Monday 5th August, 2019
  Categories: General

Why “tennis elbows” tend to not get better, and what you can do about it.

Summary

Tennis elbow is described as an “overuse injury”. Why is it though that if you have a cut, a bruise or even a broken bone it will heal, but a tennis elbow tend to not heal? They seem to defy treatment and go on forever, causing pain, disability and often a life of taking medication? In this article we present the commonly overlooked thing that helps cause tennis elbow then stops it healing. We will provide a simple test your practitioner can use to test for this, plus a strategy to help diagnose and manage this condition.

What is tennis elbow

The basics

Repetitive or over-use of muscles causes microscopic damage. Body builders use this principle to help build muscles. They exercise to cause this damage, then allow the body time to recover and re-build the muscles stronger. Injuries such as tennis elbow occur when repetitive or over use causes such damage, but the body does not have time to repair. With further damage occurring the body's ability to repair is overwhelmed, and it tries to patch things up the best it can. In the case of tennis elbow this occurs at the elbow where a large number of forearm muscles attach.

Complications with time

As with most musculoskeletal conditions, if allowed to remain it becomes more complex. The continuing attempts at repair can cause an accumulation of scar type tissue. The continuing pain can sensitise the nervous system as occurs in fibromyalgia, where pain is felt greater than it actually is. Further, pain, disability and frustration can cause psychological, social and economic issues.

Common treatment

The common treatment is to remove the continual stress by restricting usage and possibly using a brace. Pain medications are often given for the purpose of making a patient more comfortable while they heal. When this fails (as it often does) there are therapies designed to assist healing and address the buildup of scar tissue. Examples include dry needling and other physical therapies.

Why does treatment often fail?

As mentioned previously, much more serious injuries heal, so why does this “overuse injury” persist when one stops over using it? The primary reason is trigger points. These cause the following problems.

Tension on the muscles

Trigger points cause muscles to become constantly tight. This places tension on the area where the muscles attach. This contributes to the overload that causes the injury, and can stop it from healing.

Pain from trigger points

If one googles "trigger point chart" these charts will show that trigger points in the forearm muscles can produce pain almost identical to that produced by tennis elbow.

Further complications

Tennis elbow and trigger points occur together

The same repetitive or over-use of muscles that causes tennis elbow also causes the development of trigger points. This means that where there is a tennis elbow there are almost always trigger points. Further, one of the diagnostic features of tennis elbow is that pain is reproduced by movements that stress the injured attachment. Those movements also stress the trigger points so it is very easy to mistake the diagnosis.

Lack of diagnosis

Although most competent therapists or masseurs would be able to find them, trigger points don't show up in standard medical tests or scans and cannot be treated by drugs or surgery. Therefore, they are often not even mentioned in the journal articles used to guide medical practice.

Example

Coombes, Brooke K., Leanne Bisset, and Bill Vicenzino. "Management of lateral elbow tendinopathy: one size does not fit all." journal of orthopaedic & sports physical therapy 45.11 (2015): 938-949.

Summary

Trigger points almost always develop with a tennis elbow. They create tension that helps cause the injury, then prevent it from healing. Their symptoms also mimic tennis elbow. Despite this they usually don't even rate a mention in medical guidelines. What that means if if you are diagnosed with a tennis elbow some (or even all) of the symptoms may be caused by trigger points. Even if they are caused by the tennis elbow the trigger points will help prevent healing.. Finally, if it does heal any residual pain from the trigger points will make it appear that the condition still exists. Unfortunately, journal articles such as the one mentioned above do not discuss this what so ever.

A practical solution

This situation is very bad for anyone with a tennis elbow It only benefits those who provide drugs and medical services for those who do not get better. To help remedy this we will provide some practical information one can discuss with his or her health care professional. We give two simple diagnostic tests they can use, plus advice on treating trigger points.

Pain reproduction tests

A masseur or therapist will examine the forearm muscles for trigger points. When these trigger points are pressed upon they shoot pain. If this pain is similar to the pain experienced it indicates that some or all the "tennis elbow" pain is caused by trigger points

Tenderness relief test

If the injured muscle attachment at the area is a problem it will be tender when pressed upon. If tension produced by a trigger point is exacerbating this injury treating the trigger point allowing the the muscle to relax should cause a reduction in tenderness. To do this test a professional first presses the injury site near the elbow, noting it's tenderness. The trigger point is then treated. There are many ways to do this, but the simple method we use is by applying one of our General Purpose Massagers for 30-60 seconds. The muscle is then re-examined to make sure the trigger point is relaxed and no more trigger points are present. The injured area is pressed upon again once the trigger points are treated and the muscle is relaxed. If it is less tender it confirms that the abnormal muscle tension is aggravating the injury

The treatment of trigger points

For information about how trigger points are treated please see our guide on trigger points and other chronic soft tissue problems

Professional consultation

We want people to be informed and discuss issues with their health care professional, but discourage self diagnosis and management. Please feel free to read the Practitioner version of this article or download a .pdf version

We are continually adding more information on research and uses. Subscribe below to have us email them to you "hot off the press".

Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more