Elbow Tendonosis (“Tendonitis”)
by Eric Winder, DC
It’s surprising how aggravating elbow tendinosis pain can be. With this problem, simply lifting a coffee mug or gripping a steering wheel can become a difficult task. For many people, this issue is brief and easily treated, but a significant number of other people experience chronic pain that does not respond to typical treatment. Fortunately, specific fascia therapies can often resolve even difficult, long-term elbow pain.
Tendonosis (some doctors still use the older term “tendonitis”) can occur on either the inside or the outside of the elbow, commonly called “golfer’s elbow” or “tennis elbow” respectively. While golf and tennis are common causes of this problem, many other forms of repetitive stress can also be responsible.
In the past, when writing was performed with a quill and ink, there was “writer’s cramp.” The equivalent today is the elbow stress caused by typing for hours at a time, day after day on a keyboard. But, in many cases of elbow tendonosis, there is no obvious repetitive stress to be blamed. Regardless of the cause of injury, the same type of treatment is required.
Frontline conventional treatment methods can stop many cases of elbow tendonosis in their tracks. Initially, the most important parts of treatment include rest, use of ice and often a compression strap to support the muscles of the elbow. Then, stretching and strengthening the muscles and tendons is the next critical step. This should be started slowly, gradually increased over time to improve strength and flexibility.
While cortisone injections can offer short-term relief, research show they can lead to poorer results in the long-term. Moreover, the return to an activity such as tennis or typing should involve improvements in ergonomics. Perhaps the tennis player needs a more balanced racquet or improved technique, or the computer user needs an armrest or an ergonomic keyboard. When an obvious repetitive stress is the cause, sustainable changes must be made to reduce the stress, or the pain will return over time.
In my practice, I treat many cases of elbow tendinosis where all of the above treatment methods have been applied, but the patient still has significant pain. The focus of my treatment for this and many similar problems is on the fascia, or fibrous connective tissue, of the tendon and its muscle. In most cases of elbow tendonosis, there is tissue degeneration without inflammation. The connective tissue fibers of the tendon are less tightly organized and become wavy and tangled in appearance when seen under a microscope.
At our office, these fibers are a major focus of successful treatment. Gentle manual therapy is applied to release restriction from the affected muscle and tendon. Research has also demonstrated that treatment at the thoracic and cervical spine can provide better results with elbow tendonosis, and I have found this to be true as well. In fact, restrictions in the fascia of the wrist and shoulder can also affect the muscles that attach to the elbow.
A woman I will refer to as Shirley is a recent example of successful elbow tendinosis treatment at my office. Shirley developed “golfer’s elbow,” also known as medial epicondylitis, as a result of her work as a massage therapist. She had been diligent about stretching and strengthening, and underwent a course of physical therapy that helped her pain considerably. However, the pain returned, and the conventional treatments no longer relieved her pain. When I first saw her, she had been having pain for two years, and was considering a need to leave her profession.
On examination, I found problematic fascia restriction in the elbow tendons, several of the muscles of the mid-back and lower neck, and also in the pectoral muscles of the chest. Over the course of several visits, these restrictions were released by gentle manual therapy. In addition, Shirley was given new exercises to perform daily. With the combination of fascia release and specialized exercises, her pain gradually diminished. She was able to return to a full schedule of massage work with only mild pain and continued to improve with her home stretching and strengthening program.
Elbow tendinosis can become frustrating when regular treatment fails, but fortunately, fascia release therapy is usually successful in these cases. In my experience, the best treatment combines rest, stretching, a custom strengthening program, ergonomic modification of stressful activities and patient specific fascia release. With these tools, most people can leave behind the sharp, searing pain of tendinosis return to the activities they enjoy.
You are invited to attend an evening program on April 24, where you can learn in-depth about fascia, why it is important and how to solve fascia problems when they create pain or issues like headaches. Dr. Eric Winder will discuss case examples, provide a treatment demonstration and hold a Q&A session following the presentation. Attendees are invited to arrive at 6:50 p.m. for refreshments, and the program itself will take place from 7–8 p.m. This free event is located at 3131 S Tamiami Trail, #102, Sarasota. To RSVP, call 941-957-8390. Dr. Eric Winder has 21 years in practice and focuses on relieving pain and restoring alignment and motion through fascia release therapies without forceful manipulation. For more information, visit GentleBay.com.
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