Wimbledon Tennis Championships is underway and it reminded me to touch on the dreaded “tennis elbow” diagnosis. I hear this all the time from people who complain of lateral elbow pain (pain on the outer elbow) but don’t even play tennis. I always ask “did you hurt your arm playing tennis?” If not, then you don’t have “tennis elbow”. Patients then claim to have some kind of tendonitis or lateral epicondylitis . Unfortunately, you most likely have a tendonosis or epicondylosis. I spoke with some Crossfit and basketball athletes last week who have battled “tennis elbow” before without ever playing tennis. “Tennis Elbow” affects not only sports people but office workers and labourers as well.”
“”Tennis Elbow” affects not only sports people but office workers and laborers as well.”
My doctor or therapist said I have “tennis elbow”, I guess I have some kind of tendonitis or tendonosis. What is the difference?
Tendinitis is the active inflammation of the tendon. The mechanism usually occurs due to micro-tears that occur with repeated heavy or sudden overload. Tendonitis occurs overs a few days to weeks and time to recovery can be anywhere from 4 to 6 weeks. The key for this diagnosis is that there has to be an inflammatory, chemical, component. Unfortunately, research has shown us that more often than not, there is NO active inflammatory component in long standing cases of “tennis elbow”.
Tendonosis is more degenerative in nature. The injury occurs due to the tendon chronic overuse. Without adequate rest, even light, repetitive strains can result in a tendonisis. Tendonosis occurs typically over 7 to 10 weeks and time to recovery can take even longer, between 3 to 6 months. This tendonisis has a degenerative component over an inflammatory one.
Why is the diagnosis important?
Depending on what process is going on will depend on what treatment will best affect your body.
Depending on what process is going on will depend on what treatment will best affect your body. Inflammatory tendonitis requires an initial anti-inflammatory treatment protocol. By trying to give strengthening or stretching during this phase could hinder your recovery. Less conservative approaches, such as anti-inflammatory medications, and corticosteroid injections, may not be particularly effective if you do not have an active inflammatory component in your injury. In some cases, corticosteroid injections risks have been shown to increase the degeneration of tendons, risk of recurrence and therefore, make the tendon at risk for rupture.
Degenerative tendonosis requires an approach that addresses rebuilding the tendon as quickly and safely as possible. Specific exercises like those prescribed by FR and FRC practitioners can target the muscles and tendons without causing further degeneration. Diagnosis is also important to know when to rest and when do proceed with more advanced exercises like eccentric training. Modalities such as shockwave therapy, to help with proper neovascularization (big word meaning blood vessel supply) may be used. Blood vessel formation in tendonosis problems tends to be poorly done by the self-healing body which can lead to pain and slow healing. Other modalities such as dry needling and supportive taping can help improve pain control and support other tissues.
Coaching proper technique for the specific tasks is required for both diagnoses. Supportive bracing may also be recommended to reduce load on the elbow tissues.
How do I know which one I have?
See a health professional, like a Chiropractor, that can provide a detailed physical exam. The physical exam should consist of a general history of your complaint and specific palpation, muscle and orthopaedic testing. Your health practitioner should be able to discern the trouble muscles. Is it ECRL, ECRB, common extensor,blah blah …. All important structures involved in any “tennis elbow” complaint need to be thoroughly examined by hand.
In addition to the elbow, I would look at the wrist, shoulder and neck. There may biomechanical problems that need to be addressed to take pressure off of the affected tendon.
Are you in Hong Kong and suffer from elbow pain or “tennis elbow”?
Contact me for a healthy conversation. Perhaps I can help.
