Self Help Series: Lateral Elbow Pain

‍Self Help Series: Lateral Elbow Pain

By: Anna Staehli Wiser, DPT, FAAOMPT

Lateral elbow pain is often times referred to as tennis elbow and is synonymous with the terms lateral epicondylitis and lateral epicondylalgia1. Most cases of lateral elbow pain are due to injury comprising one or more of the muscles in the common extensor group - usually the extensor carpi radialis. It is important to perform a thorough clinical examination and identify other possible causes of lateral elbow pain such as ligamentous instability, joint arthritis, nerve entrapment, or pain referral from the cervical spine. In most scenarios, imaging such as x-rays and MRIs are not necessary.2

Lateral elbow pain is most commonly associated with tennis players, but can also affect pickleballers as well. The high repetition and loading forces through the muscles and tendons in the forearm can cause injury to these tissues during racquet sports. Also, poor technique can play a role in manifestation of this injury too. For example, if the athlete is late on the back swing or has poor strength at the shoulder, he or she might over-extend the wrist as a compensation strategy.

Compensation at the wrist due to lack of strength at the shoulder is a very common cause of elbow problems in tennis and pickleball players2

Lateral elbow pain, however, is not exclusive just to athletes. People performing sustained and repetitious jobs involving the wrist and hands, such as operating heavy equipment, manipulating hand tools, and even typing on a keyboard can cause injury. 3

Lateral elbow pain can be completely debilitating and can lead to loss of ability to grip and lift even the lightest objects. The good news is that there are very effective treatments for this condition.

There is no need to live with this problem and just “put up with it”.

Many primary care doctors may recommend the wait and see approach and prescribe pills. When this does not work, they may recommend a corticosteroid injection or even a surgical consult!

So, the problem with this approach is that people are anxious to get back to normal life and want a solution now. “Waiting and seeing” is just not acceptable, and pills only mask the problem but are not a cure. Corticosteroid injection, although helpful in the short term, can have deleterious effects on the integrity of the tendons and may lead to future tendon problems, especially if the underlying cause of the injury is not addressed4-6. Surgical intervention should be a last ditch effort only, after all other treatment approaches have failed - and even then, surgery is not an optimal solution due to the inherent risks and poor outcomes. 7

So what are the best treatments for lateral elbow pain?

There is mounting evidence that support the following statements:

Therapeutic exercise is helpful8,9
Counterforce bracing is helpful10
Kinesiotaping is helpful11
Soft tissue and cross friction massage is helpful12–14
Joint mobilizations and manipulations of the elbow are helpful12,13,15–18
Joint mobilizations and manipulations to the wrist are helpful19,20
Cervical spine thrust manipulation has been proven to dramatically reduce pain at the lateral elbow21,22–24
Dry needling is strongly supported in the literature25. There is evidence to support that dry needling alone is more effective than the use of non-steroidal anti inflammatory medications (ibuprofen, aspirin) and bracing25. Also, dry needling has been proven to be more effective than corticosteroid injection26. In another study, dry needling was shown to be as effective as corticosteroid or PRP injection27

Dr. Wiser provides all of the research-supported treatments listed above. All of these treatments are administered during each treatment session to provide the quickest recovery possible. Dr. Wiser will perform a thorough evaluation and prescribe a detailed home exercise program and activity modifications for you. She will administer a multi-modal treatment that includes hands on therapy directed to the spine and entire arm to address all the impairments that are contributing to your elbow problem. Most people see dramatic improvements in just a few visits.

If you are suffering with nagging lateral elbow pain, call and make your appointment and start the journey to recovery.

Please share this newsletter with anyone you know who suffers with lateral elbow problems.

Although spinal manipulation is usually thought to be synonymous with chiropractic care, osteopractic physical therapists and osteopathic doctors are trained in spinal manipulation as well. Soft tissue massage is usually thought to be exclusively performed by massage therapists, but this is a technique that the osteopractic physical therapist is also well trained in. Lastly, dry needling is very similar to acupuncture in that both techniques employ the insertion of acupuncture needles and share the goal of promoting healing and reducing pain.

References:

1. Sanders TL Jr, Maradit Kremers H, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidemiology and health care burden of tennis elbow: a population-based study. Am J Sports Med. 2015;43(5):1066-1071.

2. Keijsers R, de Vos RJ, Kuijer PPF, van den Bekerom MP, van der Woude HJ, Eygendaal D. Tennis elbow. Shoulder Elbow. 2019;11(5):384-392.

3. Cutts S, Gangoo S, Modi N, Pasapula C. Tennis elbow: A clinical review article. J Orthop. 2020;17:203-207.

4. Lenoir H, Mares O, Carlier Y. Management of lateral epicondylitis. Orthop Traumatol Surg Res. 2019;105(8S):S241-S246.

5. Shrier I, Matheson GO, Kohl HW 3rd. Achilles tendonitis: are corticosteroid injections useful or harmful? Clin J Sport Med. 1996;6(4):245-250.

6. Smith AG, Kosygan K, Williams H, Newman RJ. Common extensor tendon rupture following corticosteroid injection for lateral tendinosis of the elbow. Br J Sports Med. 1999;33(6):423-424; discussion 424-425.

7. Bateman M, Littlewood C, Rawson B, Tambe AA. Surgery for tennis elbow: a systematic review. Shoulder Elbow. 2019;11(1):35-44.

8. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939.

9. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013;309(5):461-469.

10. Shahabi S, Bagheri Lankarani K, Heydari ST, et al. The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: A systematic review and meta-analysis of randomized controlled trials. Prosthet Orthot Int. 2020;44(5):341-354.

11. Cho YT, Hsu WY, Lin LF, Lin YN. Kinesio taping reduces elbow pain during resisted wrist extension in patients with chronic lateral epicondylitis: a randomized, double-blinded, cross-over study. BMC Musculoskelet Disord. 2018;19(1):193.