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Treatment for physiotherapy

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"lateral epicondylitis" AND physiotherapy

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JOSPT lateral elbow pain tendinopathy clinical practice guideline exercise 2022

Your notes indicate left tennis elbow (lateral elbow tendinopathy). The physiotherapy prescription says:
  • Elbow muscle strengthening
  • Supination-pronation exercises (turning palm up and down)
  • Gripping exercises
A physiotherapist should check technique and resistance, especially because you have diabetes.

Home physiotherapy plan

Do these once daily, or as tolerated. Mild discomfort during exercise is acceptable, but pain should settle back to usual level by the next day. Do not push through sharp or worsening pain.

1. Wrist extensor stretch

This targets the painful outer-elbow tendon.
  • Straighten the affected arm in front of you, palm facing down.
  • With the other hand, gently bend the wrist downward and slightly toward the little-finger side.
  • Keep the elbow straight.
  • Hold 20-30 seconds, repeat 3 times.

2. Isometric wrist-extension exercise

Useful when pain is more irritable.
  • Sit with forearm supported on a table, palm down.
  • Make a fist.
  • Use the other hand to resist as you try to lift the back of the hand upward, but do not allow movement.
  • Hold 30-45 seconds, repeat 4-5 times.
Do this at a comfortable effort, not maximum force.

3. Slow wrist-extension strengthening

Start when the isometric exercise is comfortable.
  • Forearm supported on a table, palm down, wrist over the edge.
  • Hold a light weight, such as a 500 mL water bottle.
  • Lift the wrist up with help from the other hand if needed.
  • Then lower it slowly over 3-4 seconds using the painful side.
  • Do 3 sets of 10-15 repetitions.
Start light. Increase weight only when this is comfortable for several sessions.

4. Supination-pronation

This matches your prescription.
  • Bend the elbow to 90 degrees and keep it close to your side.
  • Hold a hammer, small bottle, or stick vertically.
  • Slowly turn palm up, then turn palm down.
  • Do 2-3 sets of 10-15 repetitions.
Keep the movement slow and pain-controlled.

5. Gripping exercise

  • Squeeze a soft sponge, rolled towel, or soft ball.
  • Hold for 3-5 seconds and relax.
  • Do 2 sets of 10 repetitions.
Avoid hard gripping initially, especially with the wrist bent backward.

Activity changes

For 4-6 weeks:
  • Reduce heavy lifting, repetitive gripping, twisting tools, wringing clothes, prolonged mouse use, and lifting with the palm down.
  • Lift objects with the palm facing up when possible.
  • Keep the wrist relatively straight during lifting.
  • Take short breaks every 30-45 minutes during repetitive work.
  • A counterforce elbow strap, worn about 2-3 cm below the painful outer elbow, may provide short-term help during activities. It should not cause numbness or tightness.
The 2022 lateral elbow pain guideline supports progressive resistance exercise as the main physiotherapy treatment. It suggests strengthening programs commonly use about 3 sets of 15 repetitions, progressed according to symptoms.

See your physiotherapist or orthopaedic doctor sooner if you have

  • Numbness, tingling, or weakness in the hand
  • Marked swelling, redness, fever, or inability to move the elbow
  • Pain worsening despite reducing activity
  • No meaningful improvement after 6-8 weeks of regular, supervised exercise
Your note also mentions diabetes and long sitting work. Keeping blood glucose controlled and taking regular movement breaks can help recovery.

Modalities as per prescription

Reading File
As per the orthopaedic prescription, the modality appears to be:
  • Therapeutic ultrasound (US)
  • Stretching exercises
The handwriting after “US” looks like “& stretching ex.” The frequency is not clearly readable, so confirm this with the physiotherapy department rather than assuming a number of sessions.
The separate physiotherapy note adds:
  • Elbow muscle strengthening
  • Supination-pronation exercises
  • Gripping exercises
So the treatment plan is US for pain relief initially, followed by stretching and progressive strengthening exercises for left tennis elbow.
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