Tennis Elbow: Too Generic Of A Diagnosis

Tennis Elbow is one of the most generic diagnoses in all of healthcare.  When you receive a generic diagnosis, chances are you are going to receive generic treatment…

We see a ton of “tennis elbow” cases that have not responded to traditional treatment methods. Why is this?  Because the diagnosis lacks specificity.  A great analogy is when a meteorologist uses the term precipitation.  Is it Rain?  Snow?  Hail?  Sleet?  Precipitation in Florida may be much different than precipitation in Minnesota.

The classic symptoms are sharp pain and discomfort around the lateral portion of the elbow with use- particularly grabbing, lifting, holding, carrying or pulling. The pain can be so severe daily activities such as holding a coffee mug or opening a door becomes painful and difficult.

Tennis elbow is a term generally used interchangeably with lateral epicondylitis, which means inflammation of the tendons that attach on the lateral elbow. Just 5 years ago, evidence of effective treatment options were very poor.

The typical lateral epicondylitis treatment recommendations were (and unfortunately often are still) rest, ice, braces and anti-inflammatory medication.

A 2009 study observed using specific eccentric exercises and soft tissue work caused a research trial to be stopped early so that the control group could also benefit from the overwhelming effectiveness of the treatments. This study, combined with others shows that up to 95% of all tennis elbow cases can be treated effectively without surgery!

In some cases symptoms will resolve in 6-24 months with NO treatment; however cases left untreated can lead to chronic pain, decreased quality of life, and increased risk for surgical intervention.

If you have tried the traditional approach of reducing inflammation, then why do you still have pain?

The answer is usually simple. You likely were misdiagnosed. A more accurate term for your case is likely lateral epicondyLOSIS (NOT lateral epicondyLITIS). Lateral epicondylosis involves degeneration, microtearing and cell death, NOT inflammation. In fact, epicondylosis and epicondylitis are virtually opposite of one another and need to be treated entirely differently. Without proper diagnosis, your chance of proper treatment is extremely low.

Inflammation may be a necessary component to healing your case.

With lateral epicondylosis, the tissue literally breaks down as a result of one or more factors: repetitive use, sustained tension, prior acute injury, lack of flexibility and decreased circulation to the tissues. If this is the case, a controlled amount of inflammation must be introduced to the tissue to initiate healing processes.

How is Lateral Epicondylosis treated?

Circulation must be improved, the loading mechanism must be removed and healing must begin. Think of lateral epicondylosis as you digging yourself a hole. Every time you overload it (via exercise, repetitive trauma (typing, wrenching, etc), sustained tension, etc) you dig your hole a little deeper. Initially the pain is intermittent, but eventually the pain becomes more frequent, more intense and sometimes constant.

New, healthy tissue must be stimulated and the tensile strength of the tissue must be increased. We use several soft tissue techniques to reduce scar tissue, normalize load and increase circulation-all of which begin to get you out of the hole you’ve dug. Additionally we perform specific ECCENTRIC exercises and stretches to restore adequate strength to the tissue and minimize load to the tissue.

Potential solutions to your lateral epicondylosis are Active Release Techniques(r) and instrument-
assisted soft tissue mobilization. Both techniques effectively reduce adhesion formation (scar tissue), increase circulation (bring essential healing nutrients to the area and flush out waste products) and stimulate the fibroblast to produce collagen (replace scar tissue and dead cells with new, healthy tissue).

Additionally specific eccentric exercises must be prescribed to rebuild tensile strength and increase the tissue’s capacity to load.

Often times when we see stubborn cases it was as simple as a misdiagnosis (either by a physician or the patient themselves) and improper treatment being rendered. A clue, if you’re case has been diagnosed as “tennis elbow,” that is not specific enough to render proper treatment. Essentially it’s like trying to revive a dying plant that lacks essential nutrients in the soil by using water and sunlight. Water and sunlight should be good for the plant, but why didn’t they work? Simple, it didn’t lack water or sunlight it lacked essential nutrients beneath the soil.

Effective tennis elbow treatment (Cincinnati) can only be administered after a proper diagnosis. We are very good at diagnosing the cause of your elbow pain. If we determine you suffer from lateral epicondylosis, rather than one of the other potential diagnoses, we have the tools (pun intended) to help you get on the path to recovery and eliminate the nagging symptoms you’re experiencing.

We always offer complimentary consultations with one of our doctors if you want to discuss your case further, prior to becoming a patient.  Please click below to schedule.