Transverse friction and myofascial soft tissue techniques
In the transverse friction massage according to Cyriax, the tendons of the affected elbow extensor muscles are massaged across the tendon under intermittent pressure and tension. In addition, a cold therapy (cryotherapy) can be applied to stimulate blood circulation and inhibit inflammation. Prerequisite for this therapy is a precise examination of which tendons and in which area the affected structure (muscle-tendon transition, muscle-bone transition) must be treated.
The physiotherapist should also examine whether there are any other treatable soft tissue affections in the area of the inner side of the elbow, (elbow flexor muscles, so-called golfer’s arm) shoulder and cervical spine, which constantly maintain the pain pattern. In myofascial soft tissue techniques, muscles and connective tissue are relaxed with very soft holding and shifting techniques. These techniques can also be taught to the patient at home (assistant desirable).
- Adhesions of the tendons are removed.
- The inflammation is reduced via the drainage of the edema.
- Pain relief is achieved.
Elongations
After successful pain relief, the stretching exercises should be carried out by the physiotherapist as a home program several times a day. Important: exact execution and dosage! They are controversial as an application because some patients react with increased muscle tension and pain intensification.
I personally have had predominantly positive experiences with stretching exercises as a proven therapeutic tool for tennis elbow and would definitely carry out trial treatments to test the stimulus-response behavior of the patient. The target musculature is mainly the wrist extensor muscles, and in exercises 2 and 3 the rotational movement in the elbow joint is mobilized. Exercise example Stretching of the forearm extensor muscles The back of the hand is placed on a table as completely as possible with the elbow stretched and held in this position.
The palm of the hand is supported on a table with the elbow stretched, the elbow joint is rotated from the inside outwards and backwards. Examples of exercises Stretching the chest muscles The first exercise involves simultaneously stretching both sides of the chest muscles and mobilizing the thoracic spine in extension; the second exercise involves stretching one side and mobilizing the thoracic spine in rotation. The physiotherapist gives precise instructions on how to perform the exercise in terms of dosage, intensity (caution required), frequency/day and repetition/exercise.
