Tennis Elbow, formally known as lateral epicondylalgia, is described as pain on the outside aspect of one’s elbow. Although this condition was named after the high percentage of tennis players who experience elbow pain, tennis elbow is a common condition with occurrence reported to be as high as 12.2% in general occupational settings. Although the problem with this condition is located at the elbow, like many other musculoskeletal problems, the solution may be found in another area of the body.
Health care providers will focus their attention at the site of the pain. Manual therapy techniques and therapeutic exercises prescribed by physical therapists have shown to be effective. Cortizone injections localized at the site of pain have also shown to help reduce symptoms, but on average only lasts for up to 8 weeks. One common theme across these types of focused at the site of pain, is they seem to help relieve the symptoms to some extent. However, treatment is not optimal because research shows that this condition has high recurrence rates, including a recent study which reported a recurrence rate of 29 to 39% in individuals receiving conservative treatment. It is possible that as health care providers, we may be focusing too much on treating the site of pain and need to start looking for the root of the problem in order to prevent patients from experiencing tennis elbow more than once.
Think of tennis elbow as a criminal investigation. The scene of the crime is located at the elbow, and pain can be perceived as the victim crying out for help. Would you expect the criminal to remain at the scene of the crime? It is more likely the culprit is hiding somewhere else, and recent evidence is showing the shoulder is a good place to look. One recent study measured shoulder girdle muscle strength and endurance in a group of patients with tennis elbow and compared the results with healthy individuals. The study concluded that patients with tennis elbow demonstrated a significant amount of weakness in the muscles that help with stabilizing the shoulder when compared to healthy individuals. The researchers of this study theorized that if the shoulder is unable to stabilize efficiently during upper arm activities, energy demands will increase at the joints below the shoulder, causing increased stress and potential for injury at those joints. Thus, weakness at the shoulder may cause too much stress at the elbow.
A good physical therapist can be thought of as a detective. Yes, they will need to investigate the scene of the crime or the site of pain, but they will use those clues to investigate other areas of the body to find the culprit (or culprits) in order to treat the condition long term. In the case of tennis elbow, addressing impairments at the shoulder may be the key to reducing recurrence rates.
John Giametta DPT is a licensed therapist at Amity Physical Therapy in Woodbridge. He received his doctorate from Sacred Heart University and has experience treating cardiopulmonary, neurological and post-surgical conditions. His special interest is in orthopedic and sports related injuries. Amity Physical Therapy was founded by Michael Dow MSPT and CEO/Director with a practice that now treats patients in three offices: Woodbridge, Hamden and Branford. John Giametta can be reached in Woodbridge at 203-389-4593 or visit www.amitypt.com.