DDT: Tennis Elbow with History of Hip/Low Back Pain: Week 3 (2-5-18)

Week 3
- Organization
  - Tuesday: daily Movements
  - Wednesday: daily + strength Circuit #1 (2x through the circuit)
  - Thursday: Daily
  - Friday: Daily + Strength Circuit #2 (2x through the circuit….ice after)
  - Saturday: Daily
  - Sunday: Daily + Strength Circuit #1 and #2( 1x through each)
- This week we will continue to progress upper extremity strength, specifically trying to identify movements that feel weaker in the problematic upper extremity
- I recommend that all single arm movements be done on both arms to attempt to assess if one arm is much weaker then the other
- You will continue to do the daily movements with incorporation of a couple alternative positions to try
  - The goal with the daily sequence is to establish a sequence of 4-5 movements that you do daily to move areas of your body that typically don’t move enough during our day
  - As new options are introduced you want to pick and choose the movements that you feel are most beneficial
  - Judge that based on movements that feel really tight or movements that feel good/ pull on areas that typically feel tight/uncomfortable
- Strength Circuits
  - These will begin to get more challenging, so be careful with all newer movements
  - Each exercise will have a goal for time or for a certain number of reps
  - If you achieve the goal, you are probably ready to increase the resistance or the challenge
    - For example: I usually give a range of 8-20 reps for an exercise, if you get to 20 reps, you are probably ready to increase the weight and start back at 8-10 reps again gradually working your way up to 20 reps
    - Make sure you don’t rush it and end up increasing pain
    - IDEALLY: You should feel fatigue in muscle with very little to no tendon pain
    - If you are getting tendon pain, you want to adjust the parameters of the exercise to see if you can keep it less painful
      - This could be less weight, going through less motion, doing less reps
- Try the strength sequence every other day
- Kinesiotape may be helpful in reducing pain as we go through this process. Below is a video of a kinesiotape option that patients have reported to provide pain relief as we are in the process of strengthening the muscle tendon unit
  - Lateral Epicondylitis/Tennis Elbow Rock Tape VIDEO
Daily Sequence
- 11.2) Shoulder Extension Wrist Flexion Pillowcase VIDEO
  - 30-90sec
  - This can be done frequently throughout day, never holding the stretch
  - Can be done without pillowcase as well
  - Can be done 5-10x per day LIGHTLY, don’t over stretch
- 111) Off Edge of Bed VIDEO
  - 8-20 reps hold each 5 sec
  - Pay attention to keeping shoulder back and down
- 17) Bridge with Pec Stretch to Reach Behind Back VIDEO
  - Make sure you have good abdominal tension first
  - email me if this causes any back pain or elbow
  - 8-20reps
    - ALTERNATE POSITION
      - 13.1) Tall Kneel Cane Behind Thighs VIDEO
- 31.1) Hands Elevated Childs Pose Variation VIDEO
  - 8-20reps
  - Once again email me with any specific issues
- 12.1) Wrist Extension Dive Self Mobilization VIDEO
  - 8-20 reps
  - Should not put ant tension on the lateral elbow, but is meant to make sure limitation in ability to extend your wrist is not part of the problem
  - If this feels kind of easy, a more challenging position can be found below
    - 12) Wrist Extension with Elbow Extension Stretch VIDEO
      - 8-20 reps
      - With this one I specifically want to know if you notice a difference in the painful side being more or less tight
- Strength Circuit#1
  - 52.1) Hammer Pronation/Supination VIDEO
    - Follow the instruction of go into preferred direction first and only the the lowering portion of the more painful direction
    - 8-20reps
  - Tricep Extension with Band VIDEO
    - 8-20 reps slow
    - If using Therabands: start with red, then progress to green, then blue, then black as able
  - 109.1) Mulligan Wrist Extensor Loading VIDEO
    - Begins to directly load the lateral elbow lightly
    - follow instructions in video as endurance being more of the goal 30sec-2 min
    - Once you are able to obtain 2 minutes just making a fist, you can progress to light active wrist extension while making fist
    - Phase 2: Leave the doorway and gradually progress into a lengthened position and increased wrist motion to incorporation of a weight
      - 109) Wrist Extensor Loading Progression VIDEO
        
        Start with 1-2 minutes of active motion
        
        Once 2 minutes is achieved, try progressing to a straight elbow
        
        Then progress to a weight of 1 lb with elbow bent
- Strength Circuit #2
  - 92) Full Can/Scaption Supraspinatus VIDEO
    - Start with no weight
      - 5-20reps
      - progress to 1lb or soup can
      - Working up from 5 to 20reps
  - 96.2) Weighted Pullover Feet Elevated VIDEO
    - same as above, no weight and gradually progressing to light weight
    - TRY TO HOLD OFF ON THE MOVEMENT ABOVE AND TRY THE MOVEMENT BELOW…LET ME KNOW IF THIS IS BETTER ON THE SHOULDER
      - 122) Wall Sit Active/Band Abduction VIDEO
        
        DO IT SLOW 5-15REPS
  - 85) Scapular Control with Weight Shift Side Plank Progression VIDEO
    - Begin with 5 sec holds on each arm for 5-20reps
    - Compare is one arm much weaker