Pregnant women, or those trying to conceive can be hesitant about treatment choices for injuries such as tennis elbow.
When men or women are trying to conceive they can be understandably hesitant about reaching for drug-based pain or anti-inflammatory treatment for injuries such as tennis elbow. Even more so if a woman is actually pregnant. An option that can work really well is acupuncture. This article discusses its use in the treatment of tennis elbow.
Patients frequently present to acupuncture clinics for treatment of ‘tennis elbow’
Tennis elbow diagnosis usually involves evaluation of common symptoms and signs, accompanied by simple physical tests. Often this condition has become chronic due to delayed presentation for treatment, or unsuccessful intervention with other modalities.
Most cases of tennis elbow will resolve within a year. However manual work and high levels of pain before intervention are linked to poorer prognosis.
Pain relief, minimising aggravating movements, and muscle conditioning are considered primary rehabilitative goals for tennis elbow.
Lack of consensus regarding treatment
Despite numerous studies, and the prevalence of tennis elbow, there is little consensus regarding its treatment. Physiotherapy interventions reviewed include extracorporeal shock wave therapy, orthotics, mobilisations with movement, non-steroidal anti-inflammatory drugs, transverse friction massage, taping, laser, ultrasound, electro-magnetic field and ionisation therapy. However no conclusions were drawn from studies regarding the effectiveness of any of the treatments. Similarly there is a lack of evidence supporting or refuting surgical intervention and cortisone injection. Cortisone injection appears to only give short term relief and there may be risk of further injury during this time due to pain masking.
On the other hand, studies suggest stretches and exercises may help reduce pain. They also suggest elbow manipulation may help in the early stages of treatment. Interestingly, despite evidence suggesting a lack of inflammatory markers, oral or topical non-steroidal anti-inflammatory drugs in conjunction with avoidance of aggravating activities, may be helpful in early stage tennis elbow.
Various hypotheses have been proposed to explain the biomedical actions associated with acupuncture treatment of tennis elbow. Neurotransmitters such as serotonin, E-endorphin, methionine enkephalin and dynorphins are believed to be involved with acupuncture’s analgesic effect. However the effect of acupuncture on the associated underlying pathologies is not yet understood.
Never the less studies do suggest acupuncture is a viable treatment option. One study compares needling local acupuncture points on patients unsuccessfully treated with steroid injection, to steroid injection treatment alone. The acupuncture group was treated 1-2 times per week. This study showed similar improvements in both groups, suggesting acupuncture may be a viable alternative to steroid injection.
Another study compares manual acupuncture with electro-acupuncture treatment of tennis elbow. Both these interventions were compared to a non-intervention control group. Treatment was given three times weekly for 2 weeks. Manual acupuncture showed a 32% improvement in pain, while electro-acupuncture showed 50%. The untreated group had a 5% improvement.
Evaluation of tennis elbow in an acupuncture clinic
A skilled acupuncturist considers a number of contributing underlying pathologies when evaluating tennis elbow. Treatment of these imbalances may be significant for preventing reoccurrence of symptoms. Consequently treatment should vary according to diagnosis and presentation.
Evaluation of a patient presenting with tennis elbow should include a thorough assessment. Performance tests should be utilised and the entire arm, shoulder, neck and upper back should be palpated, range of motion evaluated and any associated signs and symptoms noted. An evaluation of the patients normal posture, and posture associated with activities that trigger tennis elbow symptoms, may also be necessary.
Neuroanatomical considerations for acupuncture
Trigger points may also be significant in the development and treatment of tennis elbow. Biomechanical force such as muscle overload and repetitive mechanical stresses may activate trigger points causing pain. Trigger points are often treated by direct needling, typically involving injection of a variety of substances. However studies suggest the needling effect is independent of the injected substance.
Poor posture may significantly contribute to tennis elbow. Many of my tennis elbow patients have occupations that contribute to compromised upper back and shoulder posture e.g carpenters, dressmakers, massage therapists, and desk workers. Needling trigger points appears to be particularly helpful in these cases.
In addition, treating the cervical spine area may also be of benefit. In particular it is important to investigate possible cervical spine problems that may refer pain to the elbow. I also treat points corresponding to the spinal innervation of the muscles involved with the pain pattern. This was a technique I learned a number of years ago and which I have found to be extremely effective for most types of arm pain.
Effective intervention for tennis elbow frequently requires evaluation and treatment of structures and functions other than that of the elbow area alone. Traditional acupuncture treatment involves evaluation and treatment of structures, as well as the physiological patterns that may be contributing to the degenerative processes involved. Acupuncture is an effective treatment for tennis elbow. The time frame it takes for pain resolution will be largely determined by the patients ability to reduce activities or biomechanical use of the body that aggravates the condition, as well as exercise rehabilitation of the affected structures.