Rehabilitation Guidelines for Tennis/Golfer’s Elbow Release

Rehabilitation Guidelines for Tennis/Golfer’s Elbow Release

(Arthroscopic/Open Lateral/Medial Epicondylar Release)

This protocol provides a structured rehabilitation plan following arthroscopic or open epicondylar release for tennis or golfer's elbow. It emphasizes soft-tissue healing during the initial weeks, progressive range of motion (ROM), and gradual strengthening.

Introduction

• Individualized Approach: Rehabilitation is tailored to each patient.
• Pain-Free Progression: Exercises should be performed without pain, respecting post-operative restrictions.
• Key Emphasis: Allow soft-tissue healing for 4-6 weeks before heavy loading.
• Milestones: Used to assess progress and guide rehabilitation.

Post-Surgery Rehabilitation Phases

Phase 1: 1–14 Days

Goals:

1. Manage Pain and Inflammation:
   • Use analgesics, NSAIDs, ice, and elevation.
   • A sling may be used for 3 days for comfort.
2. Maintain Joint Mobility:
   • Perform active elbow and radio-ulnar joint exercises (flexion/extension, supination/pronation).
   • Begin gentle, active wrist exercises through full ROM (flexion/extension), ensuring movements are pain-free and only mildly stretching at the end range.
3. Prevent Muscle Atrophy:
   • Incorporate sub-maximal, pain-free isometrics for wrist flexion/extension with the wrist in a neutral position (<30% maximal voluntary contraction).

Precautions:

• Avoid heavy loading or lifting.
• Keep wounds clean and dry.
• Elevate the arm even after discontinuing sling use.

Milestones:

• Pain, inflammation, and muscle inhibition are well managed.
• Achieve full active joint ROM.

Phase 2: 15 Days–6 Weeks

Goals:

1. Minimize Pain and Inflammation:
   • Continue strategies from Phase 1.
   • Introduce manual therapy techniques or taping as appropriate.
2. Initiate Scar Management:
   • Begin scar massage once stitches are removed.
3. Progress Strengthening:
   • Advance from sub-maximal isometrics to isotonic strengthening for the elbow, wrist, and hand, ensuring exercises remain pain-free.
   • Introduce proprioceptive exercises for the upper limb.
4. Gradually Resume Loading:
   • Start progressive loading (>2-3 kg) by Week 6.

Milestones:

• Minimal pain, inflammation, and muscle inhibition.
• Resumption of:
  • Driving: 2 weeks post-surgery.
  • Light/sedentary work: 2 weeks.
  • Heavy/manual work: 6 weeks.
  • Swimming: From 6 weeks.
  • Racquet sports: From 12 weeks.

Contact Information

• Consultant Secretary: 07810 356433
• Sulis Hospital Physiotherapy: 01761 422388
• Circle Health Group Bath Clinic Physiotherapy: 01225 838767
• St. Joseph Physiotherapy: 01633 820321

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