Also known as lateral epicondylitis, elbow tendonitis/tendinopathy can be successfully treated with LLLT to achieve resolution. To view cost of treatment click here.
GP, Dr Shikha Parmar has a special interest in providing a drug-free safe, effective treatment solution in Melbourne for acute injuries and chronic pain using low level laser light therapy (laser therapeutics).
What is tennis elbow (lateral epicondylitis)?
Tennis elbow (lateral epicondylitis) is a condition in which there is pain where the tendons from the forearm muscles attach to the bony protrusion on the outside of the elbow (lateral epicondyle). It is caused by inflammation of the tendons inserting at that point (lateral epicondylitis).
What are the symptoms?
There is pain over the outer side of the elbow, which may radiate into the forearm and wrist. The pain usually comes on gradually, and is made worse by repetitive straightening and bending backwards (extension) of the wrist or rotation of the forearm.
How is it diagnosed?
Usually, a diagnosis is able to make the diagnosis based on the history and a physical examination. X-rays may be used to help rule out other causes of elbow pain, such as arthritis. An ultrasound or magnetic resonance imaging (MRI) scan will show the degenerative changes in the tendon, but is rarely required.
What causes tennis elbow?
Lateral epicondylitis is due to inflammation of the tendon fibres resulting from overuse of the muscles responsible for bending back (extending) the wrist and lifting the hand.
Risk factors for developing Tennis Elbow tendonitis include age, working in particular jobs or participating in certain sports.
It commonly occurs in people between the ages of 35 and 55, but does occur in other age groups too.
Although it is commonly called ‘tennis elbow’, the condition is not just caused by playing tennis. It can be caused by many other activities involving repetitive use of these muscles, such as gardening, painting, using a screwdriver or other racquet sports. Using a computer keyboard or mouse incorrectly can also contribute.
Sports People who may be affected:
You may be more likely to develop Tennis Elbow tendonitis/tendinopathy if you participate in certain sports that involve repetitive motions, especially if you have engaged in increased training or competition, or your technique isn’t optimal. This can occur with:
Age
As people get older, their tendons become less flexible — which makes them easier to injure.
Treatment
LLLT WORKS WHERE ORTHOTICS, TAPING, ICING, ROLLING OVER A BALL, STRETCHING, MASSAGE AND ANTI-INFLAMMATORY MEDICINES INCLUDING CORTISONE INJECTION HAVE ALL FAILED
Traditionally, treatments for lateral epicondylitis (tennis elbow) consist of temporary pain relief using anti-inflammatory medication, rest, and icing the area. While ice numbs the pain it also prevents healthy blood flow which is essential to providing oxygen and nutrients to the area to heal it, and remove waste products and CO2. Ice should therefore not be applied to injuries after the acute phase (the first day). http://drmirkin.com/fitness/why-ice-delays-recovery.html
Wearing a tennis elbow brace can help to protect the tendon and it is important to avoid activities that aggravate the pain.
Corticosteroid (cortisone) injections are sometimes used to assist in the treatment of tendonitis. These can be painful and the procedure carries risks such as increase in pain (“steroid flare”), skin discolouration at the injection site, nerve damage, infection, to name a few. Repeated injections may weaken a tendon, increasing your risk of rupturing the tendon. In particular, the inflamed extensor tendons of the elbow causing tennis elbow should not be injected with steroid because it puts the tendon as risk of rupture.
Rest: Rest is essential to tissue healing. You may have to stop performing the offending activity that increase pain or swelling for a short period of time. Don’t try to work or play through the pain to avoid further injuring the tendon.
Although rest is a key part of treating Tennis Elbow tendonitis, prolonged inactivity can cause stiffness in your joints. After a few days of completely resting the injured area, gently move it through its full range of motion to maintain joint flexibility. You can do other activities and exercises that don’t stress the injured tendon e.g. water exercise may be well tolerated.
Activity modification: The activity that caused the injury should be modified in such a way as to relieve the stress on the tendon.
Splints: Sometimes splints are used to keep the affected joint in alignment during activities so stress is taken off the tendon (such splints and wraps are available for tennis elbow). Splints may also be used during the initial resting period to allow the tendon to heal.
Surgery: Surgery is usually only considered if the affected tendon is severely torn or ruptured.
Low Level Laser Therapy (LLLT) is the application of red and near infrared light over injuries to stimulate cellular repair. LLLT has a powerful anti-inflammatory effect as well as a healing effect on the inflamed tendons of the elbow and surrounding inflamed soft tissues. LLLT is completely safe and has no effect on normal tissues. LLLT treats the underlying cause of the injury unlike pain medication which just masks the pain.
Inflammation is the body’s response to injury to attempt to heal it. But often the inflammatory reaction is excessive and this has a paradoxical inhibitory effect on the body’s natural healing mechanisms. This then perpetuates pain and dysfunction in the affected area. By improving circulation and increasing cellular repair functions LLLT provides an environment for your body’s own natural healing processes to be activated and restored. Once normal immune processes are restored, the excessive inflammation is reduced and healing can begin.
LLLT is very comfortable and does not exert any physical force on the elbow tendon. Manipulation of the injured tendons just aggravates the problem, so you don’t want to actually handle the tendons. Instead decreasing excessive inflammation with the use of LLLT enables faster healing.
LLLT stimulates blood flow and lymphatic drainage, improved delivery of O2 and nutrition to the area, oxygen utilisation, removal of oxygen-free radicals and other waste products, and tissue healing. Read more on how Low Level Laser Therapy works.
You will be encouraged to move the affected area within range of movement/pain but not exert stretch or force during the healing phase.
The end result aim is resolution of inflammation and restoration of healthy tendons and local soft tissues. Once tissues are healed, pain is eliminated and normal range of motion and function is restored. Then muscle and tendon strength and flexibility can be addressed with graduated exercises and stretching.
LLLT has no known side effects, is safe and effective. By treating the underlying problem, LLLT results in resolution of pain and restoration of function.
