This document discusses manual therapy techniques for treating tennis elbow. It begins by introducing how manual wrist mobilization (MWM) can be used to treat tendinopathies like tennis elbow. Tennis elbow is characterized by lateral elbow pain that extends into the forearm but not the hand or above the elbow, caused by gripping activities. Laboratory studies show MWM can improve muscle force generation and reduce hyperalgesia. The document describes specific MWM techniques like lateral glides that can be applied with gripping to treat tennis elbow, provides application guidelines, and suggests these techniques can also help "golfer's elbow" on the medial elbow. It includes images demonstrating proximal radioulnar joint MWM and applying a postero-

1. Manual Therapy to
Tennis Elbow
By:
Marwa Kareem Majoud
Supervised by:
Dr. Adnan Abed Anbar

2. Introduction
The elbow serves as one of the
emblematic examples of how MWM can
be used to treat conditions that are not
conventionally conceived as being
predominantly articular in nature. For
example, tennis elbow (or lateral
epicondylalgia), which is conventionally
conceived as a tendinopathy, has been
shown to respond favourably to MWM in
laboratory studies and in combination
with exercise in case studies and clinical
trials. This chapter deals first with MWM
techniques that, along with a graduated
exercise program, might be useful in
managing tennis elbow.
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3. Tennis elbow is characterised by pain over the
lateral elbow that might extend down the forearm
but not into the hand or proximal to the elbow.
The patient will present with disability related to
activities that involve gripping and activities
involving the stabilising muscles of the wrist, of
which the tendons are likely the source of the pain.
There is evidence from laboratory studies that
MWM treatment techniques of Mulligan can
produce immediate improvements in force
generation of the involved muscles at pain
threshold as well as improvements in mechanical
hyperalgesia.
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4. Golfer's elbow
The practitioner might wish to first try either the lateral
glide MWM or the postero-anterior radial glide and in the
event the first applied technique proves ineffective to
then progress to the other one. This chapter also presents
some MWM techniques that might be useful for the
tennis elbow analogue on the medial side (Golfer's
elbow).
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6. LATERAL ELBOW PAIN Lateral elbow
pain
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7. Indication
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8. Alternatives
➢ An alternate starting position is where the therapist supports the patient's arm off
the treatment table.
➢ In this situation, the therapist's stabilising hand holds the distal humerus while the
other hand performs the lateral glide.
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9. lateral glide with gripping using belt
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10. Indication
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11. APPLICATION GUIDELINES
Grip dynamometer is used to quantify grip force as an accurate and reliable
assessment of treatment effect .
Belt uniformly applies a lateral force across the elbow.
There is a substantial Increase in grip force with each repetition and immediately
afterwards, applied up to 6-10 times for 3-5 sets in a treatment session.
Remembering to do 6-10 repetitions of a lateral glide with elbow flexion and
extension immediately after the sustained glides with gripping.
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12. Lateral glide with gripping home exercise
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13. Lateral glide tape
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14. Infection controls during orthodontic procedures
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15. Proximal radioulnar joint postero-
anterior MWM
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Patient is lying supine with the arm
resting by side, shoulder internally
rotated, elbow extended, and forearm
pronated.
The distal humerus and proximal ulna
is stabilised by the therapist's fingers.
The radial head is glided anteriorly by
thumb pressure.
While the glide is sustained, the
patient grips the dynamometer.

16. Proximal radius postero-anterior tape
for lateral elbow pain
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17. Proximal radius postero-anterior
MWM home exercise for lateral elbow
pain
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19. COMMENTS
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➢ Place a folded towel between the finger tips and the radius
to reduce discomfort.
➢ Direct the patient to alter the glide force and glide direction
if pain relief is not achieved.
➢ Taping can be a useful adjunct to this exercise.

20. Thank You