Tennis Elbow – Centre Court
A beaut topical review on tennis elbow (lateral epicondylagia or LE) emerged in the recent Journal of Physiotherapy (Bissett and Vicenzino 2015, Physiotherapy management of lateral epicondylalgia, open access). I think it’s the best review of the status of our LE knowledge. Importantly, it reminds us that LE is “not self limiting and it’s associated with ongoing pain and disability in a substantial proportion of sufferers”. This suggests to me that people experiencing lateral elbow pain deserve a bit of attention and shouldn’t be shunted to the outside courts to wait it out. The authors of the review suggest that “sensitisation of the nervous system” is “one plausible reason for persistent pain in LE”.
As an old clinician I think I, and the patients I was treating over the years, have tried most of the interventions that are reviewed in the paper – exercise, manual therapy/manipulation, orthoses, laser, ultrasound, acupuncture, shock wave therapy and multimodal therapy, and I agree with the general consensus that not much helps. Although, the authors do state that “mobilisation with movement, and exercise” are likely to be superior to “wait and see”.
But, consider that most of these interventions do not target (or even consider) “sensitisation of the nervous system”. Perhaps the poor, equivocal outcomes are understandable?
The clip below presents my current thinking and some techniques for approaching lateral elbow pain – they’re all very much related to a sensitive nervous system. Maybe there are more in this group than we realise?