Tennis elbow no more: practical eccentric and concentric exercises to heal the pain.

Lateral epicondylitis, commonly referred to as tennis elbow, affects 1% to 3% of the population.1 It is thought to be an overuse injury, originating in the wrist extensor muscles, rather than an inflammatory problem. It is brought on by occupational activities and sports that involve a repetitive wrist motion or a power grip. The condition is most commonly associated with workrelated activities,2 such as cutting meat, plumbing, and working on cars, rather than with playing tennis. The overuse causes microtears near the origin of the extensor carpi radialis brevis (ECRB) at the lateral epicondyle. This leads to the formation of fibrosis and granulation tissue. Infiltration of inflammatory cells takes place early on3 but is probably absent in more chronic cases. There are various treatment options available, including local steroid injections, strapping, extracorporeal shock wave therapy, and acupuncture; however, many cases are difficult to treat successfully.4 Although exercise treatments are often recommended, the descriptions of these exercises lack sufficient detail. The following article describes a muscle-strengthening program that involves progressive eccentric and concentric resistance exercises for treatment of lateral epicondylitis. The exercises can be done at home, and require only dumbbells, an instruction sheet, and the will to get better. Several of our patients who participated in this program have experienced long-term pain relief.