Background: Lateral Epicondylalgia is the most common musculoskeletal condition affecting the elbow. It is a significant cause of lost productivity at work and impacts individuals in their activities of daily living. Chronic pain, while not as common, is one of the most common reasons that an individual will seek medical care. While treatment for Lateral Epicondylalgia is well documented in the literature (1,2,3,6,14,15), Lateral Epicondylalgia with co-morbid Chronic pain research is lacking. The purpose of this case study is to describe an evidence based and patient led approach for the treatment of lateral epicondylalgia in a patient with chronic pain while considering biopsychosocial factors to form a strong therapeutic alliance. Case Description: The patient was a 46-year-old female who came to physical therapy while she awaited consultation for an ultrasonic tenotomy (TENEX) procedure. The patient presented with pain at her right lateral epicondyle and extensor mass with any arm or hand movement. The patient also had co-morbid chronic pain since the age of 21. Intervention: Therapy focused on building a strong therapeutic alliance, pain neuroscience education, and graded exercise exposure.
Outcome Measures: Primary outcome measures were pain free grip strength, range of motion, manual muscle tests, Focus on Therapeutic Outcomes (FOTO) questionnaire, and patient self-reported function and pain. Discussion: This case report highlights the importance of therapeutic alliance, pain neuroscience education, and graded exercise progression in the rehabilitation in patient with lateral epicondylalgia and co-morbid chronic pain.