A combination of physiotherapy techniques such as manual therapy, dry needling, structured and graduated exercises result in the best outcomes.
So, what do we know about the wrist?
- Functionally, the wrist extensor muscles work isometrically to hold the wrist in place for finger use/fine motor tasks. Therefore, treatment should target this function and progress to more elbow extended and pronated positions i.e. reaching & twisting.
- Grip strength is strongest in 30degrees of wrist flexion.
- Isometric strength exercises have the ability to improve grip strength and can improve reported level of elbow pain.
- All loading exercises targeting the lateral forearm should be non-provocative and be pain free.
- Manual therapy, especially movement with mobilisations (MWMs) and dry needling have been shown to reduce pain and help improve grip strength and exercise compliance.
References:
- Coombes, B. K., Wiebusch, M., Heales, L., Stephenson, A., & Vicenzino, B. (2016). Isometric exercise above but not below an individual’s pain threshold influences pain perception in people with lateral epicondylalgia. Clinical Journal of pain
- Wallis, J. A., Bourne, A. M., Jessup, R. L., Johnston, R. V., Frydman, A., Cyril, S., & Buchbinder, R. (2024). Manual therapy and exercise for lateral elbow pain. Cochrane Library
- Vuvan, V., Vicenzino, B., Mellor, R., Heales, L. J., & Coombes, B. K. (2020). Unsupervised isometric exercise versus wait-and-see for lateral elbow tendinopathy. Medicine and Science in Sports and exercise, Volume(57)