Tennis elbow is a common overuse condition where the outside of the elbow becomes sore and tender. Though it is extremely common amongst tennis players, it can occur in many professions involving repetitive arm and hand movements including chefs and manual tradespeople.
The pain is often described as burning, aching or a sharp pain from the elbow and referring down the forearm when gripping or holding things, or after extended periods of repetitive arm movements. With increases in repetitive activities, more force is applied to the elbow area that the tissues can handle and results in inflammation and pain. The pain often subsides with time and people commonly begin to avoid those aggravating activities or push through the pain.
After approximately three months, the acute inflammation stops occurring and is classified as chronic tennis elbow. Here new changes in the area begin including changes to the sensitivity of pain nerves, and changes to the cellular structure of the forearm tendons.
Manual therapy aims to firstly decrease the elbow and forearm pain; secondly to facilitate tissue healing to help normalize function at the elbow, and thirdly to strengthen the area to help prevent recurrences. However the problem may stem from further up the arm, and as such the shoulder, thoracic and cervical spine are also assessed and treated.
Conservative management approaches are dependent on the individual, but can include massage, stretching, mobilisation of the elbow, shoulder and thoracic spine, shockwave therapy, bracing, kinesiotaping and rehabilitation.
A study conducted in Brisbane compared manual therapy to corticosteroid injections, and a ‘wait and see’ approach. The research found that cortisone injections had significant decreases in pain after six weeks over manual therapy and the ‘wait and see’ methods. However after six weeks, this was lost and the group had high recurrence rates of pain and function loss. The study suggested that the recurrence rates from corticosteroid injections could cause a delay in recovery comparably to the ‘wait and see’ method.
Manual therapy was found to have superior benefits in pain and function, comparably to the ‘wait and see’ and corticosteroid injections in the long term. For these reasons, many researchers do not recommend injections as the only treatment approach for lateral epicondylopathy.
In conclusion, tennis elbow is a common condition in many professions involving heavy or repetitive hand and forearm movements. It can become extremely troubling with day-to-day activities and work. After the condition has become chronic, it is more difficult to treat though not unresolvable via a trial of conservative management. According to the research, conservative treatment was found to be superior in terms of pain and function to corticosteroid injections and ‘wait and see’ approaches.
Please call your Chiropractor at AHS on 9948 2826 or visit our clinic at 9/470 Sydney Rd in Balgowlah servicing the surrounding suburbs of Allambie, Balgowlah Heights, Seaforth, Fairlight and Manly on the Northern Beaches.
References:
Bisset, L. Beller, E., Jull, G. Brooks, P., Darnell, R., Vicenzino, B. 2006, ‘Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomized trial’, British Medical Journal