We’ve done a bit of research on eccentric training, especially when it comes to lateral elbow pain; the most frequent of which presents itself as lateral epicondylalgia, or “tennis elbow.” We, along with Tim Tyler MS, PT, ATC have founded a phenomenal eccentric exercise called the “Tyler Twist” for tennis elbow featuring the TheraBand Flexbar that has helped countless people around the world, but there is always a need for further research and program development for those suffering from tennis elbow. In a 2015 article in Strength and Conditioning Journal, Kenas A et al. discussed the facts about tennis elbow, eccentric training and the research to back it up.

The problem: Tennis elbow

Throughout the article, the authors shared some lateral epicondylalgia knowledge that can help clinicians better understand and treat the injury:

  • Lateral epicondylalgia (commonly referred to as tennis elbow) is a musculoskeletal condition characterized by repetitive micro-trauma to the common extensor tendon of the lateral epicondyle.
  • 9% of tennis players (novice players affected more than professional players). Workers in highly repetitive hand task industries are also at a heightened risk.
  • Peak incidence occurs between 35 and 55 years of age.
  • Relapses of lateral epicondylalgia are quite frequent with a recurrence rate of 24%

With a high prevalence rate and an even higher recurrence rate, (1 in 4 will get it again!) the need for effective treatments options is a pressing issue for therapists and athletic trainers everywhere.

The solution: Be eccentric

Why are eccentric exercises the answer? When utilized at the appropriate time, studies have shown that eccentric exercises are a key component to tendinopathy rehabilitation. (By the way, “tendinopathy” is a newer term for “tendonitis”):

“Moreover, a randomized control trial by Svernlov and Adolfsson found that regardless of the duration of symptoms, the most effective therapeutic intervention for lateral epicondylalgia is eccentric training.”

“In 2007, Croisier et al. performed an intervention study on 92 patients…. At the conclusion of the experiment, the eccentric group had significantly less pain, mitigated bilateral strength deficits, improved homogenous tendon integrity (e.g., showed evidence of pathology resolution), and improved disability status when compared with the control group.”

Eccentric exercises for tennis elbow

Lets get moving! Kenas and his collagues outlined five exercises in the article, and the parameters to perform the exercises in:

Exercises:

  • Eccentric wrist extension with dumbbell
  • The Tyler Twist with the TheraBand Flex Bar (“Eccentric wrist extension with twist bar”)
  • Eccentric supination with elastic band (Can be easily performed with the TheraBand CLX)
  • Eccentric supination with hammer

*For pictures and step-by-step exercise instructions on eccentric exercises for tennis elbow, view the article.

Eccentric supination with TheraBand

Eccentric supination with TheraBand. Photo courtesy of Kenas A et al.

Tyler Twist for Tennis Elbow using the TheraBand Flexbar Photo Courtesy of

Tyler Twist for Tennis Elbow using the TheraBand Flexbar
Photo Courtesy of Kenas A et al.

The article recommended these eccentric exercise parameters:

  • Perform eccentric exercises three times per week with 24–48 hours between bouts of eccentric work to allow for proper recovery.
  • Each exercise session should consist of one wrist supination and one wrist extension exercise for 2 sets of 10 repetitions each.
  • Each eccentric contraction should endure approximately 4–6 seconds without variation in speed throughout the repetition.

Have you performed these exercises with your patients with tennis elbow? Have any others that would help? Share your comments and exercises below so we can all take a swing at managing tennis elbow pain!

References:

Kenas A et al. 2015. Eccentric interventions for lateral epicondylalgia. Strength Condition J. 37(5):47-52

Tyler TF, et al. 2010. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: A prospective randomized trial. J Shoulder Elbow Surg. 19(6):917-922.

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