- Physical Therapy is a system for rehabilitation that has many different treatment tools known as 'Modalities' - Here are the modalities most often used in treating Tennis Elbow, with some thoughts on how appropriate and effective they are.
1. Therapeutic Exercise
- There's no debate about the necessity of exercise as a part of a rehab program for Tennis Elbow, and there's plenty of evidence to support its effectiveness. So, it's no surprise that Therapeutic Exercise seems to be the prevailing modality used in Physical Therapy clinics worldwide in the treatment of T.E.
- The only controversy may be in squabbling over the timing, frequency and type of exercise. And there is some evidence to support the idea that Eccentric Exercise may be superior to other forms when it comes to the rehab of chronic tendon problems "Tendinopathies" like Tennis Elbow.
- The top rehab exercises for Tennis Elbow are easy enough to find online, but there is a often a medical myth or two that precedes them.
- And the mistaken prerequisite that the (non-existent) inflammation needs to calm down (be suppressed, along with other symptoms, if there at all) first before one can begin exercising.
2. Ice / Cryotherapy
- Cryotherapy may be the 2nd or 3rd most commonly used modality in Physical Therapy for treating T.E. (or it may be a tie. There is not enough data to say.)
- In this clinical pilot trial the authors, P Manias and D Stasinopoulos, note that although the use of ice (along with an exercise program) has been recommended for the management of Tennis Elbow, "No studies have examined its effectiveness."
- And conclude in the results of the trial that:
"Ice as a supplement to an exercise programme offers no benefit to patients with LET." [Lateral Elbow Tendinopathy / Tennis Elbow]
- As Certified Athletic Trainer, Joshua Stone puts so succinctly in 'Ice: The Overused Modality?'
There is lack of evidence to support utility of cold for healing. Inflammation is the initiation of healing, so why do we stop the healing process?
- See also his article RICE: The End of an Ice Age
- Of course, Physical Therapists are very seldom dealing with recent 'acute' type injuries when treating Tennis Elbow, which is a 'chronic, degenerative' injury where the healing process has usually long since failed.
- Ice may be useful, purely for temporary pain relief, but it is very unlikely to have any value when it comes to actually healing Tennis Elbow. Again, see: The Inflammation Fallacy