Wednesday, February 25, 2009

Less is more

A.T.'s love to tape and I am no exception. This is an unloading technique for lateral epicondylitis, tennis elbow if you will. We know tennis players rarely get it. In fact, I don't believe I've ever seen it in a high school athlete. But this blog is dedicated to the h.s. A.T., & we all have a lot of middle age coaches, grounds keepers etc that stop in with this problem. The tape job is easy:

1. First, have the athlete place their arm at the side in the anatomical position. The elbow is flexed about 30 degrees, the hand must be maximally supinated during the entire process. Apply two strips of coverroll stretch. The frist is placed on the proximal ventral forearm moving diagonally to the lateral distal humerus. The second is place on the extensor belly moving proximally to the lateral distal humerus. Now place the leukotape-P on the diagonal piece, pulling firmly from distal to proximal. Do the same on the extensor belly strip. Wrinkling of the skin is a sign that your tape was applied correctly. The athlete should get the sensation that the elbow is "floating".

2. The tape should stay on two or three days. Give them an old roll of flexiwrap to cover it in the shower. On the 3rd or 4th day, give the skin a day's rest to recover. On that day you can apply your modalities. Plenty of cold packs during the whole process.

I know there are mobilizations/manipulations for this condition. I have rarely found them helpful. It seems the less you fuss with it, the better. Now on to what causes it- in my experience lateral epicondylitis goes hand-in-hand with a loss of wrist extension, usually contributed to OA. I believe wrist extension is one of those "use it before you lose it" phenomenons. The humble old push up, bear crawls & crab walks are great ways to develop good wrist mobility & maintain it. Hell, I'm 49 & still do them. Now I wouldn't have a 50 year old custodian who hasn't done a pushup in 30 years drop down and give me 20. But, wall slides are a good integrative alternative. I still wish I had time to organize all my patterns and for what conditions and write them down. But this blog isn't about me, it's about you guys. So what do you think?


Kevin Moody said...

I haven't treated many cases of lateral epicondylitis. I believe one cause may be prolonged gripping activities as in canoe/kayak paddling, feathering the orr in rowing and snow shoveling. What I mean is constant muscle contraction vs. contraction/relaxation.

I've used the standard treatments - ice acutely, counterbrace, friction massage, iontophoresis and eccentric training to varing degrees of success.

I will definitely try the tape job the next I run across this conditioin.

Joe Przytula said...

ECSWT is like a friction massage by an 800 pound gorilla. Has anyone hand any experiences with it?