Physiotherapy for Tennis Elbow Tendonitis
Physiotherapy for Tennis Elbow Tendonitis
What is Tennis Elbow?
The lateral epicondyle is the bony part on the outer side of your elbow. It serves as the attachment point for many of the muscles that extend the wrist. Injuries to these muscles and tendons through overuse will cause patients pain in that area. Lateral epicondylitis, or “Tennis Elbow” is the name given for inflammation or tendonitis of this region.
What Causes Tennis Elbow Tendonitis?
Researchers believe that overuse of the wrist will cause the wrist extension muscles to stretch while being contracted, damaging their fibers1. Lateral epicondylitis is a condition that affects about two million people a year3. Smoking, obesity, and repetitive wrist movement of at least two hours a day are all risk factors for this condition.
Management of Tennis Elbow
Management for an initial episode of tennis elbow consists of a combination of activity modification, use of an elbow brace, nonsteroidal anti-inflammatory drugs (NSAIDs), and traditional Physiotherapy for six weeks before re-evaluation. While this treatment option is effective in some patients, there is little high-quality evidence to support any particular approach4. If the initial therapy fails, then patients will obtain x-rays of the elbow and receive glucocorticoid injections for pain relief. However, while studies have shown a short-term improvement5, these injections do not prevent re-occurrence and may lead to worse long-term outcomes6.
Extracorporeal Shockwave Therapy for Tennis Elbow
For patients who fail initial therapy for lateral epicondylitis, extracorporeal shock wave therapy is a non-invasive treatment that is decreasing pain and improving functionality. The proposed theory behind shockwave therapy is that the energy emitted by the transducer produces a force to the tendon that promotes healing and decrease the inflammation at the site of the injury7. This type of therapy has been around since the 1980’s when it was used as a method to destroy kidney stones. However, it was not until the 1990’s that research showed that shockwave therapy is effective for soft tissue injuries. Studies have shown that this treatment shows improvement in pain and functionality when compared to sham therapy8 and surgical procedures to improve lateral epicondylitis aka Tennis Elbow9. When comparing extracorporeal shock wave therapy again glucocorticoid injections, patients had better short-term pain relief and functionality with the injections. However, paints with the shockwave therapy had better long-term results10,11.
Research is ongoing to prove the efficacy of shock wave therapy for the treatment for tennis elbow tendonitis, however clinical trials are demonstrating shockwave therapy to be an effective, non-invasive procedure that can decrease pain and improve long-term functionality in people with this chronic condition.
- Tsuang, Y., et al. Isokinetic Eccentric Exercise can Induce Skeletal Muscle Injury within the Physiologic Excursion of Muscle-Tendon unit: A Rabbit Model. Journal of Orthopedic Surgery and Research. 2007;2(13):1-7.
- Zeisig, E., Ohberg, L., Alfredson, H. Extensor Origin Vascularity Related to Pain in Patients with Tennis elbow. Knee Surgery, Sports Traumatology, Arthroscopy. 2006;14(7):659.
- Struijs, P., Kerkhoffs, G., Assendelft, W., Van Dijk, C. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both-a randomized clinical trial. American Journal of Sports Medicine. 2004;32(2):462.
- Cowan, J., Lozano-Calderón, S., Ring, D. Quality of prospective controlled randomized trials. Analysis of trials of treatment for lateral epicondylitis as an example. The Journal of Bone and Joint Surgery. 2007;89(8):1693
- Tonks, J., Pai, S., Murali, S. Steroid Injection Therapy is the Best Conservative Treatment for Lateral Epicondylitis: A Prospective Randomised Controlled Trial. International Journal of Clinical Practice. 2007;61(2):240.
- Coombes B., 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.
- Notarnicola, A., Moretti, B. The Biological Effects of Extracorporeal Shock Wave Therapy (ESWT) on Tendon Tissue.Muscles, Ligaments and Tendons Journal. 2012;2(1): 33–37.
- Rompe J, Decking J, Schoellenr C, et al. Repetitive Low Energy Shock Wave Treatment for Chronic Lateral Epicondylitis in Tennis Players. American Journal of Sports Medicine. 2004;32:734–43.
- Radwan, Y., et al. Resistant Tennis Elbow: Shock-Wave Therapy versus Percutaneous Tenotomy. International Orthopaedics32.5 2008;32(5): 671–677.
- Ozturan, K., Yucel, I., Cakici, H., Guven, M., Sungur, I., Autologous Blood and Corticosteroid Injection and Extracorporeal Shock Wave Therapy in the Treatment of Lateral Epicondylitis. Orthopedics.2010;33(2):84-91.
- Gunduz, R., Malas, F., Borman, P., Kocaoglu, S., Ozcakar, L. Physical Therapy, Corticosteroid Injection, and Extracorporeal Shock Wave Treatment in Lateral Epicondylitis: Clinical and Ultrasonographical Comparison. Clinical Rheumatology. 2012;31(5):807-812.