M31972 Rehabilitation in Strength and Conditioning Assignment Sample 2024
Introduction
Lateral Epicondylitis is a very common occurrence at tennis grounds hence this is named after tennis players’ elbows. At the point of a tennis groundstroke, this phenomenon occurs and causes muscle injury. Muscle of the elbow teras out with excessive stress due to overuse of elbow in different positions. This is common among athletes and it is easily cured able with rehabilitation and some basic exercises.
Anatomy and epidemiology of Tennis Elbow
Anatomy
Three bones that are located in the arm such as, the upper arm bone called humerus and the other two forearm bones called ulna and radius form the elbow joint. Epicondyles are skeletal ridges at the bottom of the humerus in which various forearm muscles start their path. The lateral epicondyle is a skeletal protrusion, which is located at the outer side of the elbow (Zayedet al. 2019). Ligaments, tendons, and muscles link the elbow joint.
Lateral epicondylitis often referred to as tennis elbow, impacts the tendons and forearm muscles involved for the extension of finger and wrist (Hegazyet al. 2021). The forearm muscles reach all the way to the wrist and fingers. Forearm tendons, often known as extensors, connect muscles to bone. A tendon called the “Extensor Carpi Radialis Brevis (ECRB)” (Alsayed et al. 2020) causes the tennis elbow.
Epidemiology
Recent studies have deducted that the reason behind tennis elbow is forearm muscle damage. The “extensor carpi radialis brevis (ECRB)” muscle’s purpose is to stabilize the wrist joint when the elbow is positioned forward (García-Fernándezet al 2019). ECRB weakens with overuse and it causes microscopic tears to form in the tendon thatis attached to the lateral epicondyle.
The microscopic tears lead to inflammation which results in pain for the individual. The positioning of the ECRB muscle can also be the reason behind this disease (Muralidharagopalanet al 2021). As it bends and the muscle rubs against bony bumps, which result in microscopic tears in the muscle.
The biomechanical and physiological underpinnings of rehabilitating for Tennis Elbow
“Lateral elbow tendinopathy (LET)” is considered as the most frequent “musculoskeletal elbow tissue” damage, and it is able to affect substantial functional limits and limited involvement in activities.
LET, also known as lateral epicondylitis also known as tennis elbow is a specific reason for causing discomfort, soreness, and functional restrictions at or around the lateral epicondyle of humerus (García–Fernándezet al. 2018). The mechanism of injury varies, however it is usually caused by overuse of the regularly used wrist extensors.
LET can appear precisely as tendonitis, but it is most usually seen chronically, with degenerative tendon alterations, disordered collagen bundles, scar tissue, and hypervascularity. Load-related (biomechanical) and systemic risk factors for tendinopathy exist (Li et al. 2019).
Age, hypercholesterolemia, genetics, hormonal imbalances, and diabetes are all known “systemic risk factors”. In particular, systemic risk factors are hypothesized to diminish tendon capability to handle the stress to the point that regular activities that have become a habit and may become sufficient to initiate a pathological cycle (Juet al. 2021).
In spite of the fact, it can also be reciprocatedby; equivocal, rehabilitative therapies are often preferred as the initial line of therapy over drugs, cortisone injections, or surgery. According to a comprehensive review of the research, effective rehabilitation exercises and peer support are different types of therapeutic exercise and manual treatment for instant and temporary pain and function development (Wong et al. 2020).
Even so, there is no clear definition of what is a scientific proof multi-modality therapeutic approach is a concrete proof multimodal treatment regimen for LET, particularly when it comes to avoiding reappearance of the symptoms of the illness. Furthermore, there is minimal information available regarding exercise prescription dose (including duration, intensity, progression, and frequency).
In recent days, scientists conducted different research works and discovered shoulder girdle weakness in LET patients. As a result, if scapular muscular weakness exists, that is fair to anticipate that scapular muscle exercises must be addressed as a complete rehabilitation therapy session for LET (Papageorgiou, 2020). The Kinetic Chain Theory underpins one justification for increasing strength in scapular muscles in this group (KCT).
Kinetic energy is transmitted from the intermediate to much more distal regions of the arm throughout functional arm motions, offering an efficient and productive method for distal function, as per the KCT. Because of intermediate weakness, demand on the distal region increases, leading to distal overloading. When proximal scapular strength is inadequate, there is greater stress on distal tissues, which is located at wrist and elbow.
Because of observational research, research specialist and the opinion of research analysts, KCT, and the performance of scapular muscle is considered as an important aspect for rehabilitation experts to point out within LET sufferers. Furthermore, no research has detailed a Tennis elbow rehabilitation process, which incorporates the scapular muscle movements in sufficient depth for clinical replication.
As a result, the goal is to offer a complete rehabilitation method for people suffering from “lateral elbow tendinopathy” (Curtiet al. 2021). The rehab technique supplied will particularly comprise a scapular stabilization algorithm, whichis based on different evidences, combined with a specific therapy approach.
Stabilization is retained in the typical joint of elbow by a composite joint congruity, strength of capsuloligamentous, and completely balanced healthy muscles. The olecranon and olecranon fossa joints contribute major support when the elbow is flexed less than 20° or more than 120° (Basaket al. 2018).
Soft tissue limitations, particularly the UCL, give throughout stability. The tennis service’s kinetic chain starts with the knees and feets and continues through the shoulders, trunk/back and legs, to the elbow joint, and lastly to the wrist and hand. Biomechanically, the elbow serves largely as a link in this kinetic chain, providing kinetic energy to flow from the body to the racket.
High-quality videos evaluations from the study have shown that while serving, the elbow goes from 116° to 20° of flexion in 0.21 s, with a ball hit happening at around 35° of flexion. Throughout tennis strokes, the assessed flexion and extension movement was substantially less, within 11(46–35)° on the forehand and 18(48–30)° on the backhand (Padasalaet al. 2017).
elbow expansion, the computed angular velocity during the service action was 982°/s. These results show the tremendous stresses that the elbow must withstand repeatedly during groundstrokes in both the flexion and extension directions.
In most different sports upward movements, particularly tennis, increased outward twist of the shoulders occurs at the expense of a higher inner rotation. While serving and forehand strokes, Elliot emphasizes the need for a range of motion of the upper arm at the shoulder (Al-Edanni, 2019).
Throughout a tennis match, the need for internal rotation of the upper arm might result in a rise in internal rotational forces across the elbow joint. In tennis, one can also see aberrant load transmission in the third position, valgus and varus. In normal elbow motion, the axis of the elbow changes from flexion to extension, from varus to valgus.
Tensile pressures along the medial side, compressive on the lateral region of the elbows, and shears forces in the posterior compartment come from the coupling of valgus forces and quick extension during tennis. This coupling is sometimes referred to as a “valgus extension overload” condition among overhead athletes and can contribute to various elbow problems in tennis players (Bruyereet al. 2017).
In short, the tennis stroke places extremely high stresses on the lateral epicondyle or the elbow joints in extension, internal rotation, and valgus, and this occurs in repeating motions at extremely high speeds and forces.
Many research works identified a gradual algorithm with 3 stages of trying to strengthen the muscles. EMG activity throughout particular scapular muscle activities and improvements from an earlier study: Neuromuscular education, Resistive with low stress loads to medium loads or smaller lever arm, and Resistive with medium to high stress loads or long lever arms are the 3stages of the rehabilitation plan (Mobarakehet al. 2020).
The exercises were chosen based on their percent MVIC as well as their ability to produce appropriate UT/LT ratios. Others have suggested workouts ranging from 20-40% of MVIC for neuromuscular re-education. Exercises that produce more than 40% MVIC will, in general, produce a strengthening stimulus (Pustovitet al. 2020). As a result, workouts providing 40% or greater MVIC were included in low-load and high-load resistance.
Neuromuscular re-education includes two possibilities for scapula muscle workouts: isometric and isotonic exercises. Isotonic exercises are the preferable beginning point; nevertheless, if the individual has difficulties contracting the desired muscle, the therapist may prescribe isometric practices with practical experience and proper communication with feedback.
Since these key muscle groups usually always address scapular stability are for the serratus anterior or anterior and also for the middle or lower trapezius or posterior, the anterior and posterior scapular activities are divided (Dhageet al. 2020). Because each individual is expected to be at a distinct clinical stage, the researchers concluded on certain parameters to move every individual from the first stage to the second stage in a proper sequential method.
The researcher designed three steps of wrist strengthening, similar to the scapular muscle training matrix: Stage one Neuromuscular study, Stage two Resistive with low to moderate stressing loads or short lever arm, and Stage three Resistive with moderate to high stressing loads or long lever arms. The neuromuscular studyis primarily aimed at muscle recruitment, with an emphasis on isolating muscles in a controlled way using “isometric or isotonic contractions” (Amirmahmoudi, 2021).
The second stage is mostly based on concentric and eccentric muscle activation patterns in a low-load setting to improve and build muscular endurance. The main concepts of loading were used to progress from low-load to high-load; longer lever arms enhanced stress tolerance and weight lifting, increase in stress and load or resistance, and also plyometric exercises.
Wrist extensors and radial deviators, as well as elbow flexors and extensors, are the key muscle groups that will be treated for the strength of the wrist as well asthe elbow. The wrist, as well as elbow, the program incorporates flexibility throughout every phase to accommodate variations within patient appearance as well as choices.
The “LET dual rehabilitation program (DRP)” combines therapy to more than one region, which are the scapula as well asthe forearm (elbow/wrist). The DRP program employs exercises such as theraputic, with a focus on a phased approach to scapular and forearm to provide strength, as well as local manual treatment approaches.
The functionwas createdthrough physicians as well as academics with approximately 30 years of combined experience in treating LET, along with the specific emphasis on the best evidence in the literature. Within a multi-center randomized structured study, this holistic rehabilitation method is presently being compared against a traditional localized therapy technique (RCT). Outcomes, which are, will be gathered as part of the RCT six months and one year after discharge.
An evidence-based rehabilitation program for Tennis Elbow
Active Warm-Up
Before performing therapeutic operations, efficient comfort can be used to raise soft tissue temperature and improve muscle function. Short-term aerobic activities combined with physical treatment have also been demonstrated to reduce pain perception even while improving wellbeing and quality of life. Because patients generally arrive with varying degrees of arm discomfort, two comfort in treatments is recommended: jogging and the upper body ergometer (UBE) (Mobarakehet al. 2017).
Whereas the UBE is preferable, in patients in the acute phase of LET, jogging can be used to effectively elevate the temperature of the common wrist extensors. Despite the fact that neither the UBE nor the treadmill needs more than 10 minutes to warm up. On the UBE, patients are urged to ride at a pleasant, resistance-free rate. Patients on the gym may amble at 2.0 mph on a level incline.
Scapular muscle strengthening matrix
Progressions
Neuromuscular education is provided to all patients. The amount of time it takes to advance varies and is governed by specific criteria. To progress to low weight endurance, the patient must be able to specifically utilize scapular retraction or sternal lift with correct frontal position from a relaxed and non-stressed neutral posture 20 times in a continuous motion while maintaining a standing upright posture without substituting instead of supporting himself and not deceiving any increasing signs of the disease.
Each set of the activity should be continued for at least five seconds, although if it causes any irritation within this period the activity must be stopped immediately. To go to a high load resistance, patients should be able to reflect that individually and independently each person is able to maintain 20 repetitions individually with a set of loads that is each 10 pounds.
Withoutany discomfort, replacement, or increasing symptoms. The patient needs to begin with each arm as in a single-arm to continue with 10 pounds will create 10 pounds the after it has been completed of the exercise to relax muscles for most individuals participating in this, who are between the heights of 5 and 6 feet (Nabil et al. 2019). A 60cm TheraBand or a cable column is necessary requirement that needs to be used if the patient is more than 6 feet.
Furthermore, the patients must be encouraged for doing a single-arm push also referred to as punch with 10 pounds from the waist to the level of the shoulder without experiencing any discomfort, displacement, or any signs that refer to as increasing the disease symptoms.
Repetitions and resistance
Since this primary aim of the first phase is to engage the scapular muscles such as rhomboids lower trapezius, and middle trapezius, and serratus anterior,a patient should perform each exercise for three sets of ten with no symptom repetition and appropriate technique. Following optimal motor activation, the goal is to enhance muscular fitness.
Therefore, throughout the second and third stages of this treatment, the patient may complete up to three sets of 15, with a rest period of 60 seconds between sets. The patient initiates without a load in all stages, and the load is gradually increased until the individual no longer feels one day-long process for muscle soreness or the pain does not increase by more than one level on the numeric pain rating scale (NPRS) (0-10) (Fatemaet al. 2021).
This also allows the individual to self-regulate sessions, sets, or weights based on internal feedback while assessing for individual differences within responsiveness to training.
Similar to the “scapular muscle strengthening matrix”, the researchers developed three stages of wrist strengthening: neuromuscular education, resistive with low to medium stress loads or short lever arms, and resistive with medium to high stress loads or long lever arms. The primary goal of neuromuscular education is muscle initialization for recruitment, with an emphasis on individually identifying the muscles in a certain structure for utilizing isometric or isotonic contractions.
To increase and develop muscular endurance, resistive with low-loads that concentrates o activation patterns of concentric as well as eccentric muscle within a low-load situation. To go from resistive with loads to resistive with higher loads, the following loading principles were used: longer lever arms increased the capacity to be able to manage more stress in the form of weight bearing, this will also implement a higher strategy in load management plyometric exercises.
The major muscle groups refer to as the strength of wrist and elbow, as these are wrist extensors as well as radial deviators, as well as also elbow flexors or extensors. To address variances in patient demonstration and interests, the wrist and elbow course requires smooth movement capability throughout each step.
Wrist and elbow strengthening matrix
Scapular-muscle training is identical to the first stage of goal for the patient to complete each exercise three times in a row with no symptom replication and great technique. Following optimal motor activation, the main goal is to increase muscular strength and endurance.
As a consequence, the patient is able to complete all three sets during the second and third stages of this exercise, which requires only sixty seconds of rest means between two sets only sixty seconds is required for the rest. Individuals begin without a load in all stages, and resistance is gradually applied on the patients until that particular patient has no feeling at least up to 24-hour of the post-onset-muscle-soreness means the pain which is felt by the patient does not enhance further or more than a specific level according to the “numeric-pain-rating-scale (NPRS)” (0-10).
That particular patient is then allowed by the authority to self-regulate repetitions, sets, and weights depending on internal information while taking individual variability in responding to exercise into consideration.
Progression
All sufferers get neuromuscular instruction, and the time required to improve varies and is determined on certain parameters. To advance to resistance with lighter loads, the patient must be able to execute full hand active strength, flexibility, and isometric wrist abduction without discomfort. To advance to a greater load impedance, the patients must execute twenty rounds of circumferential wrist flexion with the elbows bent, forearms maintained in range of motion, and hand over the border of a supporting surface.
Based on the clinical practice, the patient should satisfy particular requirements before progressing to higher-load training. Before proceeding to increased load endurance, the patient must first accomplish twenty repeats with a set load of Two lbs. without discomfort, substitute, or developing indications. As an alternate, the patient might show a maximal attempt hand function of at least 80 percent of their age and sex-matched standardized criteria.
The examination should be done while standing, with the neck in normal, the elbow bent to ninety degrees, and the wrist normal. Regular assessment of grip strength using a portable force sensor not only gives objective evidence to the practitioner, but it could also improve patient incentive during the recovery process.
Practical exercise guides
Tennis elbow is mostly cured by doing some exercises as guidance for strengthening muscles and curing the joint and reducing inflammation of muscle. One patient who is suffering from tennis elbow can follow the mentioned 5 activities to reduce the pain and restore their muscles to a healthy muscle. All the pieces of information are provided and described in a systematic manner.
One must consult a physician before starting any of the exercises as this can also lead to major challenges for the patient and it can make the situation worse for them. One also must not exceed the weight limit and do the exercises slowly to ensure that no further damage is done to their condition.
- Fist clench
Tennis elbow is frequently accompanied by a loss of grip strength. Strengthening grip through developing the forearm muscles will help an individual perform better in everyday tasks.
Equipment needed table and towel
Muscles worked long flexor tendons of the fingers and thumb
The first step is letting the patient sit on a table and let their forearm resting on the table.
Then holding a towel and make a small ball of the towel in hand.
Then the patient needs to squeeze the towel in hand for 10 seconds.
This step needs to be repeated 10 times and then the patient needs to switch to the other arm.
- Supination with a dumbbell
The supinator muscle is a big forearm muscle that joins to the elbow. It is in charge of rotating the palm upward and is frequently involved in activities that might result in tennis elbow.
Equipment needed table and 2-pound dumbbell
Muscles worked supinator muscle
For this exercise, the patient needs to sit on a chair first and then hold a 2-pound dumble on hand while resting the elbow on the knee.
Then they need to let the dumbbell rotate while keeping their hands outward by turning their palm up.
Then the individual needs to rotate their hand and let their palm face downward.
Each set needs to be repeated 20 times.
The precautions for this exercise is to keep the upper arm and elbow stable while focusing on movements of the lower arm
- Wrist extension
Wrist extensors are a collection of muscles that are required for twisting the wrist, including stop hand signal. These tiny muscles that link to the elbow are frequently overused, particularly in Tennis.
Equipment needed table and 2-pound dumbbell
Muscles worked wrist extensors
Sitting in a seat with a 2-pound weight in each hand, palms bottom edge, and the elbow securely rested on the knee.
Curl the wrist across the body while maintaining the palm staring down. If that is too difficult, perform the action without any weight.
Return to the starting location and continue on every side ten times.
Attempt to limit the motion to the wrist while maintaining the rest of the arms stationary position.
- Wrist flexion
Wrist flexors are a collection of muscles that act in the reverse way of wrist extensor muscles. These tiny muscles that link to the elbow are similarly overworked, resulting in discomfort and inflammation.
Requirements: a table and 2-pound dumbbells
Wrist flexors were exercised.
Sitting on a couch and grip a 2-pound weight in each hand, face up, elbows gently lying on the knee.
Extend the arm by bending that towards the body while maintaining the hand looking ahead.
Back to the starting location and continue on every side ten times.
Attempt to limit the action to the wrist while maintaining the remainder of the arms stationary.
- Towel twist
Equipment needed hand towel
Muscles worked wrist extensors, wrist flexors
Sit on the sofa, all hands on a cloth, hips straight.
Rotate the cloth in opposing sides including both hands, as though squeezing out water.
Continue ten times in one manner, then ten times in another.
All of the mentioned programsare based on different perspectives and every patient has a different case study for himself or herself. One must always consult a doctor before starting any exercise. The activities should be started after the inflammation has subsided. In the case of pain, many traditional techniques are available, whenever pain persists after activities, rest and ice the arm and wrist, and visit a medical or sensory therapist to confirm that the activities are being performed appropriately.
Altering the way you execute a regular task may sometimes help reduce symptoms, and a psychologist can assist patients in determining which motions may be producing discomfort.
Apart from exercises, one should maintain the fact that these tears mainly occur due to high stress and carrying much load for themselves. This will be a very measured load carrying and all the steps must be followed as mentioned in this paper. This includes the weights and procedures. This also needs to be conducted under the guidance of an expert.
If any patient is facing any method that leads to an uncomfortable situation, they must immediately stop the exercise and discuss this matter with a reputed therapist.
Return to play guidelines
Tennis elbow can be cured following this therapy session. This is an effective method that is provenable to cure most of the irritation caused by the microscopic tears and it is expected to restore all the muscle tears and make the muscle strong against. The patient is expected to take a rest after some time and eventually, they will be able to get back in their regular life. This disease is most common among athletes.
Due to high stress in the muscle, individuals are required to follow certain guidelines for their health and safety. This factor is based on the medical condition of individuals. This also deals with their present position of the muscles and their health condition along with other qualities that include gender, age, regular lifestyle, diet, and activity routine.
Isometric and isotonic movements are two options for scapula muscle training in neuromuscular re-education. Although osmotic pressure workouts are the preferable, first step, if the individual is having trouble tightening the targeted muscle, the therapist may prescribe inversion exercises with aural and visual feedback. Because each patient would be at a different clinical stage, the researchers agreed on key parameters to shift individuals from phase to phase in a systematic manner.
Following this therapy session, the tennis elbow can be healed. This is an efficient treatment that has been shown to repair the majority of the discomfort produced by tiny tears, and it is predicted to restore all muscle tears and strengthen the muscle. After some time, the patient is supposed to relax, and they will finally be able to resume their normal life. This ailment is more frequent in athletes. Individuals are obliged to follow particular standards for their health and safety due to increased tension in the muscles.
This element is dependent on an individual’s medical status. This also includes their current muscle posture and health status, as well as other characteristics such as gender, age, daily lifestyle, nutrition, and activity routine. Tennis elbow can be treated after this treatment session.
The LET dual rehabilitation program (DRP) involves treatment for the forearm and scapula. Therapeutic exercise is included in the DRP program, with a focus on a series of iterations to scapular and forearm development, as well as regional conventional therapy techniques. Lengthy effects will be gathered as components of the RCT six months one and year after release. This is expected to cure the patient within rehabilitation.
Return to play or everyday work for this condition mosly varies with the pain receptions and pain degree on a relaxed position. The strength of an individual also varies with their physical condition and one must be able to manage the issues based on the discomfort degree in various activities.
In complete healthy muscle with all tears being restored, the patient must not feel any pain throughout the process and they should not cause any pain in any activity. The inflammation should also be completely deceased and the patient must not feel any irritation during their game. The normal movements should not cause any irritation and different movements can be developed based on their criteria.
Reference List
Journal
Al-Edanni, M. S. (2019). Chronic Tennis Elbow Treated by Platelet-Rich Plasma Versus Steroid Injections: A Comparative Study. AL-Kindy College Medical Journal, 15(2), 35-39. Retrieved from https://jkmc.uobaghdad.edu.iq/index.php/MEDICAL/article/download/158/127 [Retrieved on: 12/12/21]
Alsayed, A., Eid, A., &Fahmy, F. S. (2020). Arthroscopic Management of Tennis elbow. Zagazig University Medical Journal, 26(2), 248-254.Retrieved from https://zumj.journals.ekb.eg/article_48904_9697f6812cb68d712c983e656e3ca4eb.pdf [Retrieved on: 12/12/21]
Amirmahmoudi, S. (2021). Comparison the result of PRP, conservative treatment and Needling injections under ultrasound examination in tennis elbow disease (Doctoral dissertation, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran).Retrieved from http://eprints.kmu.ac.ir/38459/1/8568.pdf [Retrieved on: 12/12/21]
Basak, T., Pal, T. K., Saha, M. B., Agarwal, S., & Das, T. (2018). Comparative Efficacy of Wrist Manipulation, Progressive Exercises and Both Treatments in Patients with Tennis Elbow. International Journal of Health Sciences and Research, 8(4), 87-94.Retrieved from https://www.researchgate.net/profile/Tapas-Pal-5/publication/329525975_Comparative_Efficacy_of_Wrist_Manipulation_Progressive_Exercises_and_Both_Treatments_in_Patients_with_Tennis_Elbow/links/5c0decca299bf139c74d5867/Comparative-Efficacy-of-Wrist-Manipulation-Progressive-Exercises-and-Both-Treatments-in-Patients-with-Tennis-Elbow.pdf [Retrieved on: 12/12/21]
Bruyère, O., Croisier, J. L., &Kaux, J. F. (2017). Cross-cultural adaptation and validation of the Patient-Rated Tennis Elbow Evaluation Questionnaire on lateral elbow tendinopathy for French-speaking patients. European Journal of Sports Medicine, 5(Supplement 1), 66-67. Retrieved from https://orbi.uliege.be/bitstream/2268/216216/2/156-740-1-PB.pdf [Retrieved on: 12/12/21]
Curti, S., Mattioli, S., Bonfiglioli, R., Farioli, A., &Violante, F. S. (2021). Elbow tendinopathy and occupational biomechanical overload: A systematic review with best-evidence synthesis. Journal of occupational health, 63(1), e12186. Retrieved from https://www.jstage.jst.go.jp/article/joh/63/1/63_e12186/_pdf [Retrieved on: 12/12/21]
Curti, S., Mattioli, S., Bonfiglioli, R., Farioli, A., &Violante, F. S. (2021). Elbow tendinopathy and occupational biomechanical overload: A systematic review with best-evidence synthesis. Journal of occupational health, 63(1), e12186. Retrieved from https://www.jstage.jst.go.jp/article/joh/63/1/63_e12186/_pdf [Retrieved on: 12/12/21]
Dhage, P., Uttamchandani, S. R., &Phansopkar, P. (2020). Physical Therapy Rehabilitation In Patients With Lateral Epicondylitis-A Case Report. European Journal of Molecular & Clinical Medicine, 7(11), 2020. Retrieved from https://www.ejmcm.com/article_6369_d62e57a066f033392eeb4836e5945b6c.pdf [Retrieved on: 12/12/21]
Fatema, N., Dass, B., &Hotwani, R. (2021). Impact of Movement with Mobilization and Triceps Eccentric Strengthening in Tennis Elbow: Case Report. Journal of Pharmaceutical Research International, 10-14. Retrieved from http://dspace.uswr.ac.ir:8080/bitstream/handle/123456789/48/1-s2.0-S089411301730279X-main.pdf?sequence=1&isAllowed=y [Retrieved on: 12/12/21]
García-Fernández, P., Guodemar-Pérez, J., Ruiz-López, M., Rodríguez-López, E. S., García-Heras, A., &Hervás-Pérez, J. P. (2019). EPIDEMIOLOGY OF INJURIES IN PROFESSIONAL AND AMATEUR SPANISH PADDLE PLAYERS. RevistaInternacional de Medicina y Ciencias de la ActividadFísica y delDeporte, 19(76). Retrieved from https://revistas.uam.es/rimcafd/article/download/rimcafd2019.76.006/11635/0 [Retrieved on: 12/12/21]
García–Fernández, P., Guodemar–Pérez, J., Ruiz-López, M., Rodríguez-López, E. S., García-Heras, A., &Hervás–Pérez, J. P. EPIDEMIOLOGY OF INJURIES IN PROFESSIONAL AND AMATEUR SPANISH PADDLE PLAYERS EPIDEMIOLOGÍA LESIONAL EN JUGADORES ESPAÑOLES DE PADEL PROFESIONALES Y AMATEUR. Retrieved from http://cdeporte.rediris.es/revista/inpress/artepidemiologia1090e.pdf [Retrieved on: 12/12/21]
Hegazy, A. F., Zaghlol, M. I., Elkholy, R. M.,&Eldeeb, A. E. (2021). Ultrasound-Guided Local Injection of Lyophilized Platelet-Rich Plasma versus Autologous Platelet-Rich Plasma in Tennis Elbow. Annals of the Romanian Society for Cell Biology, 25(6), 15755-15768.Retrieved from https://www.annalsofrscb.ro/index.php/journal/article/download/8721/6359 [Retrieved on: 12/12/21]
Ju, Y. Y., Chu, W. T., Shieh, W. Y., & Cheng, H. Y. K. (2021). Sensors for Wheelchair Tennis: Measuring Trunk and Shoulder Biomechanics and Upper Extremity Vibration during Backhand Stroke. Sensors, 21(19), 6576. Retrieved from https://www.mdpi.com/1424-8220/21/19/6576/pdf [Retrieved on: 12/12/21]
Li, N. Y., Goodman, A. D., Lemme, N. J., & Owens, B. D. (2019). Epidemiology of Elbow Ulnar Collateral Ligament Injuries in Throwing Versus Contact Athletes of the National Collegiate Athletic Association: Analysis of the 2009-2010 to 2013-2014 Seasons. Orthopaedic journal of sports medicine, 7(4), 2325967119836428.Retrieved from https://journals.sagepub.com/doi/pdf/10.1177/2325967119836428 [Retrieved on: 12/12/21]
Mobarakeh, M. B., Letafatkar, A., &Barati, A. H. (2017) Effect of Eight Weeks of the Powerball® Mediated Resistance Training on Strength, Proprioception, and Upper Extremity Performance in Volleyball Players with Tennis Elbow. Retrieved from https://www.sid.ir/FileServer/JF/3004813970316 [Retrieved on: 12/12/21]
Mobarakeh, M. B., Letafatkar, A., &Barati, A. H. Effect of Eight Weeks of the Powerball® Mediated Resistance Training on Strength, Proprioception, and Upper Extremity Performance in Volleyball Players with Tennis Elbow. Retrieved from https://www.sid.ir/FileServer/JF/3004813970316 [Retrieved on: 12/12/21]
Muralidharagopalan, N. R., Gopal, R., & Natarajan, S. (2021). Addition of Eccentric Elbow Exercises to Local Corticosteroid Injection for Tennis Elbow–A Prospective Randomized Study. Annals of the Romanian Society for Cell Biology, 99-108. Retrieved from https://www.annalsofrscb.ro/index.php/journal/article/download/2443/2049 [Retrieved on: 12/12/21]
Nabil, B. A., Ameer, M. A., Abdelmohsen, A. M., Hanafy, A. F., Yamani, A. S., Elhafez, N. M., &Elhafez, S. M. (2019). The Impact of Tennis and Golfer’s Elbow on Shoulder External Rotators and Abductors’ Peak Torque. Journal of sport rehabilitation, 29(4), 469-475. Retrieved from https://www.researchgate.net/profile/Salam-Elhafez/publication/332745179_The_Impact_of_Tennis_and_Golfer%27s_Elbow_on_Shoulder_External_Rotators_and_Abductors_Peak_Torque/links/5ea87ce7a6fdcc705094f7b4/The-Impact-of-Tennis-and-Golfers-Elbow-on-Shoulder-External-Rotators-and-Abductors-Peak-Torque.pdf [Retrieved on: 12/12/21]
Padasala, M., Sharmila, B., Bhatt, H. J., &D’Onofrio, R. Comparison of efficacy of the eccentric concentric training of wrist extensors with static stretching versus eccentric concentric training with supinator strengthening in patients with tennis elbow: A randomized clinical trial. Retrieved from https://www.academia.edu/download/57971315/1_Comparison_of_efficacy_of_the_eccentric_concentric_training_of_wrist_extensors_with_static_stretching.pdf [Retrieved on: 12/12/21]
Papageorgiou, K. (2020). On Sports Biomechanics Methodology. EpistēmēsMetron Logos, (4), 50-61. Retrieved from https://ejournals.epublishing.ekt.gr/index.php/episteme/article/viewFile/24289/20467 [Retrieved on: 12/12/21]
Pustovoit, B., Pashkevych, S., &Duhina, L. (2020). PHYSICAL THERAPY FOR CHRONIC LATERAL ELBOW TENDOPATHY (TENNIS ELBOW). Slobozhanskyi herald of science and sport, 8(5), 80-91. Retrieved from http://pip.med-expert.com.ua/index.php/2311-6374/article/view/217868/pdf_279 [Retrieved on: 12/12/21]
Wong, D.W.C., Lee, W.C.C. and Lam, W.K., 2020. Biomechanics of table tennis: a systematic scoping review of playing levels and maneuvers. Applied Sciences, 10(15), p.5203. Retrieved from https://www.mdpi.com/2076-3417/10/15/5203/pdf [Retrieved on: 12/12/21]
Zayed, F. H., Yassin, I. A., & Al-Attar, W. A. A. S. (2019). Arthroscopic Release of Resistant Tennis Elbow. The Egyptian Journal of Hospital Medicine, 76(2), 3595-3599.Retrieved from https://journals.ekb.eg/article_39166_625cf423fc346141761f2498bd526b3c.pdf [Retrieved on: 12/12/21]
Know more about UniqueSubmission’s other writing services:
