Here is a list of treatment options we have been using for our tennis elbow cases. I also link to research which we use to help guide our treatment protocols.
Shock wave therapy, high-intensity laser therapy, dry needling, manual therapy, and exercise have all shown positive outcomes in the management of tennis elbow.
Extracorporeal Shock Wave Therapy (ESWT):Multiple studies have demonstrated the efficacy of ESWT in treating lateral epicondylitis (tennis elbow). A systematic review and network meta-analysis found that ESWT was superior to injection therapies for pain relief and grip strength recovery. Another meta-analysis confirmed that ESWT effectively relieves pain and improves grip strength compared to other methods. Additionally, a randomized controlled trial showed that ESWT combined with physiotherapy significantly improved pain, grip strength, and function.[1-3]
High-Intensity Laser Therapy (HILT): HILT has also shown positive outcomes in managing lateral epicondylitis. A randomized clinical trial found that HILT was more effective than ESWT in reducing tenderness, alleviating pain, and improving disability. Another systematic review and meta-analysis supported the efficacy of HILT in reducing pain intensity and improving quality of life.[4-5]
Dry Needling: Dry needling has been shown to be effective in reducing pain and improving function in patients with lateral epicondylitis. A systematic review and meta-analysis indicated that dry needling significantly improved pain intensity, elbow disability, and grip strength. Another meta-analysis found that dry needling reduced pain and related disability with large effect sizes.[6-7]
Manual Therapy: Manual therapy, including wrist manipulative therapy, has been found to be effective in reducing pain in lateral epicondylitis. A systematic review concluded that wrist joint manipulations positively affect pain in the short term compared to other interventions. Additionally, a randomized clinical trial demonstrated that adding thrust manipulation to a multimodal physical therapy program significantly improved pain and function.[8-9]
Exercise: Exercise interventions have been shown to have better outcomes than passive interventions for lateral epicondylitis. A systematic review and meta-analysis found that exercise outperformed corticosteroid injections and wait-and-see approaches in improving pain, grip strength, and elbow disability. Another randomized controlled trial demonstrated that eccentric exercise was more effective than concentric exercise in reducing pain and increasing muscle strength.[10-11]
Collagen and isometric exercise for Tennis elbow:
There are studies looking at collagen supplementation with isometric exercise for tendon disorders, particularly in the context of improving pain and function:
The study by Praet et al. investigated the effects of oral collagen peptide supplementation combined with structured exercise in patients with chronic mid-portion Achilles tendinopathy. The results showed significant improvements in function and reductions in pain when collagen peptides were combined with exercise.[1] Although this study focused on Achilles tendinopathy, the principles may be extrapolated to lateral epicondylitis (tennis elbow) due to the similar pathophysiology of tendinopathies.
Additionally, the systematic review by Khatri et al. highlighted that collagen peptide supplementation, when combined with exercise, can improve joint functionality and reduce joint pain.[2] This review supports the potential benefits of collagen supplementation in conjunction with exercise for connective tissue disorders, including tendinopathies.
Furthermore, the study by Vuvan et al. demonstrated that isometric exercise alone can improve pain and disability in lateral elbow tendinopathy.[3] Combining this with collagen supplementation, as suggested by the aforementioned studies, could potentially enhance these benefits.
In summary, while direct studies on collagen supplementation with isometric exercise specifically for tennis elbow are limited, existing evidence from related tendinopathies suggests that this combination could be beneficial in improving pain and function.
The history of tennis elbow:
It’s interesting to look back sometimes at what we thought we knew and how understanding has evolved. We no longer think of this as a simple inflammatory condition. Here’s a quick history lesson for fun:
Early Recognition:
The earliest recorded description of what we now recognize as tennis elbow dates back to 1873. German physician Runge was the first to document the condition, but it wasn’t specifically linked to tennis. He described the pain and inflammation of the tendons near the elbow, primarily affecting workers engaged in repetitive hand motions. This was the start of recognizing overuse injuries in the forearm.
The Connection to Tennis:
By the late 19th and early 20th centuries, the growing popularity of tennis (especially lawn tennis) led to more widespread cases of lateral elbow pain among players. In 1883, Henry J. Morris, a British surgeon, specifically linked the condition to the sport and coined the term “lawn tennis arm.” The repetitive backhand motion in tennis was identified as a significant contributing factor.
Evolution of Diagnosis:
For much of the 20th century, tennis elbow was understood primarily as a repetitive strain injury affecting the extensor muscles of the forearm. The term lateral epicondylitis became more commonly used, reflecting the inflammation at the lateral epicondyle (where these tendons attach). However, by the late 20th century, research began to show that this wasn’t simply an inflammatory condition but rather involved degenerative changes in the tendons, leading to a shift in terminology toward tendinosis rather than “itis.”
Diagnostic techniques evolved from clinical observation to imaging tools like MRI and ultrasound, which allowed for more precise identification of tissue degeneration and partial tears, moving away from the idea of pure inflammation.
Treatment Evolution:
1. Early Approaches (19th-early 20th century): Treatment initially focused on rest, immobilization, and sometimes the use of counterforce braces. In the absence of modern pharmaceuticals, hot and cold applications, along with basic physical therapies, were common.
2. Mid-20th Century: As corticosteroids became available, injections were frequently used to manage inflammation and pain, despite only providing temporary relief. Surgery was reserved for chronic, unresponsive cases. Physical therapy methods also started to gain traction, incorporating exercises to strengthen the forearm muscles.
3. Late 20th-21st Century: Over time, treatment shifted to more evidence-based approaches. Eccentric strengthening exercises, focused on controlled lengthening of the tendons, became a primary intervention, especially after studies highlighted their effectiveness in promoting tendon healing. Alongside this, shockwave therapy, dry needling, soft tissue mobilization, and more sophisticated bracing techniques became popular.
4. Current Approaches: There’s a deeper understanding of tendon pathology, leading to the use of regenerative therapies like platelet-rich plasma (PRP) injections, which aim to promote tendon healing rather than merely manage symptoms. Conservative approaches, including eccentric loading, continue to be a first line of treatment, with surgery as a last resort.
Overall, the history of tennis elbow reflects broader shifts in how we understand and treat musculoskeletal conditions, moving from a focus on inflammation to tendon degeneration and adopting more precise, patient-specific treatment modalities.
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