Tennis elbow exercises are mostly advocated for tennis elbow treatment. Most of the researchers in the field of orthopedics are of the opinion that a well designed combination of strengthening and stretching exercises can cure this problem in the safest way.

This naturally makes us curious to know what happens inside our tendons when we perform these exercises and  how  these exercises works against the adverse changes in the tendons to cure tennis elbow.  To find an answer to this, recently I reviewed the findings of several researchers in this area.

Researchers like  Khan, Cook, Taunton, Kannus, Ohberg, Alfredson, Lorentzon, Vilarta etc. have done extensive study on how the tennis elbow exercises, heals the tendons. A good review of their works can be found in a research paper by Stasinopoulos, Stasinopoulou and Johnson.  According to Khan, Cook, Taunton, Kannus, Ohberg, Alfredson, Lorentzon, Alfredson and others, eccentric exercises stimulates the mechano-receptors in tenocytes to produce collagen. This helps the tendons to recover and get  the strength back. Researchers including Khan, Cook, Taunton, Kannus, Ohberg, Alfredson, Lorentzon, Alfredson, Vilarta, Stanish etc. have reported that in addition to stimulating the mechano-receptors in tenocytes, eccentric exercise training may induce a response that normalizes the high concentration of glycosaminoglycans. This may also be helpful in improving the collagen alignment of the tendons and simulate collagen linkage formation, both of which can lead to improving the tensile strength. Alfredson, Pietila, Johnson and others believe that the effect of stretching, with a lengthening of the muscle-tendon unit and consequently less strain experienced during joint motion, or the effects of loading within the muscle-tendon unit, with hypertrophy and increased tensile strength in the tendon may also be the reasons of the recovery of the tendons by the tennis elbow exercises.

References:

1.  Stasinopoulos, D., Stasinopoulou, K., Johnson, M.I., “An exercise programme for the management of lateral elbow tendinopathy,” Br J Sport Med, 2005, 39, 944-947

2.  Khan K, Cook J, Taunton J, et al. Overuse tendinosis, not tendinitis: a new paradigm for a difficult clinical problem,” Phys Sportsmed 2000, 28, 38–48

3. Khan KM, Cook JL, Kannus P, et al., “Time to abandon the ‘‘tendonitis’’ myth,” BMJ, 2002, 324, 626–627

4. Hawary R, Stanish W, Curwin S. “Rehabilitation of tendon injuries in sport,” Sports Med, 1997, 24, 347–358

5. Alfredson H, Pietila T, Johnson P, et al., “Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis,” Am J Sports Med, 1998, 26, 360–366

6. Ohberg L, Lorentzon R, Alfredson H., “Eccentric training in patients with Achilles tendinosis: normalized tendon structure and decreased thickness at follow up,” Br J Sports Med, 2004, 38, 8–11.

7. Vilarta R, Vidal BDC, “Anisotropic and biomechanical properties of tendons modified by exercise and denervation: aggregation and macromolecular order in collagen bundles,” Matrix, 1989, 9, 55–61

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