Massage techniques
As with traditional approaches for epicondylitis, rest from the offending activity is key to successful healing. Initially, compressive effleurage and general sweeping cross-fiber helps reduce tension and enhance tissue mobility. After this, deep compression broadening to the wrist-extensor muscles is beneficial (see Figure 1). Compression broadening techniques enhance the ability of the fibers to spread and broaden as they go into concentric contraction.

The tissue’s ability to elongate should also be improved. This is done with deep longitudinal stripping methods (see Figure 2). Deep longitudinal stripping is effective for identifying myofascial trigger points that later can be neutralized with static compression techniques.

Further into the rehabilitation stage - as the tendons become less sensitive - the effects of pressure and movement are enhanced through active engagement techniques for the wrist extensors. It may be helpful to use some form of resistance, like rubber tubing or elastic resistance bands. Compression broadening techniques will be performed during the concentric phase of contraction of the wrist extensors (see Figure 3). This is then followed by the eccentric or elongation phase, which uses longitudinal stripping performed during the lengthening process (see Figure 4).

In addition to reducing tension on the associated muscles, it is important to address the primary tissue problem: collagen degeneration in the tendon fibers. This is effectively performed with deep-friction massage, which stimulates collagen production in the damaged tendon tissue. Deep-friction treatment to the extensor tendons can be performed with the thumb or fingers (see Figure 5). It is often advocated that the tendons be held on some degree of stretch during the friction applications. This is done by holding the wrist in flexion as friction is applied.

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