Lateral

Epicondylitis

DefinitionDescription

Lateral

epicondylitis

also

known

as

Tennis

Elbow

is

the

most

common

overuse

syndrome

in

the

elbow

It

is

an

injury

involving

the

extensor

muscles

of

the

forearm

These

muscles

originate

on

the

lateral

epicondylar

region

of

the

distal

humerus

In

a

lot

of

cases

the

insertion

of

the

extensor

carpi

radialis

brevis

is

involved

Lateral

epicondylitis

is

also

known

as

tennis

elbow

but

it

should

be

remembered

that

only

of

people

suffering

from

tennis

elbow

relate

the

injury

to

tennis

This

group

is

characterised

by

a

high

activity

level

and

they

often

play

tennis

times

a

week

for

at

least

minutes

per

session

Contractile

overloads

that

chronically

stress

the

tendon

near

the

attachment

on

the

humerus

are

the

primary

cause

of

epicondylitis

It

occurs

often

in

repetitive

upper

extremity

activities

such

as

computer

use

heavy

lifting

forceful

forearm

pronation

and

supination

and

repetitive

vibration

Despite

the

name

you

will

also

commonly

see

this

chronic

condition

in

other

sports

such

as

squash

badminton

baseball

swimming

and

field

throwing

events

People

with

repetitive

onesides

movements

in

their

jobs

such

as

electricians

carpenters

gardeners

also

commonly

present

with

this

condition

Bony

Anatomy

of

the

elbow

Clinically

Relevant

Anatomy

The

elbow

joint

is

made

up

of

three

bones

the

humerus

upper

arm

bone

the

radius

and

ulna

two

bones

in

the

forearm

At

the

distal

end

of

the

humerus

there

are

two

epicondyles

one

lateral

on

the

outside

and

one

medial

on

the

inside

Muscular

anatomy

of

the

lateral

elbow

The

area

of

maximal

tenderness

is

usually

an

area

just

distal

to

the

origin

of

the

extensor

muscles

of

the

forearm

at

the

lateral

epicondyle

Most

commonly

the

extensor

carpi

radialis

brevis

ECRB

is

involved

but

others

may

include

the

extensor

digitorum

extensor

carpi

radialis

longus

ECRL

and

extensor

carpi

ulnaris

The

radial

nerve

is

also

in

close

proximity

to

this

region

and

divides

into

the

superficial

radial

nerve

and

the

posterior

interosseous

nerve

Epidemiology

Etiology

Lateral

epicondylitis

is

classified

as

an

overuse

injury

that

may

result

in

hyaline

degeneration

of

the

origin

of

the

extensor

tendon

Overuse

of

the

muscles

and

tendons

of

the

forearm

and

elbow

together

with

repetitive

contractions

or

manual

tasks

can

put

too

much

strain

on

the

elbow

tendons

These

contractions

or

manual

tasks

require

manipulation

of

the

hand

that

causes

maladaptions

in

tendon

structure

that

lead

to

pain

over

the

lateral

epicondyle

Mostly

the

pain

is

located

anterior

and

distal

from

the

lateral

epicondyle

Epicondylitis

occurs

at

least

five

times

more

often

and

predominantly

occurs

on

the

lateral

rather

than

on

the

medial

aspect

of

the

joint

with

a

to

ratio

It

affects

of

the

population

with

those

years

old

most

commonly

being

affected

If

a

patient

is

it

is

important

to

consider

differential

diagnosis

growth

plate

disorder

referral

from

the

cervical

spine

If

a

patient

is

consider

OA

referred

cervical

spine

pain

In

a

study

by

Nirschl

of

tennis

players

aged

had

symptoms

of

tennis

elbow

at

some

stage

This

injury

is

often

workrelated

any

activity

involving

wrist

extension

pronation

or

supination

during

manual

labour

housework

and

hobbies

are

considered

as

important

causal

factors

Lateral

epicondylitis

is

equally

common

in

both

sexes

Between

the

ages

of

years

the

disease

is

most

prevalent

Obtaining

of

the

condition

at

the

both

lateral

epicondyle

is

rare

the

dominant

arm

has

the

greatest

chance

of

the

occurrence

of

lateral

epicondylitis

Twenty

percent

of

cases

persist

for

more

than

a

year

A

systematic

review

identified

risk

factors

handling

tools

heavier

than

kg

handling

loads

heavier

than

kg

at

least

times

per

day

and

repetitive

movements

for

more

than

hours

per

day

Other

risk

factors

are

overuse

repetitive

movements

training

errors

misalignments

flexibility

problems

aging

poor

circulation

strength

deficits

or

muscle

imbalance

and

psychological

factors

There

are

several

opinions

concerning

the

cause

of

lateral

epicondylitis

Although

the

term

epicondylitis

implies

the

presence

of

an

inflammatory

condition

inflammation

is

present

only

in

the

earliest

stages

of

the

disease

process

Microscopic

tearing

Nirschl

and

Pettrone

attributed

the

cause

to

microscopic

tearing

with

formation

of

reparative

tissue

angiofibroblastic

hyperplasia

in

the

origin

of

the

extensor

carpi

radialis

brevis

ECRB

muscle

This

microtearing

and

repair

response

can

lead

to

macroscopic

tearing

and

structural

failure

of

the

origin

of

the

ECRB

muscle

That

microscopic

or

macroscopic

tears

of

the

common

extensor

origin

were

involved

in

the

disease

process

was

postulated

by

Cyriax

in

The

first

to

describe

macroscopic

tearing

in

association

with

the

histological

findings

were

Coonrad

and

Hooper

Histology

of

tissue

samples

shows

collagen

disorientation

disorganization

and

fibre

separation

by

increased

proteoglycan

content

increased

cellularity

neovascularization

with

local

necrosis

Nirschl

termed

these

histological

findings

bangiofibroblastic

hyperplasia

The

term

has

since

been

modified

to

bangiofibroblastic

tendinosis

He

noted

that

the

tissue

was

characterized

by

disorganized

immature

collagen

formation

with

immature

fibroblastic

and

vascular

elements

This

grey

friable

tissue

is

found

in

association

with

varying

degrees

of

tearing

involving

the

extensor

carpi

radialis

brevis

Degenerative

Process

The

histopathological

features

of

patients

who

had

lateral

epicondylitis

were

examined

by

Regan

et

al

They

determined

that

the

cause

of

lateral

epicondylitis

was

more

indicative

of

a

degenerative

process

than

an

inflammatory

process

The

condition

is

degenerative

with

increased

fibroblasts

vascular

hyperplasia

proteoglycans

and

glycosaminoglycans

and

disorganized

and

immature

collagen

Repetitive

eccentric

or

concentric

overloading

of

the

extensor

muscle

mass

is

thought

to

be

the

cause

of

this

angiofibroblastic

tendinosis

of

the

ECRB

Epicondylitis

is

a

degenerative

condition

in

which

increased

fibrolastic

activity

and

granulation

tissue

formation

occur

within

the

tendon

Hypovascularity

Because

this

tendinous

region

contains

areas

that

are

relatively

hypovascular

the

tendinous

unit

is

unable

to

respond

adequately

to

repetitive

forces

transmitted

through

the

muscle

resulting

in

declining

functional

tolerance

CharacteristicsClinical

Presentation

The

most

prominent

symptom

of

epicondylitis

lateralis

is

pain

this

pain

can

be

produced

by

palpation

on

the

extensor

muscles

origin

on

the

lateral

epicondyle

The

pain

can

radiate

upwards

along

the

upper

arm

and

downwards

along

the

outside

of

the

forearm

and

in

rare

cases

even

to

the

third

and

fourth

fingers

Furthermore

it

is

also

often

seen

that

the

flexibility

and

strength

in

the

wrist

extensor

and

posterior

shoulder

muscles

are

deficient

According

to

Warren

there

are

four

stages

on

the

development

of

this

injury

with

regard

to

the

intensity

of

the

symptoms

Faint

pain

a

couple

of

hours

after

the

provoking

activity

Pain

at

the

end

of

or

immediately

after

the

provoking

activity

Pain

during

the

provoking

activity

which

intensifies

after

ceasing

that

activity

Constant

pain

which

prohibits

any

activity

Furthermore

it

is

also

often

seen

that

the

flexibility

and

strength

in

the

wrist

extensor

and

posterior

shoulder

muscles

are

deficient

At

least

patients

report

weakness

in

their

grip

strength

or

difficulty

carrying

objects

in

their

hand

especially

with

the

elbow

extended

This

weakness

is

due

to

finger

extensor

and

supinator

weakness

Some

people

have

a

sense

of

paralysis

but

this

is

rare

Symptoms

last

on

average

from

weeks

to

years

of

the

patients

recover

within

year

without

any

treatment

except

perhaps

avoidance

of

the

painful

movements

sport

injuries

Subjective

Assessment

Onset

of

pain

after

provocative

activity

involving

wrist

extension

Pain

may

radiate

down

forearm

as

far

as

the

wrist

and

hand

Difficulty

with

lift

and

grip

Pain

weakness

Changes

in

biomechanical

factors

new

tennis

racquet

wet

ball

overtraining

poor

technique

shoulder

injury

Objective

Assessment

Pain

and

point

tendernesss

over

lateral

epicondyle

andor

distal

to

epicondyle

Pain

and

weakness

on

resisted

wrist

extension

Weakness

on

grip

strength

testing

Dynamometer

Pain

andor

decreased

movement

on

passive

elbow

extension

wrist

flexion

and

ulnar

deviation

and

pronation

Weak

elbow

extensors

and

flexors

Differential

Diagnosis

Radial

Tunnel

Syndrome

o

Pain

in

the

posterolateral

area

of

the

forearm

o

Pain

sometimes

spreads

to

the

dorsal

side

of

the

wrist

o

Parasthesia

o

Weakness

overuse

injuries

of

the

musculoskeletal

system

Posterior

Interosseus

Syndrome

o

Pain

o

Weakness

involving

wrist

extension

and

finger

extension

o

Motor

deficits

Elbow

osteoarthritis

o

Pain

o

Loss

of

range

of

motion

Fractures

o

Distal

Radial

Fractures

o

Radial

Head

Fracture

o

Olecranon

Fracture

Cervical

Radiculopathy

o

Radiating

arm

pain

corresponding

to

the

dermatomes

o

Neck

pain

o

Parasthesia

o

Muscle

weakness

in

myotome

o

Reflex

impairmentloss

o

Headaches

o

Scapular

pain

o

Sensory

and

motor

dysfunction

in

upper

extremities

and

neck

Cervical

Disc

Disease

Cervical

Myofascial

Pain

Cervical

Spondylosis

Fibromyalgia

Medial

Epicondylitis

Diagnostic

Procedures

The

diagnose

starts

with

asking

about

the

activity

level

occupation

risk

factors

recreational

sports

participation

medication

and

other

medical

problems

During

the

physical

exam

the

medicine

will

feel

the

structure

of

the

elbow

and

other

joints

Also

the

nerves

muscles

bones

and

skin

are

exanimated

Its

important

to

know

which

activities

cause

symptoms

and

where

on

your

arm

the

symptoms

occur

Investigations

Investigations

are

usually

not

performed

in

the

straightforward

case

of

lateral

elbow

pain

However

in

longstanding

cases

plain

Xray

AP

and

lateral

views

of

the

elbow

may

show

osteochondritis

dis

secans

degenerative

joint

changes

or

evidence

of

heterotopic

calcification

Ultrasound

examination

may

prove

to

be

a

useful

diagnostic

tool

in

the

investigation

of

patients

with

lateral

elbow

pain

Ultrasound

may

demonstrate

the

degree

of

tendon

damage

as

well

as

the

presence

of

a

bursa

Xrays

These

may

be

taken

to

rule

out

arthritis

of

the

elbow

calcification

along

lateral

epicondyle

Magnetic

Resonance

Imaging

MRI

if

the

symptoms

are

related

to

a

neck

problem

an

MRI

scan

may

be

ordered

This

will

show

if

there

is

a

possible

herniated

disk

or

arthritis

in

your

neck

Both

of

these

conditions

often

produce

arm

pain

MRI

thickening

Electromyography

EMG

An

EMG

is

used

to

rule

out

nerve

compression

Many

nerves

travel

around

the

elbow

and

the

symptoms

of

nerve

compression

are

similar

to

those

of

tennis

elbow

Outcome

Measures

Pain

reported

outcome

measures

Numeric

Pain

Rating

Scale

NPRS

Visual

Analogue

Scale

VAS

Selfreported

Questionnaires

The

Upper

Limb

Functional

Index

ULFI

Patient

Rated

Tennis

Elbow

Evaluation

PRTEE

QuickDASH

Disabilities

of

the

Arm

Shoulder

and

Hand

httpwwwdashiwhoncaconditionsuse

Patient

Specific

Functional

Scale

PSFS

httpwwwtacvicgovauuploadPatientspecificpdf

Although

the

PSFS

has

not

yet

been

validated

for

lateral

epicondylalgia

it

has

been

shown

to

be

valid

reliable

and

responsive

to

change

in

other

conditions

such

as

knee

dysfunction

cervical

radiculopathy

acute

low

back

pain

mechanical

low

back

pain

and

neck

dysfunction

Pain

ICC

Function

ICC

Total

ICC

Examination

The

diagnosis

of

lateral

epicondylitis

is

substantiated

by

tenderness

over

the

ECRB

or

common

extensor

origin

By

the

following

methods

the

therapist

or

physiotherapist

should

be

able

to

reproduce

the

typical

pain

To

examine

the

severity

of

the

tennis

elbow

there

is

a

dynamometer

and

a

Patientrated

Tennis

Elbow

Evaluation

Questionnaire

PrTEEQ

The

dynamometer

measures

grip

strength

The

PrTEEQ

is

a

questionnaire

its

designed

to

measure

forearm

pain

and

disability

in

patients

with

lateral

epicondylitis

The

patients

have

to

rate

their

levels

of

tennis

elbow

pain

and

disability

from

to

and

consists

of

subscales

There

is

the

pain

subscale

no

pain

worst

imaginable

en

the

function

subscale

no

difficulty

unable

to

do

Cozens

test

Cozens

test

is

also

known

as

the

resisted

wrist

extension

test

The

elbow

is

stabilized

in

flexion

The

therapist

palpates

the

lateral

epicondyle

and

the

other

hand

positions

the

patients

hand

into

radial

deviation

and

forarm

pronation

Then

the

patient

is

asked

to

resist

wrist

extension

The

test

is

positive

if

the

patient

experiences

a

sharp

sudden

severe

pain

over

the

lateral

epicondyle

Chair

test

The

patient

grasps

the

back

of

the

chair

while

standing

behind

it

and

attempts

to

lift

the

chair

by

using

a

three

finger

pinch

thumb

index

long

fingers

and

the

elbow

fully

extended

The

test

is

positive

when

pain

occurs

at

the

lateral

epicondyle

Mills

Test

The

patient

is

seated

with

the

upper

extremity

relaxed

at

side

and

the

elbow

extended

The

examiner

passively

stretches

the

wrist

in

flexion

and

pronation

Pain

at

the

lateral

epicondyle

or

proximal

musculotendinous

junction

of

wrist

extensors

is

positive

for

lateral

epicondylitis

Maudsleys

test

The

examiner

resist

extension

of

the

third

digit

of

the

hand

while

palpating

the

lateral

epicondyle

A

positive

test

is

indicated

by

pain

over

the

lateral

epicondyle

The

coffee

cup

test

by

Coonrad

and

Hooper

While

doing

a

specific

activity

such

as

picking

up

a

full

cup

of

coffee

or

a

milk

bottle

The

patient

is

asked

to

rate

their

pain

on

a

scale

of

zero

to

ten

Medical

Management

NonOperative

Treatment

NonOperative

medical

management

of

lateral

epicondylitis

is

initially

based

on

the

following

principles

relieving

pain

and

controlling

inflammation

Relieving

pain

can

be

countered

by

rest

and

avoiding

painful

activities

Inflammation

on

the

other

hand

can

be

prevented

by

NSAIDs

in

the

acute

cases

The

use

of

ice

three

times

per

day

for

minutes

is

also

recommended

because

it

reduces

the

inflammatory

response

by

decreasing

the

level

of

chemical

activity

and

by

vasoconstriction

which

reduces

the

swelling

Elevation

of

the

extremity

is

also

indicated

if

an

edema

of

the

wrist

or

fingers

is

present

The

use

of

an

elbow

counterforce

brace

can

be

helpful

because

it

plays

the

role

of

a

secondary

muscle

attachment

site

and

relieves

tension

on

the

insertion

at

the

lateral

epicondyle

The

brace

is

applied

around

the

forearm

below

the

head

of

the

radius

and

is

tightened

enough

so

that

when

the

patient

contracts

the

wrist

extensors

he

or

she

does

not

fully

contract

the

muscles

Injections

should

be

given

subperiosteally

to

the

extensor

brevis

origin

These

injections

have

an

early

and

beneficial

effect

During

the

initial

hours

increased

pain

be

experienced

A

steroid

injection

should

be

followed

by

weeks

rest

and

should

not

be

repeated

more

than

times

Steroid

injection

seems

to

be

effective

for

about

months

indicating

that

the

patient

must

continue

with

the

exercise

program

Surgical

treatment

If

the

symptoms

of

epicondylitis

lateralis

will

prove

to

be

resistant

surgical

treatment

is

indicated

Usually

this

is

after

a

failed

conservative

treatment

for

more

than

months

Most

surgical

procedures

for

tennis

elbow

involve

removing

diseased

muscle

and

reattaching

healthy

muscle

back

to

bone

The

right

surgical

approach

for

you

will

depend

on

a

range

of

factors

These

include

the

scope

of

your

injury

your

general

health

and

your

personal

needs

Open

surgery

The

most

common

approach

to

tennis

elbow

repair

is

open

surgery

This

involves

making

an

incision

over

the

elbow

Open

surgery

is

usually

performed

as

an

outpatient

surgery

It

rarely

requires

an

overnight

stay

at

the

hospital

Arthroscopic

surgery

Tennis

elbow

can

also

be

repaired

using

tiny

instruments

and

small

incisions

Like

open

surgery

this

is

a

sameday

or

outpatient

procedure

Physiotherapy

Management

There

are

different

types

of

therapies

to

treat

lateral

epicondylitis

all

with

the

same

aim

reduce

pain

and

improve

function

General

Physiotherapy

Management

o

EducationAdvice

Pain

control

Modify

and

restrict

activities

o

Manual

therapy

Mulligan

Mobilisation

with

movement

o

Exercises

Strengthening

Stretching

o

Modalities

Ultrasound

Transcutaneous

electrical

nerve

stimulation

TENS

o

BracesSplintsStraps

No

clear

evidence

o

Medications

NSAIDs

offer

a

short

term

benefit

weeks

pain

relief

o

Corticosteroids

injection

Short

term

effect

weeks

o

Surgery

o

SportOccupation

Specific

Rehabilitation

Evidence

for

Physiotherapy

The

study

of

Nagrale

et

al

demonstrate

that

Cyriax

physiotherapy

is

a

better

treatment

compared

to

phonophoresis

and

exercise

for

treating

lateral

epicondylalgia

The

cyriax

physiotherapy

group

had

significantly

better

scores

for

all

measurements

at

follow

up

Level

of

Evidence

Rajadurai

et

al

demonstrate

that

supervised

exercise

program

may

be

the

first

treatment

in

managing

tennis

elbow

in

comparison

to

Cyriax

physiotherapy

Much

more

studies

should

be

done

to

prove

the

evidence

of

using

manual

treatment

like

Cyriax

physiotherapy

Level

of

Evidence

Physical

therapy

interventions

including

elbow

joint

mobilization

with

movement

combined

with

exercise

has

been

shown

to

have

better

results

thanTherapeutic

Corticosteroid

Injection

at

weeks

and

to

wait

and

see

at

weeks

but

not

weeks

Recent

research

regarding

cervicothoracic

joint

mobilization

in

conjunction

with

local

treatment

for

lateral

epicondylalgia

has

shown

improvements

in

strength

pain

and

tolerance

to

activity

compared

to

local

treatment

alone

Level

of

Evidence

Corticosteroid

injections

have

a

shortterm

beneficial

effect

on

lateral

epicondylitis

but

a

negative

effect

in

the

intermediate

term

Evidence

on

the

longterm

effect

is

conflicting

Manipulation

and

exercise

and

exercise

and

stretching

have

a

shortterm

effect

with

the

latter

also

having

a

longterm

effect

Level

of

Evidence

Physical

therapy

management

including

only

the

use

of

Therapeutic

Ultrasound

for

Lateral

Epicondylitis

massage

and

exercise

has

been

shown

to

be

no

better

than

a

wait

and

see

treatment

method

Level

of

Evidence

Activity

modification

when

possible

can

help

prevent

recurrent

episodes

of

lateral

epicondylalgia

as

well

as

use

of

a

counterforce

brace

as

needed

ESWT

for

Lateral

Epicondylitis

Extracorporeal

Shockwave

therapy

Shockwave

Therapy

is

a

method

of

treatment

for

multiple

tendonopathies

that

can

be

used

for

the

treatment

of

lateral

epicondylitis

ESTW

is

a

treatment

technique

in

which

patients

are

exposed

to

a

strong

mechanical

wave

impulses

which

can

be

used

on

a

fairly

accurate

position

There

are

several

studies

Level

of

Evidence

Level

of

Evidence

that

examine

the

effects

of

extracorporeal

shockwave

on

lateral

epicondylitis

Statistical

analysis

of

visual

analogue

scale

VAS

disabilities

of

the

arm

shoulder

and

hand

DASH

questionnaire

and

painfree

grip

strength

test

scores

has

shown

both

after

treatment

and

to

the

followup

at

months

significant

difference

comparing

study

group

versus

control

group

P

Level

of

Evidence

The

use

of

RSWT

allowed

a

decrease

of

pain

and

functional

impairment

and

an

increase

of

the

painfree

grip

strength

test

in

patients

with

tennis

elbow

Level

of

Evidence

Although

the

technique

is

widely

reported

to

be

safe

there

is

a

potential

for

haemorrhage

and

local

soft

tissue

damage

through

cavitation

and

this

appears

to

be

more

likely

with

high

doses

Studies

has

shown

that

Extracorporeal

shockwave

therapy

offers

a

significant

placebo

effect

with

a

moderate

dos

of

ESWT

in

subjects

with

lateral

epicondylitis

However

there

is

no

evidence

of

added

benefit

of

treatment

when

compared

to

sham

placebo

therapy

This

may

be

the

reason

why

there

are

significant

improvements

noted

by

other

studies

Level

of

Evidence

Level

of

Evidence

Cyriax

Physiotherapy

Level

of

Evidence

Level

of

Evidence

Level

of

Evidence

Its

a

very

common

intervention

that

combines

the

use

of

deep

transverse

friction

DTF

with

Mills

manipulations

which

was

used

with

success

by

Cyriax

and

Cyriax

for

treating

lateral

epicondylitis

Both

the

treatment

components

mentioned

above

must

be

used

jointly

in

the

sequence

specified

Patient

must

follow

the

protocol

three

times

a

week

for

four

weeks

Level

of

Evidence

There

are

several

contraindications

regard

to

this

therapy

active

infections

bursitis

disorders

of

the

nerve

structures

ossification

and

calcification

of

the

soft

tissues

active

rheumatoid

arthritis

anticoagulant

Rajadurai

et

al

demonstrate

that

supervised

exercise

program

may

be

the

first

treatment

in

managing

tennis

elbow

in

comparison

to

Cyriax

physiotherapy

Much

more

studies

should

be

done

to

prove

the

evidence

of

using

manual

treatment

like

Cyriax

physiotherapy

Level

of

Deep

transverse

frictions

for

tennis

elbow

Deep

Transverse

Frictions

Deep

transverse

friction

is

a

specific

type

of

connective

tissue

massage

applied

precisely

to

the

soft

tissue

structures

The

therapist

must

try

to

reach

an

analgesic

effect

applying

the

DTF

at

the

point

of

the

lesion

for

min

till

a

numbing

effect

has

been

reached

that

all

for

preparing

the

tendon

for

Mills

manipulations

Pain

during

the

friction

massage

is

considered

as

a

wrong

indication

An

interval

of

hours

between

two

sessions

is

necessary

Comparison

of

effectiveness

of

supervised

exercise

Level

of

Evidence

The

purpose

of

the

deep

friction

massage

is

to

maintain

the

mobility

within

the

soft

tissue

structures

Level

of

Evidence

It

seems

to

have

a

pain

relief

function

due

to

modulation

of

the

nociceptive

impulses

gate

control

theory

a

better

alignment

of

connective

tissue

fibrils

softens

the

scar

tissue

and

blood

flow

increases

but

further

studies

are

needed

The

patient

should

be

positioned

with

arm

fully

supinated

in

of

elbow

flexion

identify

the

area

of

tenderness

on

the

lateral

epicondyle

and

apply

pressure

DTF

with

the

tip

of

the

thumb

on

the

lateral

epicondyle

in

a

posterior

direction

on

the

tenoosseous

junction

The

other

hand

stabilized

the

patients

wrist

Level

of

Evidence

Mills

Mobilisation

Your

browser

does

not

currently

recognize

any

of

the

video

formats

available

Click

here

to

visit

our

frequently

asked

questions

about

video

Mills

manipulation

is

the

most

common

technique

used

by

physiotherapists

and

is

a

smallamplitude

highvelocity

thrust

performed

at

the

end

of

elbow

extension

while

the

wrist

and

hand

are

held

flexed

Level

of

Evidence

the

aim

of

this

technique

is

to

elongate

the

scar

tissue

by

rupturing

adhesions

within

the

tenooseous

junction

making

the

area

mobile

and

pain

free

Its

used

to

imitate

the

mechanism

of

spontaneous

recovery

Level

of

Evidence

Mills

intention

was

to

shift

the

annular

ligament

and

replace

it

Cyriax

found

out

that

the

annular

ligament

applies

the

greatest

possible

stretching

tension

to

the

extensor

carpi

radialis

muscles

thats

why

the

manipulative

procedure

should

be

carried

out

with

a

sharp

jerk

in

order

to

open

the

tear

in

the

tendon

and

relieve

tension

on

the

tendon

scar

by

converting

a

tear

Level

of

Evidence

This

manipulation

must

only

be

performed

if

a

fully

painfree

elbow

extension

can

be

achieved

and

with

a

properly

technique

To

prevent

symptoms

worsening

full

wrist

flexion

must

be

achieved

during

the

procedure

Level

of

Evidence

Patient

seated

with

the

affected

extremity

in

abduction

and

internal

rotation

olecranon

faced

upTherapist

stands

behind

the

patient

stabilized

the

patients

wrist

in

full

pronation

and

flexion

while

the

other

hand

is

placed

on

the

olecranon

The

maintenance

of

full

wrist

flexion

is

important

as

failure

to

maintain

this

position

could

lead

to

a

majority

of

the

thrusting

force

being

bome

by

the

humeroulnar

joint

The

highvelocity

low

amplitude

HVLA

thrust

at

the

end

range

of

elbow

extension

is

a

quick

movement

in

the

direction

illustrated

Level

of

evidence

This

manipulation

may

produce

mild

discomfort

at

the

instant

of

its

performance

The

clinician

applies

this

procedure

a

times

a

week

until

cure

with

a

range

of

sessions

Level

of

Evidence

Exercise

therapy

Exercise

therapy

is

a

regimen

or

plan

of

physical

activities

designed

and

prescribed

for

specific

therapeutic

goals

Its

purpose

is

to

restore

normal

musculoskeletal

function

or

to

reduce

pain

caused

by

diseases

or

injuries

Strength

stamina

and

mobility

should

be

improved

by

exercises

once

the

pain

and

inflammation

are

under

control

Level

of

Evidence

Level

of

Evidence

Stretching

The

literature

on

the

treatment

of

a

Lateral

Epicondylitis

suggests

that

strengthening

and

stretching

exercises

are

the

most

important

components

of

exercise

programmes

for

the

reason

that

tendons

should

not

only

be

strong

but

also

flexible

The

stretching

exercises

are

intended

to

improve

the

flexibility

of

the

extensor

group

of

the

wrist

These

exercises

ought

to

be

instituted

and

continued

until

the

range

of

motion

of

the

wrist

is

the

same

as

that

of

the

uninvolved

side

The

underlying

principle

of

the

stretching

phase

is

that

by

lengthening

the

tendon

during

relaxation

we

can

reduce

its

stretching

during

offending

movements

The

best

stretching

position

for

the

Extensor

Carpi

Radialis

Brevis

tendon

is

reached

with

the

elbow

in

extension

forearm

in

pronation

wrist

in

flexion

and

with

ulnar

deviation

of

the

wrist

according

to

the

patients

tolerance

This

stretching

should

be

held

for

s

and

times

before

and

after

the

eccentric

exercises

during

each

treatment

session

with

a

s

rest

interval

Other

programs

says

that

stretching

exercises

for

the

extensor

muscles

of

the

wrist

and

fingers

should

be

performed

in

the

following

manner

fully

extend

the

elbow

and

palmary

flex

the

wrist

Remain

in

the

point

of

maximum

non

painful

extension

for

a

period

of

to

this

exercises

is

repeated

four

to

five

times

a

day

with

two

series

of

ten

exercises

in

each

session

the

patient

should

always

stop

at

the

first

sign

of

pain

In

this

phase

of

therapy

the

patient

should

also

perform

isotonic

exercises

once

a

day

according

to

the

following

plan

Level

of

Evidence

Stretching

exercises

repeat

times

seconds

Isotonic

exercises

repeat

times

series

Stretching

exercises

repeat

times

seconds

Icing

massage

the

tender

area

with

ice

or

crushed

ice

for

minutes

Sample

eccentric

exercises

for

tennis

elbow

Eccentric

exercises

There

are

three

principles

of

eccentric

exercises

These

are

load

resistance

speed

velocity

and

frequency

of

contractions

Level

of

Evidence

resistance

Increasing

the

load

ensures

the

tendon

is

subjected

to

greater

stress

and

forms

the

fundamental

basis

of

the

progression

of

the

exercise

programme

The

basis

of

all

physical

training

programmes

is

formed

by

this

principle

of

progressive

overloading

According

to

the

patients

symptoms

it

is

important

that

the

load

of

these

eccentric

exercises

should

be

increased

If

its

not

increased

then

the

possibility

of

reinjury

will

be

high

velocity

The

speed

velocity

of

contractions

is

also

a

fundamental

principle

of

successful

eccentric

exercises

In

each

treatment

session

the

speed

of

the

eccentric

training

should

be

increased

Hence

the

load

on

the

tendon

increases

to

stimulate

the

mechanism

of

the

injury

However

the

therapists

must

ensure

that

the

patients

perform

the

eccentric

exercises

slowly

to

avoid

pain

of

contractions

The

frequency

of

contractions

is

the

third

principle

of

eccentric

exercises

There

can

be

variations

of

sets

and

repetitions

in

the

literature

According

to

the

therapists

sets

of

repetitions

can

normally

be

performed

without

overloading

the

injured

tendon

as

determined

by

the

tolerance

of

the

patient

The

elbow

is

in

full

extension

forearm

in

pronation

and

the

arm

is

supported

The

greatest

strengthening

result

for

the

extensor

tendons

of

the

wrist

is

reached

in

this

position

This

is

a

recommendation

and

the

frequency

must

be

patient

specific

Level

of

Evidence

Theraband

Exercise

Theraband

exercises

or

exercises

with

a

small

weight

are

performed

each

day

for

sets

of

You

fix

one

side

of

the

theraband

under

you

feet

or

another

place

and

you

take

the

other

side

in

your

hand

or

you

have

a

small

weight

in

your

hand

The

patient

starts

the

exercise

in

wrist

flexion

then

heshe

does

a

wrist

extension

and

comes

back

to

the

start

position

very

slowly

Level

of

Evidence

This

exercise

is

an

concentric

en

eccentric

exercise

for

the

wrist

extensors

They

concluded

that

supervised

exercise

consisting

of

static

stretching

and

eccentric

strengthening

produced

the

largest

effect

in

reducing

pain

strenght

and

improving

function

Once

the

patients

can

do

this

they

can

progress

to

another

colour

of

theraband

or

you

increase

the

weight

Level

of

Evidence

In

this

study

the

subjects

were

assigned

to

group

A

or

group

B

Group

A

received

supervised

therapeutic

exercise

program

which

included

static

stretching

of

the

Extensor

Carpi

Radialis

Brevis

followed

by

eccentric

strengthening

of

the

wrist

extensors

Group

B

was

treated

with

Cyriax

physiotherapy

The

groups

that

performed

supervised

exercise

program

group

A

for

weeks

showed

significantly

greater

improvement

in

reduction

of

pain

and

functional

status

than

the

Cyriax

physiotherapy

treatment

Level

of

Evidence

Flexbar

for

tennis

elbow

Flexbar

Exercises

Level

of

Evidence

The

Flexbar

is

an

effective

and

beneficial

eccentric

exercise

for

patients

with

lateral

epicondylitis

This

resistance

device

is

easy

to

use

at

home

and

is

an

excellent

example

of

true

evidencebased

practice

in

physical

therapy

Instructions

for

the

Steps

of

the

Exercise

Hold

FlexBar

in

the

affected

right

hand

Make

sure

its

in

full

wrist

extension

The

other

end

of

the

device

must

be

held

with

your

unaffected

left

hand

Twist

FlexBar

with

unaffected

wrist

while

holding

Your

browser

does

not

currently

recognize

any

of

the

video

formats

available

Click

here

to

visit

our

frequently

asked

questions

about

video

The

FlexBar

exercise

is

performed

each

day

for

sets

of

It

takes

seconds

to

complete

each

repetition

and

between

each

set

of

repetitions

there

is

seconds

of

rest

Once

the

patients

can

perform

sets

of

they

progress

to

another

colour

FlexBar

with

a

higher

intensity

of

eccentric

resistanceThe

treatment

continued

until

the

patient

had

a

resolution

of

symptoms

which

occurred

at

an

average

of

weeks

of

treatment

with

clinic

visits

The

treatment

should

be

continued

until

this

resolution

occurs

The

treatment

should

be

continued

until

this

resolution

occurs

Key

Research

Rajadurai

Viswas

Rejeeshkumar

Ramachandran

Payal

Korde

Anantkumar

et

al

Comparison

of

effectiveness

of

supervised

excercise

program

and

cyriax

physiotherapy

in

patients

with

tennis

elbow

lateral

epicondylitis

A

randomized

clinical

trail

Scientific

World

Journal

Clinical

Bottom

Line

Lateral

epicondylitis

is

the

most

common

overuse

syndrome

in

the

elbow

It

is

an

injury

involving

the

extensor

muscles

of

the

forearm

In

a

lot

of

cases

the

insertion

of

the

extensor

carpi

radialis

brevis

is

involved

Contractile

overloads

that

chronically

tension

or

stress

the

tendon

near

the

attachment

on

the

humerus

are

the

primary

cause

of

epicondylitis

It

occurs

often

in

repetitive

upper

extremity

activities

such

as

computer

use

heavy

lifting

forceful

forearm

pronation

and

supination

and

repetitive

vibration

Medical

management

consist

of

NSAID

ice

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O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I B I O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O 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Core Strengthening Programme Introduction Stage 1 Contracting Deep Muscles Stage 2 Increasing Deep Muscle Endurance Stage 3 Arm Leg Movements Stage 4 Core Strengthening Exercises Trunk Circuit Exercises Arm Circuit Exercises Leg Circuit Exercises Back Circuit Exercises Gluteal Circuit Exercises Shoulder Trunk and Adductor Exercise Position your shins on the top of the Swiss Ball with your hands on the floor Slowly roll the ball round to your right then over to the left Hamstring Exercises Lie on your back with your heels on top of the Swiss Ball Dig your heels into the ball and lift your pelvis up Hold for 4 seconds Hip Flexor Hamstring and Gluteal Exercise Lie on your back with your heels on the Swiss Ball Arms across chest Lift up your pelvis and hold Lift up alternate legs and hold for 4 seconds Hamstring and Gluteal Exercise With your knees and ankles 15cm apart balance with your back on the Swiss Ball Your knees should be at 90 degrees Tighten your bottom and push your pelvis up Raise your alternate legs to horizontal and hold for 4 seconds Sit Ups Sit with the small of your back on the Swiss Ball and with a medicine ball between your knees Fold your arms across your chest and slowly sit up Trunk and Gluteal Exercise Balance with your back on the Swiss Ball your pelvis pushed up and your knees at 90 degrees Hold the medicine ball out with your arms straight above you Keep your pelvis pushed up and rotate the medicine ball slowly to the left then to the right Keep your arms straight Trunk Exercise Sit on the Swiss Ball and balance with your feet off the ground How long can you balance before touching the ground Top Stage 4 Core Strengthening Exercises Arm Circuit Exercises

O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O B O B B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


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Learning About Landforms Social Studies Projects Social Studies Activities Science Activities For Kids Science Lessons Science Week Educational Activities Kindergarten Science Elementary Science Teaching Science Landform mosaicthis is a great group project to have students create a various landforms and then present them to the class Andrea Knight Learning About Landforms Teachers Pay Teachers Learning About Landforms Differentiated Materials for Grades12 3rd Grade Social Studies Social Studies Resources Teaching Social Studies Social Studies Classroom Science Classroom Elementary Science Science Education Teaching Science Integrate science literacy with Learning About Landforms Student Book Andrea Knight Learning About Landforms Dinosaurs Preschool Preschool Letters Preschool Projects Daycare Crafts Preschool Learning Preschool Themes Preschool Art Dinosaur Crafts For Preschoolers Dinosaur Art Projects Volcano craft paper plate brown construction paper red orange yellow streamers Letter V week Andrea Knight Learning About Landforms Simple Science How Fold Mountains are Made Hands On Geography Middle School Geography Geography Classroom Geography Activities Geography Lessons Teaching Geography Middle School Science Volcano Activities Physical Geography This is a great handson science experiment to explain how fold mountains are formed Fold mountains are the most common type of mountain in the world Examples include the Himalayas Andes and Alps Andrea Knight Learning About Landforms Paper Art Landforms for Kids Teaching Science Teaching Art Teaching Social Studies Teaching Tips Arts Integration Geography Lessons Geography Activities Teaching Geography Physical Geography Cool idea for arts integration w geography but I would have students work in groups on different settings on a larger scale and have them teach each other Paper Art Landforms for Kids Kid World Citizen Andrea Knight Learning About Landforms Learning and Writing About Landforms Science Books Science Lessons Teaching Science Geography Activities Science Centers Science Resources Social Science Writing Resources Landform Reading Nonfiction Books Teaching Landforms Handson activity ideas for kids noprep engaging landform resources and a FREEBIE landform activity Andrea Knight Learning About Landforms Dinosaur Program Reading Tent Reading Room Dinosaurs Preschool Preschool Alphabet Preschool Songs Classroom Design Classroom Organisation Dinosaur Time Dinosaur Birthday My mouth is a volcano self control over speaking miniprogram celebration idea Andrea Knight Learning About Landforms Landforms Hey Crash Course Kids 171 Kindergarten Science Science Classroom Kindergarten Social Studies Elementary Science Teaching Social Studies Teaching Science Preschool 3rd Grade Social Studies Crash Course Kids has lots of great short informational science videos They have a whole series on Earth Science Andrea Knight Learning About Landforms Preschool Geography Kindergarten Science Kindergarten Social Studies Elementary Science Teaching Social Studies Science Classroom Teaching Science Geography Activities Teaching Geography Need something to help make maps and geography come alive for your kids Heres a fun Montessoribased project Andrea Knight Learning About Landforms Science Education Earth Science Experiments Earth Science Projects Science Ideas Kid Science Stem Science Kitchen Science Preschool Science Science Lessons Have your kids ever asked you How are mountains made Find out with this fun and YUMMY Science Experiment for Kids This is a great way to introduce plate tectonics Andrea Knight Learning About Landforms Kindergarten Science Kinder Science Science Classroom Teaching Science Primary Science Elementary Science Science Education Life Science This is a flipbook showing the different landforms The students can do it show the diversity of landforms in each region I also like how it portrays the height level of the different landforms Andrea Knight Learning About Landforms Waterfall Decoration Waterfall Design Diy Waterfall Rainforest Theme Rainforest Crafts Brazil Rainforest Rainforest Classroom Jungle Book Party Jungle Theme Birthday VBS 2012 Victoria Falls scene from Lifeway site could use for jungle jaunt love how the rock material continues behind the shimmery tinsel instead of the typical blue cloth image only Andrea Knight Learning About Landforms Fairy Garden Houses Gnome Garden Fairies Garden Mini Fairy Garden Fairy Gardening Fairy Box Fairy Tree Fairy Land Dioramas How to make miniature waterfall and cave with hot glue and styrofoam Andrea Knight Learning About Landforms Decorating Ideas for VBS Rainforest Project Rainforest Classroom Rainforest Theme Jungle Classroom Door Jungle Door Rainforest Crafts Jungle Bulletin Boards Rainforest Activities Rainforest Habitat This would be fun to have for a junglerainforest theme Andrea Knight Learning About Landforms Teachers Pay Teachers Wonderful Waterfall A Nonfiction SMARTICLE About Niagara Falls Grades 24 3rd Grade Writing 3rd Grade Reading Third Grade Grade 1 Comprehension Activities Reading Comprehension Flat Stanley Teacher Supplies Jan 1 Wonderful Waterfall A Nonfiction SMARTICLE About Niagara Falls This 4page student article focuses on waterfalls specifically Niagara The download also includes comprehension activities and a short quiz 10 pages Andrea Knight Learning About Landforms Pop Rocks Volcano Preschool Science Science For Kids Science Classroom Science Fun Science Lessons Science Experiments Teaching Science Activities For Kids Make your own erupting SOUND volcano using pop rocks other simple household ingredients What kid wouldnt want to make a volcano with pop and fizzle sound effects as it erupts and bubbles Way too fun fourth grade Unit Andrea Knight Learning About Landforms Awesome Science Fair Projects Biology Science Fair Projects Plant Science Fair Projects Plant Experiments Environmental Science Projects Science Ideas Kid Science Earth Science Experiments Sustainability Science Plant Water Filtration Experiment looks like a great science fair project Andrea Knight Learning About Landforms Science Experiments Kids Science Education Elementary Science Preschool Science Science For Kids Science Projects Science Lessons Science Classroom Simple volcano science for kids demonstrating how magma breaks through the surface of the earth creating an eruption Earth science standards observing and describing variations in soil Andrea Knight Learning About Landforms Student Reading Guided Reading First Grade Reading Close Reading Reading Resources Reading Activities Reading Response Nonfiction Creating Readers and Writers When Scientists Read Write Andrea Knight Learning About Landforms Underwater Theme Party Ocean Party Underwater Room Luau Party Diy Party Under The Sea Theme Mermaid Under The Sea Under The Sea Party Under The Sea Games Under the Sea Decor For instant under the sea ambiance hang blue and green streamers from the ceiling from one side of the room to the other They will move with the activity of the party and create a dreamy underwater effect Andrea Knight Learning About Landforms Ocean in a Bottle with 3 Simple Ingredients Happy Hooligans Crafts To Do Crafts With Kids Easy Crafts For Toddlers Fun Diy Easy Crafts For Kids Projects For Kids Science Projects Toddler Science Experiments DIY this Ocean in a Bottle craft from Happy Hooligans is an easy craft to make with younger children Combine water vegetable oil and food coloring in a twoliter bottle and watch the wave action Andrea Knight Learning About Landforms Dinosaur Crafts Dinosaur Art Projects Dino Craft Volcano Projects Painting For Kids Bubble Painting Art For Kids Crafts For Kids Elementary Art W a torn paper multihue blue background and torn white clouds RT volcano painting Paint simple black triangle and place several puddles of yellow orange and red With a straw blow the paint It swirls and bubbles making a realistic lava effect Andrea Knight Learning About Landforms Salt Volcano Groovy Liquid Density Science Experiment Science Projects For Kids Science Experiments Kids Science Fair Preschool Science Science For Kids Science Lessons Science Classroom Teaching Science Crafts For Kids Week Fun and easy and a good starting place for more experiments Science with Kids Salt Volcano A salt volcano acts a lot like a lava lamp kids are in awe over this fun Science Andrea Knight Learning About Landforms Teachers Pay Teachers Learning About Landforms Differentiated Materials for Grades12 Teaching Second Grade Second Grade Science 2nd Grade Writing Corner Social Nonfiction Activities Science Inquiry Ocean Activities Ocean Unit Sea Theme Learning About Landforms Differentiated Materials for Andrea Knight Learning About Landforms 4th Grade Science Elementary Science Middle School Science Preschool Science Science Resources Science Education Science Classroom Science Projects Science Lessons Learning Lab Resources Erosion and Landforms Science Activity With A Freebie Andrea Knight Learning About Landforms Kindergarten Science Elementary Science Science Classroom Teaching Science 3rd Grade Social Studies Teaching Social Studies Pop Jr Landforms from Brain Pop Jr First grade Andrea Knight Learning About Landforms Landform Flipbook 2nd Grade Social Studies Projects Elementary Social Studies Kindergarten Social Studies Lessons Social Studies Lesson Plans Social Studies Activities Elementary Science Teaching Social Studies Student Teaching Homeschool Kindergarten Ginger Snaps Landform Flipbook perfect for making Maps Graphs and Globes more interesting Andrea Knight Learning About Landforms Teachers Pay Teachers Landforms Map Skills Unit 1st Grade Science Elementary Science Science Classroom Teaching Science Classroom Projects Social Science 3rd Grade Social Studies Teaching Social Studies Map Skills Mix 2 cups flour 1 cup salt and cup water This should make a very thick dough After shaping landforms allow to dry for a day or two before painting Andrea Knight Learning About Landforms 3D Salt Dough Maps for Kids Maps For Kids Geography For Kids Geography Activities Teaching Geography World Geography Lessons Continents Activities Physical Geography Human Geography Montessori This is a great way to have some fun and do something different while learning geography Making a salt dough map is one of the only lessons that I remember from social studies in elementary school You could make maps of the continents or of the states Andrea Knight Learning About Landforms Creating Torn Paper Landscapes Teaching Art Art For Kids Construction Paper Art Landscape Art Lessons Earth Science Collages Boom Town Projects For Kids Art Projects Torn Paper Landforms for Earth Science What an awesome idea to put some color in the classroom after learning about landforms This would be a great way to get students to share their picture as well as explain what type of landforms they made and talk a Andrea Knight Learning About Landforms 4th Grade Science Middle School Science Preschool Science Science For Kids Teaching Science Elementary Science Classroom Science Ideas Elementary Science Fair Projects Science Erosion ExperimentWater wind and glacial The students could experiment with which type of erosion causes the most change and what could be done to prevent it Andrea Knight Learning About Landforms Volcano Project Science Experiments Kids Preschool Science Science For Kids Teaching Science Volcano For Kids Making A Volcano Activities For Kids Mad Science Week 34 Hawaii Fourth Grade Physical Science Activities Volcano Project Andrea Knight Learning About Landforms 4D Trioramas Science Lessons Life Science Science Resources Teaching Science Teaching Resources 2nd Grade Science Projects Ecosystem Activities 2nd Grade Crafts But some different biome animals This triorama could be used for book reports story sequencing science projects geography studies other SOSE topics or anything else you can think of Andrea Knight Learning About Landforms Elementary Science Science Education Science Classroom Science Lessons Teaching Science Science Ideas Teaching With Class Interactive Landforms Activity Andrea Knight Learning About Landforms 3rd Grade Social Studies Social Studies Activities Teaching Social Studies Teaching Science Social Studies For Kids Social Science Science Ideas Ginger Snaps Landforms Activity and Gradebook Printableso cute Might use for my grade social studies lesson Andrea Knight Learning About Landforms 6th Grade Social Studies Social Studies Classroom Social Studies Activities Teaching Social Studies Science Classroom Elementary Social Studies Social Science History Classroom Landform Maps fun easy and meaningful to make grade Social studies and Science Students will have fun making this and it will help them visualize important land forms in the United States Andrea Knight Learning About Landforms Library Lesson Plans Library Lessons Teaching Social Studies Teaching Math First Grade Lessons Elementary Library Science Classroom Rock Cycle Nonfiction Creating Readers and Writers When Scientists Read Write Nonfiction Articles about Landforms Andrea Knight Learning About Landforms Teachers Pay Teachers Learning About Landforms Differentiated Materials for Grades12 Social Science Science Education Science Classroom 2nd Grade Activities Teacher Forms Second Grade Science Science Standards Science For Kids I love this set of supplemental materials for teaching landforms The photos in this set are personal to me because I took them over the years fr Andrea Knight Learning About Landforms 3rd Grade Social Studies Social Studies Activities Teaching Social Studies Teaching Science Science Ideas Kid Science Social Science Science Education A Series of Grade Events Muy Bueno Landform Models Andrea Knight Learning About Landforms Teaching Geography Geography Lessons Social Studies Activities Teaching Social Studies Teaching Science Science Ideas Science Projects Teaching Tools Across the Landscape Across the Landscape lesson plan Create a unique stunning display of the Earths landforms Showcase learning with textured materials such as sandpaper aluminum foil and corrugated paper Andrea Knight Learning About Landforms Geography Activities Geography Lessons Teaching Geography Science Experiments Science Education Science Classroom Teaching Science Science Projects Landforms Project Great for art project while teaching geography and land forms Andrea Knight Learning About Landforms Elementary Science Science Classroom Middle School Science Science Experiments Science Ideas Science Fun Science Lessons Preschool Science Graham Crackers The Homeschool Den Earth Science Plate Movements Earthquakes Volcanoes and MountainMaking with graham crackers jelly and frosting Andrea Knight Learning About Landforms Teachers Pay Teachers Learning About Landforms Differentiated Materials for Grades12 Social Studies Classroom Teaching Social Studies Student Teaching Second Grade Science Third Grade Grade 1 Science Education Teaching Science Learning About Landforms Differentiated Materials for Andrea Knight Learning About Landforms Teachers Pay Teachers Learning About Landforms Differentiated Materials for Grades12 Geography Activities Teaching Geography Social Studies Activities Teaching Social Studies Teaching Science Land Forms Second Grade Science First Grade Reading Close Reading Sample nonfiction article from Learning About Landforms Supplemental Andrea Knight Learning About Landforms NEW Loaves of Landforms Elementary Science Science Education Science Classroom Science Lessons Teaching Science Teaching Geography Hands On Geography I love this tactile handson idea for teaching children about different types of landforms Students can see the landforms and identify where the land and water will be Andrea Knight Learning About Landforms Landforms 3rd Grade Social Studies Social Studies Activities Teaching Social Studies Teaching Geography Teaching Science Social Science Science Classroom Land Forms Science Videos Landforms VideoLittle bit advanced Andrea Knight Learning About Landforms 3rd Grade Social Studies Teaching Social Studies Student Teaching Teaching Science Social Science Teaching Geography Elementary Teaching Resources This is a landform flipbook that students can create in order to differentiate between the different types of landforms This activity could be done as guided practice and it could also be an assessment tool after a lesson on landforms Andrea Knight Learning About Landforms 3rd Grade Social Studies Social Studies For Kindergarten Elementary Social Studies Social Studies Activities Science Resources Science Ideas Teaching Social Studies Elementary Science Kindergarten Science After learning about land forms students can better visualize them by coloring a chart to keep with them We worked on land forms and made an anchor chart together They each made a land form poster and they came out cute Andrea Knight Learning About Landforms 1st Grade Science Kindergarten Science 2nd Grade Math Science Classroom Second Grade Grade 1 First Grade Teaching Social Studies Student Teaching One wonderful perk about the 15 hour drive home I was able to put the finishing touches on my Landforms unit This unit i Andrea Knight Learning About Landforms Landforms and Spring Break 3rd Grade Social Studies Social Studies Classroom Teaching Social Studies Science Classroom Classroom Resources Geography Lesson Plans Teaching Geography Science Lessons Help your primary grade students explore learn and write about landforms See our handson landforms activities plus our culminating writing project Andrea Knight Learning About Landforms Kindergarten Social Studies Social Studies Classroom Teaching Social Studies Music Classroom Future Classroom Teaching Science Kinder Science What Is a Landform Landforms Heinemann Library by Rebecca Rissman Andrea Knight Learning About Landforms Kindergarten Science Kindergarten Curriculum Map Kinder Science Kindergarten Social Studies Teaching Social Studies Science Classroom Teaching Science Teaching Habitats Elementary Science Fun edible way to teach landforms The student will locate major topographical features of the earths surface Identify and describe landforms Andrea Knight Learning About Landforms 3rd Grade Social Studies Kindergarten Social Studies Social Studies Activities Teaching Social Studies Teaching Science Science Ideas Teaching Geography Science Classroom A land form sheet made out of construction paper that students can create and then keep in their desks as a reference sheet Standard Locate major landforms and bodies of water on a map or other representation Andrea Knight Learning About Landforms Flying Over America 3rd Grade Social Studies Social Studies Activities Teaching Social Studies Teaching Science Teaching Tips Vegas Educational Videos Study Homeschool Andrea Knight Learning About Landforms Geology Cake Science Classroom Teaching Science Science For Kids Science Fun Science Projects Geography Classroom Teaching Aids Class Projects I HATE to add sweets to the classroom but this is a very visual way to teach this if the children are involved with baking the Geology cake All of the layers of the Earth with landforms and other things that would be useful to teach with Andrea Knight Learning About Landforms Billy Blue Hair What is Erosion Teaching Social Studies 3rd Grade Social Studies Kindergarten Social Studies Social Studies Projects Science Classroom Teaching Science Social Science Kinder Science Elementary Science This is a fun kidfriendly video to help students learn in a fun way the many characteristics of different landforms we will go over in our unit Andrea Knight Learning About Landforms

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