Pathophysiology of Lateral Epicondylitis: Occupational and Non-Athletic Causes - Research Paper

Introduction

The pathophysiology of lateral epicondylitis is worsening. It entails the long-term changes of the extensor carpi radialis brevis (ECRB) muscle that is recognized during the surgical pathology specimens (Vaquero-Picado et al., 2016). Occasionally, the breakdown of tendons causes the extensor muscles to be painful. The occupational and nonathletic activities constitute the theories regarding the pathophysiology of lateral epicondylitis. They necessitate the repetitive and forceful forearm supination and movement of the ECRB muscles of the forearm that emanate from the lateral epicondyle of the elbow. For instance, the writs and elbow will be extended when a player has a return. The aspects that contribute to these are the weak shoulder and wrist muscles that hit on the heavy balls on the rackets (Vaquero-Picado et al., 2016).

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The injuries occur when an individual engages in too much activity or participating in equivalent movements frequently. In addition, they might happen when there is an imbalance of the muscles between the forearm flexors and extensors. On the other hand, the nonathletic activities such as twisting the elbow when turning a screwdriver or engaging in repetitive gasping will cause lateral epicondylitis. The tendon degeneration happens when there is the formation of the lateral epicondyle (Rose, 2018).

The demographics of Lateral epicondylitis is quite interesting. It is dominant among adults whose age ranges from 35 to 50 years of age. The tennis players are the athletes that are at high risk of being infected with the illness-the risk increases with striking the ball off-centre, difficult court surfaces, and poor stroke mechanics.

In terms of etiology, the repetitive stress that develops tiny tears in the ECRB at its point of attachment on the humerus causes pain. The poor approach when performing a backhand stroke in tennis can cause prompt stress to the muscle.

Theraupetic Exercises

Lateral epicondylitis has a well-defined clinical presentation as the key complaints are pain and a reduce grip strength that might impact the activities of everyday living. Diagnosis is simple and can be confirmed by tests that reproduce the pain, including the palpation over the facet of the lateral epicondyle, rebelled wrist extension and passive wrist flexion.

There is no perfect treatment for lateral epicondylitis even though the signs and symptoms of tennis blow are obvious. Many conservative treatments have been applied to treated diverse patients. Nearly, forty distinct methods have been documented in the literature. These treatments are aimed at alleviating pain and enhancing function. The diversity of treatment choices recommends that the optimal treatment approach is not recognized and further research is required to find out the most effective treatment in patients suffering from lateral epicondylitis.

The clinician should determine the cause of the injury during the rehabilitation of lateral epicondylitis. The therapeutic exercises can only be progressed under the condition that they can be completed with minimal or no pain as the injury can be persistent. The recovery period will rely on the duration that the patient has experienced the condition. The therapeutic exercises are applied when the initial soreness has been decreased, and the ordinary soft tissue mechanics have been formulated. The ordinary gliding of nerves and muscles has to be established through the application of stretching and transceiver friction massage. The strengthening exercises centre on eccentric muscle activity and training that has confirmed to decrease pain and disability.

Deep Transceiver Friction Massage

Deep transverse friction is a specific form of connective tissue massage that is applied to the soft tissue structures. It was developed empirically by Cyriax and has continued to be applied extensively in rehabilitation practice. It is crucial for the therapeutic exercise to be performed at the precise site of the lesion with the height of the friction bearable to the patient. The effect is localized under the condition that the finger is applied to the exact side and friction based on the appropriate direction and that the relief cannot be anticipated. Furthermore, the clinicians contend that the rhythmical transverse stress of the technique will stimulate the fibre orientation with the outcome of improving the strength of the tensile.

Home Exercise Program

The therapists can design a home exercise program depending on the severity of the condition. The patient is guided to engage in exercises thrice per day. The patients are required to perform every exercise using the household items that weigh nearly 1 pound including a can of soup. The weight will increase because the therapy program progresses and the tolerance of the patient enhances. The exercises are performed when the arm is extended under the condition that the pain is experienced during exercises. The patient will be required to engage in exercises with some elbow flexion. The patients are required to apply a cold pack thrice per day for ten minutes to alleviate pain. A systematic review on eccentric exercise programs has justified that the eccentric exercises impact positively the decrease of pain and enhance the function and grip strength (Cullinane et al., 2014).

It is recommended that the patients should feel at ease to change their activity and perhaps their equipment and have a coach or specialist who can assess their mechanics to determine whether they are at fault. One of the ways to hider reoccurrence of lateral epicondylitis is to avoid permitting the patent to engage in activities that cause pain or when the elbow is painful. The patient should be offered sufficient rest in between activities that plunge the elbow at risk of developing the condition. The tennis players should ensure that they use proper mechanics to avoid lateral epicondylitis.

The maximum protection phase constitutes the early healing period and the regulated motion period. The early healing period involves the instilling of a principle that necessitates the regulation of forces to hinder the distribution of the attachment site. This moment will differ based on the approach to surgery. The motion would not be permitted during this moment.

In the controlled motion period, the motion is permitted though the control external factors aim at safeguarding the elbow. The moderate protection stage constitutes the crutch-weaning and walking moments. The main objective of the moderate protection stage is to prepare the patient for walking. The principles that define the phase are that walking activities develop the vast anterior forces and healing strength though it is in its low moments. A balance of forces is essential for proper elbow mechanics. The emphasis of quadriceps and stress of elbow muscles is suitable. The crutch-weaning moment aims at enabling the increase of motion and strength to enable the movement of the elbow. Also, a paradox of the exercise will build strength. He weight from 30 degrees of flexion will aim at safeguarding the joints at the elbow. The compromise is to push the low weight through a diversity of motion. The final three stages of the initiative is to develop the dynamic stability trough strength for coordination and endurance.

Therapists should cautiously instruct the patients to engage in exercises that are painless. Throughout the stages of recovery, the patients should elude stressful, painful activities to impede the exacerbation of the chronic illness. Progressive motion exercises and rising resistance exercises form the basis for a return to function stage. The eccentric and concentric muscle contractions are included when the patient can show the increased quality of isometric contractions. Therapists should be cautious when instigating the eccentric and concentric resistance exercises as these contractions might generate symptoms. Light resistance is agitated when having the patients to perform these exercises for the first instance. A significant element for these resistance exercises used with the condition involves the performance of the sluggish, regulated eccentric contractions. They generate the contraction of the eccentric muscles generate greater tension than either isometric exercise. Nonetheless, the use of energy entails the adenosine triphosphate (ATP) which is less for eccentric exercise rather than for isometric exercise.

Conclusion

Lateral epicondylitis is a chronic disorder that can be treated in many ways. The therapists can prescribe a home exercise program and perform a deep transceiver friction massage on the patient. The many treatment options justify the significance of the goals and occupations of the patients before formulating a treatment plan. It is a dominant practice for therapists to listen to their patients on the most effective approaches and the necessity to change the treatment plan.

References

Cullinane, F. L., Boocock, M. G., & Trevelyan, F. C. (2014). Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clinical Rehabilitation, 28(1), 3-19. doi:10.1177/0269215513491974

Rose, N. E. (2018). Lateral Epicondylitis "Placebo" Surgery Was Actually a Lateral Denervation Procedure: Letter to the Editor. The American journal of sports medicine, 46(9), NP41-NP41.

Vaquero-Picado, A., Barco, R., & Antuna, S. A. (2016). Lateral epicondylitis of the elbow. EFORT open reviews, 1(11), 391-397.