tennis elbow, lateral epicondylalgia, lateral epicondylopathy, lateral epicondylitis

What Is Tennis Elbow And How Do You Fix It?

Chiropractor in Amarillo TX discusses it

 

That pain you're feeling on the outside of your elbow is commonly known as 'tennis elbow'. Most people know that's the term for the spot and the pain. What most people don't necessarily know is why it hurts, what they did to make it hurt, or how to get it to go away. 

I'm going to give you a brief education on the condition, also known as 'lateral epicondylalgia', and some tips toward getting it to go away and leave you alone! 

Symptoms of Tennis Elbow

  • Pain over the outside part of the elbow
  • Pain when extending the wrist
  • Pain upon gripping movements

What causes tennis elbow?

Boiled down to the simplest concept, it is pain where the muscle and tendon attach to the bone on the outside of your elbow. The Mayo Clinic describes it as "a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm." What that means is that it is essentially an 'overuse' issue. But can it be more than that? The research suggests that it is more than that and may not all be coming from the elbow joint and the tendon attachment alone. 

Think about it; tissue has a healing time and while some patients get out of pain and recover, some never do. Even when avoiding the use of the joint and muscles in the area. This suggests that there may be a bigger, more neurological ingredient to the recipe. A couple of mentors of mine, Dr. Anthony Nicholson and Dr. Matthew Long pose the question, "Could functional impairments in motor control and pain processing be present first, which then predispose the person to a mechanical injury from a trivial activity? If this is the case then it’s possible that a person is in some way predetermined to suffer chronic lateral epicondylalgia before the elbow tendon even becomes painful."

This is a very legitimate question considering there is research suggesting that the trigger point found in the muscle began with dysfunction within the brain before manifesting as a trigger point in the muscle. 

The old idea of it being strictly one of overuse is looking more and more outdated these days. For example, it's known that there is abnormal collagen separation in patella tendons of athletes yet they have no pain. The same goes for nonpainful tears in the rotator cuff mechanism of the shoulder. Knowing this, it seems unlikely that just collagen damage is the pain generator. Indeed, rather than an inflammatory overuse injury, it's looking more and more that it is a degenerative tendon insertion that has a deranged structure triggering the complaint. 

Let's add to the mix that long-lasting pain also resides in the central nervous system as well as in the elbow. Your central nervous system makes up your pain experience based on the actual source of your pain (your elbow) as well as a host of other factors including but not limited to things you may have been told by other doctors, things you believe about yourself, and your physical abilities, your beliefs about being able to eventually recover, and things of that nature. All of these factors and more combine to make up your pain experience. 

Now it's starting to become more apparent that this is a non-inflammatory degenerative process of a tendon insertion connected to a hyper-excited set of spinal cord circuits that themselves are not being dampened will by areas of the brainstem that control pain, painful triggers, and whether that information is allowed into the noggin to cause you pain. 

I know, we're getting a little deep into the weeds. I hope you're following along because it's all fascinating. Especially when you hear that based on studies by Berglund et. al. and Vincenzino et. al, 90% of patients with tennis elbow also have some dysfunction in their neck region and 70%  had neck and/or mid-back pain. Wow, right? Everything really is connected. 

There absolutely appears to be some connection between the neck and upper back pain and tennis elbow, believe it or not!

There are explanations for this that I will spare you in this space here because the explanation gets VERY DEEP into the weeds unless you are an expert in neurology. But, trust me, a chiropractor can help through various forms of treatment focused at the elbow but also in the neck and upper back regions. 

How do we treat Tennis Elbow?

Since the pain isn't typically just coming from the elbow joint, we want to increase healthy movement patterns in the whole chain from the neck region, through the upper back, into the shoulder and elbow. This helps to 'remap' proper movement and functionality. Research by Fernandez-Carnero et. al. shows that spinal manipulative therapy (going to the chiropractor) in the neck region had an immediate pain-relieveing effect at the elbow and an immediate 38% reduction in pain from gripping! Wow!

We want to do what we can to decrease the 'chronic pain syndrome' aspect of the complaint through techniques that desensitize the central nervous system that is dialed up to 11 on a scale of 1-10 and has been allowing the pain to persist beyond the time it takes tissue to heal up. 

Low-Level Laser - Also known as cold laser, this technique is excellent at healing painful soft tissue injury. Another possible consideration is shockwave treatment which is a newer modality increasing in clinical use. 

We involve the patient in active exercise including eccentric exercise to facilitate the repair of degenerative tendons. Dr. Nicholson says, "It appears that collagen production is the key to a successful recovery from the peripheral dimension of tendonosis.  We know from animal experiments that eccentric loading improves tensile strength."

 

Wrapping it up

Tennis Elbow (Lateral Epicondylalgia) is much more than an overuse injury. some recover quickly. For those that do not, it is imperative to visit an evidence-based, patient-centered practitioner that knows what's going on and has techniques and tricks that can get the elbow to behave. The longer the condition is allowed to persist, the more difficult it becomes to eradicate. 

So be seen by an expert. Today!

 

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Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist, Orthopedic specialist, and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (https://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected] Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com.

Dr. Williams was voted Best Chiropractor In Amarillo in the Best of Amarillo 2020. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.  

 

References:

Ashe, M. C., McCauley, T., & Khan, K. M. (2004). Tendinopathies in the upper extremity:. Journal of Hand Therapy, 17(3), 329–334. doi:10.1197/j.jht.2004.04.002

Berglund, K. M., Persson, B. H., & Denison, E. (2008). Prevalence of pain and dysfunction in the cervical and thoracic spine in persons with and without lateral elbow pain. Manual Therapy, 13(4), 295–299. doi:10.1016/j.math.2007.01.015

Ruiz-Ruiz, B., Fernández-de-las-Peñas, C., Ortega-Santiago, R., Arendt-Nielsen, L., & Madeleine, P. (2011). Topographical Pressure and Thermal Pain Sensitivity Mapping in Patients With Unilateral Lateral Epicondylalgia. The Journal of Pain, 12(10), 1040–1048. doi:10.1016/j.jpain.2011.04.001

Lim, E. C. W., Sterling, M., Pedler, A., Coombes, B. K., & Vicenzino, B. (2012). Evidence of Spinal Cord Hyperexcitability as Measured With Nociceptive Flexion Reflex (NFR) Threshold in Chronic Lateral Epicondylalgia With or Without a Positive Neurodynamic Test. The Journal of Pain. doi:10.1016/j.jpain.2012.04.005

Hsu, S. H., Moen, T. C., Levine, W. N., & Ahmad, C. S. (2012). Physical Examination of the Athlete's Elbow. The American journal of sports medicine, 40(3), 699–708. doi:10.1177/0363546511428869

Fernández-Carnero, J., Cleland, J. A., & Arbizu, R. L. T. (2011). Examination of Motor and Hypoalgesic Effects of Cervical vs Thoracic Spine Manipulation in Patients With Lateral Epicondylalgia: A Clinical Trial. Journal of manipulative and physiological therapeutics, 34(7), 432–440. doi:10.1016/j.jmpt.2011.05.019

Barr, S., Cerisola, F. L., & Blanchard, V. (2009). Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: a systematic review. Physiotherapy, 95(4), 251–265. doi:10.1016/j.physio.2009.05.002

Vicenzino, B., Smith, D., Cleland, J., & Bisset, L. (2009). Development of a clinical prediction rule to identify initial responders to mobilisation with movement and exercise for lateral epicondylalgia. Manual Therapy, 14(5), 550–554. doi:10.1016/j.math.2008.08.004

Herd, C. R., & Meserve, B. B. (2009). A Systematic Review of the Effectiveness of Manipulative Therapy in Treating Lateral Epicondylalgia. Journal of Manual & Manipulative Therapy, 16(4), 1–14.

Fernández-Carnero, J., Fernández-de-las-Peñas, C., & Cleland, J. A. (2008). Immediate hypoalgesic and motor effects after a single cervical spine manipulation in subjects with lateral epicondylalgia. Journal of manipulative and physiological therapeutics, 31(9), 675–681. doi:10.1016/j.jmpt.2008.10.005

Vincenzino, B., Cleland, J., & Bisset, L. (2007). Joint Manipulation in the Management of Lateral Epicondylalgia- A Clinical Commentary. Journal of Manual & Manipulative Therapy, 1–8.

Waugh, E. J. (2005). Lateral epicondylalgia or epicondylitis: what's in a name? The Journal of Orthopaedic and Sports Physical Therapy, 35(4), 200–202.

Dunning, J., & Rushton, A. (2009). The effects of cervical high-velocity low-amplitude thrust manipulation on resting electromyographic activity of the biceps brachii muscle. Manual Therapy, 14(5), 508–513. doi:10.1016/j.math.2008.09.003

 

 

 

 

 

 

 

 

 

Jeff Williams, DC, FIANM

Jeff Williams, DC, FIANM

Owner/Chiropractor

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