Elbow tendinopathy, whether it presents as tennis elbow (lateral elbow pain) or golfer’s elbow (medial elbow pain), is one of the most common overuse injuries in active people, desk workers, and manual labourers. At Melbourne Massage and Treatment in Fitzroy North, I frequently help patients recover from both forms of elbow tendinopathy. Elbow Tendinopathy: How Does It Manifest? “Tendinopathy” refers to irritation and degeneration within a tendon due to repeated overload. Elbow Tendinopathy, in both of its forms, tennis or golfer’s elbow, can sound like a sport-related injury, but it has little to do with the sports world. The reason why those presentations carry their name is due to the sport action, which requires that specific muscle group to work to deliver the golfer strike (medial) or tennis strike (lateral). So what can actually cause an elbow tendinopathy are: Sudden increase of tendon load – lifting heavier than usual, at the gym or at work Repetitive action – think of that constant mouse or keyboard action in the office environment Overstretching of the tendon – Poor office ergonomics can overload the elbow joint and the elbow’s tendons To be more specific, the office worker presenting with elbow tendinopathy often has repetitive mouse/keyboard use, which is often accompanied by poor ergonomic factors, such as the forearm being in a prolonged pronated position (palm facing down), which places the common extensor digitorum tendon (CEDT) under stretch. Medial and Lateral Tendinopathy of the Elbow Let’s look into the difference between the actual Tennis (lateral) and Golfer’s (medial) Elbow. Tennis Elbow (Lateral Epicondylitis) Pain in the outer elbow Irritation of the wrist extensor tendons, especially the Extensor Carpi Radialis Brevis (ECRB) Familiar with typing, lifting, racquet sports, and DIY tasks Golfer’s Elbow (Medial Epicondylitis) Pain in the inner elbow Irritation of the wrist flexor tendons Related to gripping, pulling, forearm rotation, and throwing How To Recover From a Tendinopathy? Despite different pain locations, the rehab approach is almost identical, and while rest provides temporary relief, it does not fix the underlying tendon changes. The true solution? A structured, progressive exercise rehab program that restores tendon strength and resilience. In fact, as the tendinopathy itself came to be an issue due to an overload of the elbow’s tendon, to settle the pain and discomfort, we have to: Reinforce the elbow tendon and muscle so that it can perform better. Analyse what overloaded the elbow tendons – we have to understand what can be changed in the loading process, starting from: Shoulder stability (looking up in the joint chain – Mobility and Stability) The ergonomic of your workload, that is, office or heavy repetitive work (like gardening, for example, or construction). Workout program – ensure there is a progressive load in the program that is right for your capacity. The 3-Phase Exercise Program for Elbow Tendinopathy Here at Melbourne Massage and Treatment in Fitzroy North, as a clinical myotherapist, I get to see many patients presenting with Elbow Tendinopathy, and the rehab protocol and recovery that I used is detailed below. Phase 1: Pain Reduction & Tendon Activation (Week 1–3) In this initial phase, the goal is to calm symptoms without resting the tendon completely. Tendons respond best to gentle, controlled tension, better known as isometric exercises. Isometric is ideal because: Tendons have a low blood supply compared to muscles, so in order to receive the nutrients that allow the healing process to be delivered, they need long and steady engagements. A tenodon that is inflamed presents with disorganised collagen fibres, which are not running straight, and no longer form a compact line. And there is a need for a constant load to restore new fibres that can regain the tendon’s functionality. Wrist Extension Isometric (for Tennis Elbow) You will be sitting at a desk with your forearm comfortably supported by the desk, with your hand in a prone position (palm down) Slightly extend your wrist against resistance. Pain-free movement (it could be a bend or a lightweight) Hold 20 seconds, repeat 10 reps Wrist Flexion Isometric (for Golfer’s Elbow) You will be sitting at a desk with your forearm comfortably supported by the desk, with your hand in a supine position (palm up) Deliver a slight wrist flexion against resistance. Again, it has to be a pain-free movement. Hold 20 seconds, repeat 10 reps Time of hold, repetition and pain response are subjective to each individual. That’s where we would stop and focus on each individual clinical history and presentation, and adapt the elbow tendinopathy rehab program to your needs. Gentle Mobility & Dry Needling From a point of view of massage for elbow tendinopathy, there are a few techniques that work really well, especially in the early phase of recovery: Joint Mobilisation – passive movement applied to the wrist and elbow joint, to improve the range of motion of this joint and disengage the area. Dry Needling – The usage of a needle on muscle, to create a micro-inflammation and to drive more attention from the nervous system into the targeted area. Deep Tissue Massage – When dry needling is not an option, deep tissue massage can also help in creating this targeted central nervous system response. Phase 2: Strength & Tendon Remodelling (Week 3–8) This is the most critical phase, and the one that actually restores tendon health. Eccentric Wrist Extension (Tennis Elbow Gold Standard) How to do it: Extend the wrist of the affected side with your good hand, while in the affected side, you are holding a lightweight or resistance band. Slowly lower the weight with your injured side with a tempo that last 3–5 seconds Repeat 12–15 reps, 2–3 sets – this is an endurance setup. Between each set, rest for at least 30 seconds. Eccentric Wrist Flexion (Golfer’s Elbow Gold Standard) Same method, but applied in a flexion motion. Assist the initial movement of flexion Slowly bring the wrist back to the straight position with a 3-5 second tempo. Look always at somewhere between 12-15 reps, for endurance performance. […]
Tag Archives: isometric
Blog
Face Swelling After Rhinoplasty: What You Should Know
Along with many types of post-cosmetic surgery presentations I get to work with, Rhinoplasty can [...]
Continue readingJan
Blog
Elbow Tendinopathy Rehab: What You Should Know About It?
Elbow tendinopathy, whether it presents as tennis elbow (lateral elbow pain) or golfer’s elbow (medial [...]
Continue readingDec
Blog
Brazilian Lymphatic Drainage vs Vodder MLD
As a therapist who works with Lymphatic Massage in Fitzroy North and post-cosmetic-surgery patients, I [...]
Continue readingDec
Blog
Myotherapy for ACL Rehab in Fitzroy North
ACL stands for anterior cruciate ligament, and is the strongest ligament in the knee. ACL [...]
Continue readingDec
Blog
Liposuction Recovery – How Can MLD Help?
Liposuction interventions are on the rise, driven by the enormous influence of social media on [...]
Continue readingDec
May
Knee replacement surgery, or knee arthroplasty, is a transformative procedure designed to alleviate pain and restore function in patients suffering from severe knee damage. While the surgery is a crucial step toward improved mobility, the journey doesn’t end in the operating room. The rehabilitation process is vital for ensuring a successful recovery and regaining your pre-surgery quality of life. A key component of this recovery is Manual Lymphatic Drainage (MLD) and a tailored exercise program. Understanding Knee Replacement Surgery Knee replacement surgery as the name says, is basically the replacement of a damaged knee joint with an artificial one. There are two type of knee replacement surgery: a total knee replacement (TKR), which replaces the entire knee joint, or a partial knee replacement, which targets only the damaged part of the joint. Nowadays, the decision to undergo knee replacement surgery is often made when conservative treatments, such as medications and physical therapy, have failed to provide relief. This is because, we are more aware now than ever, of how surgery are complex intervention that can yes, give pain relief and benefit, and save life, but occasionally can come with complications and leave the person with other permanent damage. The Rehabilitation Process As in any surgery, the rehabilitation process is extremely important to ensure that the patient returns to the best of their functions. What the rehabilitation involves are physical therapy, exercises, and, where needed, even mental support. Immediate Post-Surgery Care: Pain Management: Right after your surgery, you will be given pain relief medications and antibiotics, which will help in managing the pain response and keep you free from infection risks. Initial Movement: As a few days are pass, is super important to start moving. Initially would be a matter of few mm or cm, passive and active movement, but as days goes by these movement has to be increased, in order to avoid further muscle atrophization and to increase the blood flow to the area. Exercise: Isometric Exercises: As per discussed in many other blogs, those exercises are the first step in the recovery process. An isometric exercise consists of muscle contraction and barely any limb movement. This allows for maintaining a connection between the muscle and the Central Nervous System (CNS), which is essential to ensure muscle engagement for more complex tasks. Initially, those exercises can be achieved with only 25% of your strength, and within 10 days post-surgery, you may start pushing at 50% of your strength or more. Strengthening Exercises: This second step in the exercise journey can start in week three or four after surgery. The process focuses on strengthening the muscles surrounding the knee joint. These exercises are essential for supporting the new joint and improving overall stability. Strengthening exercises may look different from person to person, in terms of load, but they all aim to increase the load to which the knee joint is placed, to stimulate muscle growth, blood flow, and restore all tissue damaged along the surgery. Plyometric Exercises: Lastly, along the rehabilitation process, there are the plyometric exercises, which consist of loading the tendon like a spring (that’s what their function is) and releasing that loading in a fast motion. For a knee joint, think of explosive squat-type exercises. These type of exercises would start around week 8 to 10 post surgery. This is a step-by-step guide of what a rehabilitation process may look like. Each individual then may have a different journey to follow, given their clinical history, and other factors, including genetics and return to daily activities. In addition to the exercises, physical therapy Consistency: Adhering to a home exercise program is crucial for maintaining progress during therapy sessions. Monitoring Progress: Regularly perform your home exercises and track your progress. If you encounter any issues or experience increased pain,get in touch with your physical therapist to discuss what you are presenting with and what can be done about it. Monitoring and Follow-Up: Your surgeon and physical therapist will evaluate you on an ongoing basis to ensure that your recovery is progressing as expected. Any complications or concerns will be addressed promptly. The Importance of Manual Lymphatic Drainage (MLD) Manual Lymphatic Drainage (MLD) is a gentle, hands-on therapy designed to stimulate the lymphatic system and reduce swelling, which can be particularly beneficial following knee replacement surgery. Here’s how MLD supports recovery: Benefits of MLD in Knee Replacement Recovery: Reducing Swelling: Fluid Management: Swelling or edema is a common issue after knee replacement surgery. MLD helps move excess fluid away from the surgical site and reduces overall swelling, which can enhance comfort and mobility. Enhancing Circulation: Improved Blood Flow: By promoting lymphatic flow, MLD also improves blood circulation, delivering essential nutrients and oxygen to the healing tissues, which supports a faster recovery. Reducing Pain and Discomfort: Pain Relief: The gentle massage techniques used in MLD can help alleviate pain and discomfort associated with swelling and inflammation, contributing to a more comfortable recovery experience. Facilitating Faster Recovery Helping the Healing: By reducing swelling and improving circulation, MLD can lead to a more efficient recovery process, enabling more effective physical therapy and exercise. Incorporating MLD into Your Rehab Routine Timing: MLD can be introduced a few days to a week after surgery, depending on your surgeon’s recommendations and your individual healing progress. How can I help? At Melbourne Massage and Treatment, as a Clinical Myotherapist I am trained in helping people recovering from knee surgery or other major surgeries, either with Fitness Class, which can be part of a Myotherapy treatment plan, but even via treatment like Manual Lymphatic Drainage. So if you are about to get a surgery, that is a knee replacement or any other surgery, and you are looking for someone that can assist you with your recovery, get in touch now to discussed your needs and I can give you a rund down on how I will be able to help you. Knee replacement surgery and lymphoedema. As mentioned earlier, we can all have different outcomes from the […]