Houston Methodist. Leading Medicine

Elbow FAQ

Question:

Our daughter is just starting a rehab program at a sports physical therapy clinic for her tennis elbow. She's actually a volleyball player but they still call it tennis elbow. We are wondering what to expect and how long she'll be in this program.

Answer:

Overhead athletes (e.g., tennis players, javelin throwers, baseball pitchers, volleyball players) can lose significant function of the arm after an elbow tendon injury. Physical therapists are often in charge of getting these players back to full force in hitting, pitching, serving, and spiking. But what is the optimal rehabilitation program for athletes who injure their elbows? In a recent publication, an expert in sport rehabilitation and research addressed the current recommendations for treatment of elbow tendon injury. We offer you a brief summary here. The basic idea presented is that physical therapists must first know the specific pathologic process going on in the injured tendon. And second, it is equally important to understand the healing mechanism occurring throughout the rehab process. To accomplish step one (recognize and diagnose elbow injury), it involves an examination of the entire arm (upper extremity), baseline X-rays, and specific clinical tests applied to the arm. For example, it's not enough to just measure the available elbow range of motion. The physical therapist must evaluate individual motions of the shoulder, scapula (shoulder blade), and wrist. It's not unusual for athletes to lose motion in one direction while gaining motion in another. Asymmetries (differences in strength and motion from one arm to the other) can create significant problems in stability and mobility. There may be ligamentous laxity (looseness) in the elbow joint that put increased stress on the nearby muscle tendons that are trying to compensate. When the muscle/tendon unit has to do the job of the ligament (to stabilize the joint), it can't do its own job (move the arm). Eventually, other problems can develop as the body adapts but loses optimal function. The physical therapist views each athlete as a total person -- not just the elbow or the arm. The clinical evaluation takes into consideration other structures and injuries (or compensations) in other areas of the body. The therapist must determine what phase of injury and healing the player is in and provide treatment that 1) protects function, 2) restores strength, and when appropriate, 3) returns the player back to full sports activity. The goals of physical therapy in the rehabilitation of tendon injuries are to restore strength, endurance, and flexibility. Before returning an athlete to activity, it is advised that strength and motion on the injured side equal the other arm. Of course, the therapist who evaluates and develops a plan of care to treat your daughter is the one to ask this question but it doesn't hurt to get a general idea of what to expect. We hope this information helps! Todd S. Ellenbecker, DPT, MS, SCS, OCS, CSCS, et al. Current Concepts in Examination and Treatment of Elbow Tendon Injury. In Sports Health. March/April 2013. Vol. 5. No. 2. Pp. 186-194.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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