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Phase I Acute Phase (approximately 0 to 14 days)
- Goal: Decrease inflammation and pain of the involved muscular origin.
- Gentle passive ROM.
- Cryotherapy – ice massage at home multiple times per day.
- Modalities as necessary (TENS, iontophoresis, phonophoresis).
- NSAIDS.
- Friction massage.
- Use counter-force brace to decrease tension on region of damage.
- Avoid aggravating activity.
Phase II (14 days to 8 weeks)
- Goal: Increase flexibility, strength and endurance
- Flexibility –wrist and elbow flexion and extension, pronation and supination, radial and ulnar deviation
- Upper limb strength.
- Continue cryotherapy pre and post session.
- Concentric, eccentric strengthening of involved muscle groups.
- Continue counter-force brace.
Phase III (9 to 12 weeks)
- Goal: Return to full activity.
- Initiate gradual return to previous activities.
- Wean off counter-force brace.
- Equipment modification
- Grip size of racquet/tools.
- Tennis players: Graphite, ceramic, composite racquet have good shock absorbing characteristics.
- Emphasize maintenance program.
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