Physiotherapy Management of Muscle Imbalance due to Lateral Epicondylitis: A Case Report

Abstract

Background: Lateral epicondylitis (LE), commonly known as tennis elbow, is an overuse-related tendinopathy frequently associated with repetitive wrist extension activities. Although LE is widely reported, muscle imbalance as a contributing factor remains underrecognized and rarely discussed in clinical case reports.
Objective: This case report aimed to evaluate the effects of an integrated physiotherapy intervention on muscle imbalance secondary to lateral epicondylitis.
Methods: A case report was conducted involving a 27-year-old right-hand–dominant male presenting with pain and functional limitation of the right elbow. The patient underwent four physiotherapy sessions over a two-week period. The intervention program consisted of progressive strengthening exercises, muscle release techniques, stretching, and electrotherapy. Outcomes were assessed using the Visual Analog Scale (VAS) for pain, Manual Muscle Testing (MMT) for muscle strength, goniometric measurement for range of motion, and clinical provocation tests.
Results: Pain intensity decreased substantially from VAS 7 at baseline to VAS 1 after the final session, representing an 85.7% reduction. Wrist extensor muscle strength improved from MMT grade 4 to grade 5, while wrist range of motion increased. Mill’s and Maudsley’s tests changed from positive to negative. Functional performance improved, allowing the patient to resume daily activities and recreational sports without pain. No adverse effects were reported.
Conclusion: An integrated physiotherapy approach combining strengthening exercises, muscle release, stretching, and electrotherapy was effective in reducing pain, correcting muscle imbalance, and restoring functional performance in a patient with lateral epicondylitis. This case highlights the importance of comprehensive neuromuscular assessment and targeted physiotherapy management in LE.