Early Occupational Therapy After Lateral Epicondylitis Surgery
Occupational therapy should begin within the first postoperative week after lateral epicondylitis surgery, starting with isometric exercises and progressing based on objective criteria rather than arbitrary timeframes.
Immediate Postoperative Period (Week 1)
- Isometric exercises for the wrist extensors should be initiated when they provoke no pain, following the same principles established for other tendon repairs 1
- Gentle wrist and finger range of motion exercises (wrist circles, flexion/extension within pain-free ranges) can be performed to prevent stiffness 2
- Edema control with elevation and compression should be implemented immediately 3
Early Mobilization Phase (Weeks 1-4)
- Closed kinetic chain exercises should be prioritized over isolated open kinetic chain movements in the early phase to reduce stress on the healing extensor carpi radialis brevis tendon 4, 1
- Progress from isometric to concentric exercises when the elbow does not react with effusion or increased pain 3
- Light resistance training (1-2 pounds or resistance bands) for wrist extension and grip strengthening can begin as tolerated, performed in pain-free ranges 1
- Neuromuscular training should be added to strength training to optimize functional outcomes and prevent compensatory movement patterns 1
Progression Criteria (Not Time-Based)
Advancement must be based on objective criteria rather than time alone, including:
- Absence of pain with current exercise level 1
- No increase in swelling, warmth, or effusion after activity 1, 3
- Ability to perform exercises with proper form without compensation 1
- Normal movement patterns during functional tasks 3
Eccentric Exercise Integration (Weeks 4-8)
- Eccentric exercises should be introduced cautiously starting with body weight, as eccentric loading is the cornerstone of tendinopathy rehabilitation 1, 5
- Progressive resistance should be added gradually, with emphasis on quality of movement rather than quantity to prevent reinjury 1
Functional Testing and Return to Activity (Week 12)
- An extensive test battery should be performed at 12 weeks including manual muscle testing of wrist extension, grip strength testing, and quality of movement assessment during functional tasks 1
- Ergonomic interventions focusing on reducing force, compression, and shearing during functional activities should be integrated throughout rehabilitation 6
Critical Pitfalls to Avoid
- Do not delay mobilization beyond the first week, as immediate mobilization is critical to increase joint range of motion and reduce pain 4
- Avoid aggressive open kinetic chain exercises in the first month that may overload the healing tendon 4, 1
- Do not progress based solely on time; always use objective functional criteria 1, 3
- Recognize that most patients improve with conservative measures, and only a small percentage require surgery 7
Supervised vs. Home-Based Therapy
- Minimally supervised rehabilitation may be used in highly motivated patients who live far from a therapist, but some level of professional guidance is recommended initially 4
- Home-based programs should include education on activity modification and ergonomic principles to reduce potentially hazardous motions during daily activities 6