Last updated 27/12/2023 by The pain clinics - Interdisciplinary Health

Eccentric training for lateral epicondylitis - Photo Wikimedia Commons

Eccentric training for lateral epicondylitis / tennis elbow.

In this article, we deal with eccentric training for lateral epicondylitis / tennis elbow. Eccentric training is in fact the form of treatment that currently has the most evidence on lateral epicondylitis / tennis elbow. Pressure wave treatment is another form of treatment with good evidence.

What is Eccentric Exercise?

This is a way to exercise where the muscle gets longer while doing the repetition. It may be a little difficult to imagine, but if we take a squat movement as an example, then the muscle (squat - quadriceps) becomes longer as we bend down (eccentric movement), and shorter when we get up again (concentric movement) ).

Eccentric strength training is used to treat tendinopathy in the patellas, but also in achilles tendinopathy or other tendinopathies. The way it works is that the tendon tissue is stimulated to produce new connective tissue due to the smooth, controlled strain on the tendon - this new connective tissue will over time replace the old, damaged tissue. Of course, this works the same way when we perform the exercise aimed at the wrist extensors.

What does research / studies say about eccentric exercise as a treatment?

A larger systematic review of studies (meta-study), published 2007 i The Journal of Athletic Training (Wasielewski & Kotsko) covered 27 RCT (randomized controlled trial) studies that fell within their inclusion criteria. These were all studies that addressed eccentric strength training, and its effect on tendinopathies. 

The study concluded that, and I quote:

... "Current research indicates that eccentric exercise is an effective form of treatment for lower extremity tendinos, but little evidence suggests that it is superior to other forms of therapeutic exercise, such as concentric exercise or stretching. Eccentric exercise may produce better outcomes than some treatments, such as splinting, nonthermal ultrasound, and friction massage, and be most effective during respite from activity-related loading.»...

 

Eccentric strength training is effective in treating tendinopathies (such as lateral epicondylitis / tennis elbow), but whether it is significantly more effective than concentric exercise and stretching programs is uncertain. It is also said that the treatment should be used in conjunction with a break from provocative exercises. Later in the conclusion, they mention that:

... "We also recommend that clinicians follow the eccentric exercise protocol devised by Alfredson et al ³⁵ and have patients rest for 4 to 6 weeks for optimal reduction of tendinosis symptoms. These recommendations are based on the best current evidence and are likely to be refined as more evidence arises. » ...

 

Thus, in addition to the eccentric strength training, the patient should try to rest the involved area for 4-6 weeks for optimal reduction of tendinopathy symptoms.

NOTE: To perform this exercise you will need strength manuals / weights. 

1) Sit with the arm involved resting on a surface with the palm facing down.

2) If the table is too low, place a towel under your arm.

3) You can perform the exercise with weight or something as simple as a rice bag.

4) The palm should hang slightly off the edge of the table.

5) Help with the other hand as you bend your wrist back (extension) as this is the concentric phase.

6) Lower your wrist with a gentle, controlled motion - you are now performing the eccentric phase which is the phase we want to strengthen.

7) A variation of the exercise is that you perform the same movement with one thera band ev. flexible.

Repetitions: 10 | Views: 3 | Weekly: 3-5 sessions

What can I do even for muscle and joint pain?

1. General exercise, specific exercise, stretching and activity are recommended, but stay within the pain limit. Two walks a day of 20-40 minutes make good for the whole body and sore muscles.

2. Trigger point / massage balls we strongly recommend - they come in different sizes so you can hit well even on all parts of the body. There is no better self help than this! We recommend the following (click the image below) - which is a complete set of 5 trigger point / massage balls in different sizes:

3. Training: Specific training with training tricks of various opponents (such as this complete set of 6 knits of different resistance) can help you train strength and function. Knit training often involves more specific training, which in turn can lead to more effective injury prevention and pain reduction.

4. Pain Relief - Cooling: Biofreeze is a natural product that can relieve pain by cooling the area gently. Cooling is especially recommended when the pain is very severe. When they have calmed down then heat treatment is recommended - it is therefore advisable to have both cooling and heating available.

5. Pain Relief - Heating: Warming up tight muscles can increase blood circulation and reduce pain. We recommend the following reusable hot / cold gasket (click here to read more about it) - which can be used both for cooling (can be frozen) and for heating (can be heated in the microwave).

Recommended products for pain relief for muscle and joint pain

Biofreeze (Cold / cryotherapy)

Sources:

«Does Eccentric Exercise Reduce Pain and Improve Strength in Physically Active Adults With Symptomatic Lower Extremity Tendinosis? A Systematic Review. » J Athl Train. 2007 Jul-Sep;42(3): 409-421. Noah J Wasielewski, PhD, ATC, CSCS^* and Kevin M Kotsko, MEd, ATC^†