparing performance and simulation results. Backhand strokes of an elite subject were recorded on an artificial tennis court. Over the 50-ms period after impact, good agreement was found with an overall RMS difference of 3.3° between matching simulation and performance in terms of joint and racket angles. Consistent with previous experimental research, the evaluation process showed that grip tightness and ball impact location are important factors that affect postimpact racket and arm kinematics. Associated with these factors, the model can be used for a better understanding of the eccentric contraction of the wrist extensors during one-handed backhand ground strokes, a hypothesized mechanism of tennis elbow.

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Mohamed Kohia, John Brackle, Kenny Byrd, Amanda Jennings, William Murray and Erin Wilfong

Objective:

To analyze research literature that has examined the effectiveness of various physical therapy interventions on lateral epicondylitis.

Data Sources:

Evidence was compiled with data located using the PubMed, EBSCO, The Cochrane Library, and the Hooked on Evidence databases from 1994 to 2006 using the key words lateral epicondylitis, tennis elbow, modalities, intervention, management of, treatment for, radiohumeral bursitis, and experiment.

Study Selection:

The literature used included peer-reviewed studies that evaluated the effectiveness of physical therapy treatments on lateral epicondylitis. Future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.

Data Synthesis:

Shockwave therapy and Cyriax therapy protocol are effective physical therapy interventions.

Conclusions:

There are numerous treatments for lateral epicondylitis and no single intervention has been proven to be the most efficient. Therefore, future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.