Therapeutic eccentric exercise (TEE) has been found to be an effective intervention for a variety of tendinopathies including Achilles tendinosis, 13 shoulder impingement, 14 and patellar tendinopathy. 11 Anti-inflammatory medication may not be as effective as exercise 12 thus, the benefit of therapeutic exercise may be related to the fact that LE is not due to an acute inflammatory process. Interestingly, a systematic review and meta-analysis of interventions for LE noted a lack of evidence to support treatments other than exercise.
Traditional conservative treatments for LE include cross friction massage, electrical and thermal modalities, bracing, and therapeutic exercise. Recently, researchers have noted a lack of acute inflammatory markers in patients with tennis elbow and therefore suggest using the terms “tendinosis” or “tendinopathy” to reflect the chronicity of the condition. Historically, tennis elbow (as well as other chronic tendon conditions) has been referred to as “tendinitis,” suggesting the presence of an acute inflammatory process. Several authors have noted increased activation of the ECR and ED in patients with LE compared to those without, 4– 6 while other authors have noted decreased ECR activation. 3 Electromyographic (EMG) analyses of patients with LE has demonstrated mixed results. Studies have shown that the ECR in particular is subject to increased stress during activities requiring power from the wrist.
From a pathomechanical perspective, LE involves the proximal tendons of the extensor carpi radialis (ECR) and extensor digitorum (ED).
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