Tendinopathy of the insertional lateral epicondyle (lateral epicondylitis) or medial epicondyle (medial epicondylitis) is a typical syndrome that in most cases, is caused by pathogenesis of overload and frequently affects athletes (tennis elbow) or professionals who use repetitive movements with the ‘forearm (dentists, massage therapists).
Rehabilitation treatment and prognosis depend on the clinical phase in which you are: acute, chronic-relapsing, chronic-persistent. The rest and the suspension of gestures that are evoking the pain is the first absolute indication in the treatment of this disease.
The first phase of the rehabilitation protocol is focused on pain relief through physical therapy (laser, tens and ice daily applications) and the resolution of the muscular contraction that determines the tendinopathy through decontracting massage therapy of forearm muscles, deep transverse massage of tendon flexor and extensor muscles (especially in the distal portion, near epicondyle). It is important to inform the patient that pain, being of functional origin, will not disappear entirely but will persist even during the later stages of rehabilitation until full rebalancing of the tendon and muscle.
The next phase of the rehabilitation protocol is characterized by the strengthening of the epicondylus and epitrochlear muscles such as the short radial extensor carpi, the anconeus, the extensor carpi and the common extensor of the finger, mainly eccentrically, both manually and with the use of rubber bands and ballast. Very important at this stage is the rebalancing of the muscles flexed/extensors of the wrist and shoulder muscles (especially external rotation) to allow better control and stabilize the movement of the forearm.
After the complete remission of symptoms and the use of a specific tutor, the rehabilitation program ends with the last phase on the sports field, with the introduction of preparatory exercises, catching objects for neuromotor control and sport specific technical exercises for a gradual recovery the complex gestures and education to the right habits for the prevention of re-injury.
Carpal tunnel syndrome – Rehabilitation
It is a canalicular syndrome caused by compression of the median nerve at the wrist. The patient, depending on the degree of compression, presents different symptoms (irritation, compression, deficits, paresis or paralysis) that tend to vary by changing the position of the arm. Depending on the cause of the compression, the indicated solution can be surgical or conservative; in both cases, the rehabilitation treatment has common characteristics, obviously the recovery time varies.
The first phase of the rehabilitation protocol is aimed at reducing inflammation, through the use of physical therapies (laser, tens, ice) and draining massage therapy of forearm and hand and recovery of the joint function, especially the thumb through tensile physiotherapy of the wrist, stretching of the capsular structures and active and passive mobilization of the wrist and hand.
After reaching the full range of motion and movement without pain/paresthesia you can start the second phase of rehabilitation, the recovery of the strength and fine coordination with strengthening exercises for the muscles of the thenar eminence, the lumbrical and flexed/extensor carpi (especially in eccentric, even manual) with rubber bands, balls, nets. The goal is to improve the neuromotor control by recovering and training the opposition movements of the thumb and the gripping mechanism.
The rehabilitation program ends with the last phase, the recovery of technical movements in the field with growing difficulty exercises to safely recover the gestures and the complex movements of the hand, arm, forearm in dynamic situations.