What exactly is tennis elbow and how can you treat it effectively?

Funny thing about tennis elbow is that you don’t have to play tennis to get it. Tennis elbow is a form of tendinopathy (used to be called tendinitis) that affects the elbow. Luckily, the condition is not terribly complicated to resolve. That’s the good news, the bad news is that it usually takes between 3-6 months to fully resolve depending on the individual and how severe the condition is.  

Tennis elbow is an overuse injury to common extensor tendon of the elbow which attaches to the bony protuberance on the outside (lateral) aspect of the elbow. It is commonly due to work relate or a sport that involves excessive, quick, monotonous, repetitive movements of the wrist. Tendons are the bits that attach muscles to bones; most muscles in the body have tendons. Tendons have slightly a different makeup than muscles, and as such they react differently to use and exercise.

Tendons have relatively poor blood circulation compared to muscles, which affects tendons ability to heal and repair. Thus, muscles tend to heal much faster compared than tendons when injured. To make matters worse, is that some tendons such as the proximal hamstring tendon have even poorer blood flow than others.

As with almost all musculoskeletal injuries including tendon problems, there are three tried and tested methods to resolve the problem.

One way is to stop doing the things that caused the problem. We need to identify the cause of the problem, then eliminate or minimise the causative action/activity. In the case of tennis elbow, we know it is an overuse injury, so all we have to do is identify the action that is overloading the elbow and eliminate or minimise said action.

The second method of resolving almost all musculoskeletal problems including tennis elbow is to make the affected area stronger and more resilient. Strength and rehabilitation exercises are what is required in this method. Unfortunately, there are thousands of exercises out there and not all of them are equally effective. In fact, some exercises will perpetuate or even exacerbate a tennis elbow. It is important to get reliable information from a professional before you fully commit yourself in a strength or rehabilitation program.

There are several variables that need to be correctly assessed and coordinated in order for a strength/rehab program to yield the best results. They include the difficulty of the exercise, the load (how heavy the weights or resistance used), the number of repetitions, number of sets, the amount of rest in between sets, how many times per week the program needs to be performed. It truly is an art to designing a safe, appropriate, and effective strength/rehab program. Again, this is why it is so important that you consult an appropriately trained professional to help design a bespoke rehab program for you.

The third method of resolving almost all musculoskeletal problems including tennis elbow is passive therapy. Passive therapy is treatment that is provided by a third party, which can be some form of allied health professional. It may be a form of manual therapy: physiotherapy, chiropractic, osteopathy, acupuncture, massage therapy, myotherapy, or a form of electrotherapy (shockwave therapy, ultrasound therapy, laser therapy, inferential current). It is important to point out that research indicates that one treatment method is not superior to others, in fact most therapies tend to yield very similar outcomes. Different practitioners will possess different skillsets, some of which may better suit your individual needs. So, we recommend you actively seek out a good practitioner in order to increase your chances of a successful outcome. Several recent studies demonstrated superior results with combination therapy (therapy involving two or more treatment modalities) compared to stand-alone therapy (one single therapy done in isolation).

One therapy that I highly recommend for tennis elbow is shockwave therapy. It is a relatively new treatment modality; it was first introduced in the early 90s, however, it has become more readily available in the past decade. Research has demonstrated it to be the most effective electrotherapy on the market. Several studies specifically assessing tennis elbow show a 80-85% success rate at resolving the condition. These numbers are substantially higher than almost any other form of treatment for tennis elbow including manual therapy and exercise therapy.

Each of the three above mentioned methods of resolving tennis elbow are proven to be safe and effective. Moreover, when all three methods are combined the effects are exponential and the results are appropriately matched. I often say to patients: “One + One + One = 12” inferring that when you combine method one with method two and three, they work synergistically to yield exponential results. The great news is that two of the three methods are at your disposal 24/7, you don’t need to go anywhere or see anyone else to help you, which is both empowering and liberating.

At Back to Function Dr Adam Gavine (M. Chiro) integrates several of these treatment modalities to provide patients with the quickest and most effective non-invasive treatment available. If you would like to learn more about our services and techniques, please visit our website www.backtofunction.com.au. Call us if you wish to discuss which treatment options are best suited for your individual needs.

We hoped this information helped shed some light on tennis elbow and its different treatment options.

Your Back to Function Team