Tennis Elbow, also known as Lateral Epicondylalgia, is a very common condition we see at our clinics. Anyone who has suffered with tennis elbow will tell you that they can be very painful, start to interfere with your daily activities and be very stubborn to get rid of.
Patients with tennis elbow generally exhibit one or more of the following symptoms:
Tenderness/pain over the lateral epicondyle (bony bump on the outside of the elbow)
Pain with gripping or extending the wrist/fingers
Pain when the forearm extensor muscle is stretched
Trigger points in the muscles of the wrist and forearm.
Tennis elbow like most injuries can be split into three different stages.
Acute stage: lasts less than 6 weeks.
Subacute Stage: lasts 6weeks – 3months.
Chronic stage: lasts longer than 3 months.
This blog will focus on chronic tennis elbow and its association with dysfunction of the joints in the neck.
For years it was thought that the pain associated with chronic tennis elbow was due to inflammation of the extensor tendon at the elbow. But this has been proven to be incorrect, as countless studies of the tendons of chronic tennis elbow sufferers have shown no evidence of the chemicals typically associated with inflammation. What they did find was an increase in chemicals (glutamate and substance P) which powerfully excite the pain transmission in nerves. This in combination with a reduction in the blood supply and changes in the coordination of the muscles of the arm and hand leads to degeneration of the extensor tendon at the elbow.
This helps to explain why so many patients with tennis elbow find that cortisone injections haven’t helped. Studies show cortisone is very good at reducing the pain initially, but the majority of patients who have had cortisone injection for tennis elbow show an increase in pain after 6 weeks.
A number of recent studies have looked at chronic tennis elbow and its association with the neck.
Burgland in 2008 reported that 70% of patients with lateral epicondyle pain had neck and/or thoracic pain. Another study by Vicenzino found that 90% of the patients with lateral epicondyle pain had lower cervical hypomobility (joints in lower neck not moving properly)
A study by Haavik in 2011 found that people with a history of subclinical neck pain, but no current pain, had reduced elbow joint position sense accuracy compared with people with no history of any neck complaint. Interestingly, the study also found that performing spinal manipulation (chiropractic adjustments) to the dysfunctional joints in the neck helped improve their upper limb joint position sense.
To summarise, dysfunction of the joints in the neck can distort the brains understanding of where the elbow joint is in space. The proper control of the elbow will be slightly inaccurate, and with day to day activities, this could facilitate repetitive microtrauma to the tendons which predispose them to ongoing degeneration.
The research shows that the most effective treatment for chronic tennis elbow not only focuses on the elbow, but aims to improve the function of the joints of the neck.
This is why at Proactive Chiro & Sports Med we utilize a variety of techniques proven to effectively help patients with tennis elbow. These including:
Mobilisation of the wrist and elbow
Manipulation of the upper back and neck
Active muscle release, dry needling and Rocktape of the muscles of the forearm
Rehabilitation exercises to improve strength, coordination and proper movement patterns.
The majority of what we have discussed in this blog can be applied to patients with Golfer’s elbow. Golfer’s elbow is very similar, but the pain is around the medial epicondyle (bony bump on the inside of the elbow)
By Dr Danny Diab - Chiropractor