Image from Shutterstock, credit to Adam Turner.

by Eric Winder, DC   

It’s surprising how painful and frustrating elbow tendonitis can be. It can transform the simple acts of lifting a coffee mug or holding a steering wheel into a difficult, uncomfortable task. For some, this elbow pain is easily treated, but many others suffer from chronic pain that does not respond well to typical treatment. Fortunately, specific fascia therapies can often resolve even the most difficult, long-term elbow pain. 

Tendonitis can occur on either the inside or 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. For instance, in ages past, when writing was done with a quill and ink, there was “writer’s cramp.” 

The equivalent today is elbow stress caused by typing for hours at a time on a keyboard.  However, in many cases, there is no obvious repetitive stress to be blamed. Regardless of the cause of injury, the treatment is usually the same. 

Typical Treatment 

Frontline conventional treatment methods can stop many cases of elbow tendonitis in their tracks. Initially, the most important parts of treatment include rest and use of ice, as well as a compression strap to support the muscles of the elbow. Exercises that stretch and strengthen the muscles and tendons are the next critical steps.   

This should be started slowly, then gradually increased over time to improve strength and flexibility. While cortisone injections can offer short-term relief, research shows they often cause poorer results in the long-term. When possible, the return to an activity such as tennis or typing should include ergonomic improvements.   

Perhaps the tennis player needs a different racquet or improved technique, or the computer user needs an armrest or an ergonomic keyboard.  When an obvious repetitive stress is the cause, changes must be made to reduce the stress, or the pain will return. 

Fascia Therapy 

In my practice, I treat many cases of elbow tendonitis where all the above treatment has been applied, yet the patient still has significant pain. The focus of my treatment for this and many other types of tendonitis is on the fascia (fibrous connective tissue) of the tendon and its muscle. In many cases of elbow tendonitis, 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 the key focus of successful treatment. Gentle manual therapy is applied to release restriction from the affected muscle and tendon fascia.   

This restores pliability to the connective tissue, and over time, can return a more uniform alignment of the “tangled” connective tissue fibers. Research has demonstrated that adding in treatment at the thoracic and cervical spine can offer better results with elbow tendonitis, and I have found this to be true in my practice. Also, restrictions in the fascia of the wrist and shoulder can affect the muscles that attach to the elbow.  

Shirley’s Case 

A woman, whom I’ll refer to as Shirley, is a recent example of successful elbow tendonitis treatment at my office. Shirley developed “golfers elbow,” also known as medial epicondylitis, as a result of her work as a massage therapist. She had been diligent with exercises to stretch and strengthen the elbow, along with physical therapy that helped decrease her pain.   

However, the pain returned over time, and these conventional treatments no longer relieved her pain. When I first saw her, she had been in pain for two years and was considering the need to leave her profession, because massaging several clients a day was too painful. On examination, I found problematic fascia restriction in the elbow tendons, several of the muscles of the mid-back and lower neck, and 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, Shirley’s 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 exercises.  

Elbow tendonitis can become frustrating when conventional treatment fails, but fascia release therapy is usually quite successful in these cases. In my experience, the best treatment combines rest, stretching, a custom strengthening routine, ergonomic modification of stressful activities and, most importantly, fascia release therapy tailored to a patient’s specific pattern of restrictions. With these tools, most people can leave behind the sharp, searing pain of tendonitis and return to the activities they love. 

Dr. Eric Winder has 25 years in practice and focuses on relieving pain and restoring alignment and motion through fascia release therapies. For more information, visit GentleBay.com.