The Internet has lots of information on how to treat tennis elbow (aka lateral epicondylitis) but you need to be careful. Some treatments may leave you worse off.
As a martial artist, chiropractor and father of a young boy, elbow pain should go on the list of eventualities. At one point when Keegan was younger and wanted to be carried seemingly all the time, I was dealing with bilateral medial AND lateral epicondylitis. For those of you unfamiliar with the terms, the inside AND outside of BOTH elbows hurt. A lot.
I’ve always said that the benefit of being in the martial arts for all these years is that I’ve had pretty much everything my patients come in with. And as a chiropractor specializing in treating patient’s pain, anything that I’ve had myself I find that I’m usually better at treating. And our office is pretty darn good at treating most of what our patients come in with anyway.
With that in mind, I can tell you that treating elbow pain can be tough. Maybe it’s because by the time patients present for treatment of his or her elbow pain it’s already been going on for WAY too long. Maybe it’s because we are such a manually-oriented creature and the muscles, tendons, ligaments and fascia involved in elbow pain are constantly being abused.
What many patients who present with elbow pain are not aware of is that the soft tissues surrounding the elbow and associated with elbow pain are NOT elbow muscles. Rather, they are the muscles involved in finger and wrist movements (which is why treatment of carpal tunnel HAS to involve the soft tissues around the elbow).
Further, while the condition is called an “itis,” inflammation is actually not likely to be present. Rather, the condition is one of scar tissue. Overuse the area and inflammation occurs initially. Since the human body doesn’t heal at 100% some dysfunctional tissue is going to be left after that episode is done. This is the stage where the use of NSAIDs to calm the inflammation of the initial injury is probably going to leave you with MORE scar tissue.
Scar tissue is easier to injure, so you re-injure the soft tissues of the elbow. It heals with MORE scar tissue. The cycle repeats over and over again. As you can see, the scar tissue is the problem, NOT the inflammation.
This is why anti-inflammatories do almost nothing to fix the problem and why cortisone injections may only make the problem worse.
And just in case you don’t think that’s accurate, let me introduce you to this particular study.
Researchers looked at the use of physiotherapy and cortisone injections on outcomes at one year in lateral epicodylitis (aka tennis elbow–named so for the force on the outside of the elbow when the tennis ball hits the backhand swing). Here’s what they found:
- Patients with injections were 14% less likely to report complete recovery or “much improvement” at 1 year over placebo injection.
- Injectors were 77% more likely to report recurrence at 1 year (Tweet this).
Given that many doctors whip out the cortisone needle before you’ve even gotten the word “elbow pain” out of your mouth, what are you supposed to do?
Here is the way we handle elbow problems in our office:
- The keystone of treatment is soft tissue work to the region. This can include Graston, Active Release or Fascial Manipulation.
- Manipulation of the elbow and wrist to make sure the joints in this area do not break down.
- Eccentric strengthening exercises to rebuild strong soft tissues after we break them down with the soft tissue treatment. Use usually recommend the use of a Therabar with some variation of an exercise called the Tyler twist.
With this approach, the vast majority of patients will respond very well to elbow pain. My personal opinion (which is now supported by this article, which moves it more towards “fact” and less my opinion…) is that NSAIDs and cortisone injections are very bad for elbow pain and will likely make the condition MUCH more difficult to treat in the long run.
If you have had elbow pain, what did YOU do to recover?