An Acupuncturist's Guide To Treating Tennis Elbow

Acupuncture for Tennis Elbow

Tennis Elbow (also known as lateral epicondylitis) is a common injury caused by overuse of the tendons and muscles in the elbow.

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What causes Lateral Epicondylitis exactly? How does Tennis Elbow develop?

Tennis Elbow is a common injury caused by overuse of the tendons and muscles in the elbow as a result of repetitive motion. Despite its name and the fact the term was originally coined in 1873 as “lawn tennis elbow” (also known as lateral epicondylitis) the condition has been known to affect far more than just tennis and racket sport players including golfers, basketball and volleyball players and even fencers.(1) It’s also common amongst carpenters, construction workers, painters, cooks and many other professionals that work with their hands or bodies.(2) Studies have shown Tennis Elbow impacts about 1-3% of adults at some point in their life, and around 50% of tennis players will develop symptoms.(3)

Notorious for its nagging symptoms and persistence, the condition is easily identified by pain and inflammation developing around the extensor carpi radialis brevis(4) – a muscle outside of the elbow which connects to the extensor tendon used when bending your elbow. As this becomes overused, microtraumas form on the extensor tendon causing pain to extend from the outside of the elbow down the forearm.

Synergy Acupuncture New Jersey Extensor Radialis Diagram

Background of Treatment for Tennis Elbow

Over the years since its initial discovery, many nonoperative treatment methods have been applied to Tennis Elbow with various degrees of long and short term success. The most common approaches include exercises meant to strengthen, stretch and encourage alternative use of the muscles involved, the use of braces to improve functionality and reduce pain, the use of various forms of medication to control pain and inflammation, and, last but not least, the practice of acupuncture and other forms of physiotherapy. While no single treatment has been proven to be stronger than any other for long term recovery, it has been noted they work well in tandem with one another, providing a 90% recovery rate within a year from diagnosis.(5) 

Long term treatment for Tennis Elbow can be a daunting affair- the options beyond routine nonoperative treatment are surgery or medicinal injections – neither of which are a guarantee and both carry the potential for adverse reactions which can cause long term issues of their own. Most who get surgery do see success, however it can be costly and there is always a chance for relapse.  Rehabilitation requires several weeks, sometimes months, of time off work and up to a year from physical activity. For athletes, this can be a risky endeavor forcing them to take an excessive amount of time off exercise and practice regiments at the very least, with the prospect of game-changing complications also present. It has been reported that only 4-11% of tennis elbow cases warrant surgery as well, making it by far the least common approach. In addition, the narrative on surgery is complicated. Although there are three different approaches, surgeons aren’t quite sure which mechanisms produce good results!(6)

In recent years, many athletes have been turning to acupuncture and other forms of traditional Chinese medicine such as dry-needling as opposed to the traditional routes western medicine typically suggests. Many athletes have discovered acupuncture to be an effective, noninvasive, natural way to use their bodies’ intrinsic anti-inflammatory and healing abilities – allowing them to recover faster from symptoms and prevent their return. With acupuncture treatment, athletes are able to stay active and mobile at lower cost and with less risk.

Mike's Experience

While growing up I only sporadically played tennis – however it has quickly become my favorite sport over the past few years. I spend much of my time watching tennis tutorials on Youtube and admiring athletes during grand slams and other tournaments. I have a hitting partner that I try to play with multiple times per week and I even bought a Slinger Bag tennis ball machine and upgraded my old racket to a newer, heavier one. 

My newfound obsession with tennis and the countless hours on the court suddenly resulted in tennis elbow (lateral epicondylitis), which not only affected my game but prevented me from playing as often as I wanted. Luckily, with my knowledge of acupuncture I was able to apply dry needling and IASTM (instrument-assisted soft tissue mobilization) to the extensor muscles and tendons causing symptoms. I found that a single treatment significantly reduced my pain the following day, so much so that I was able to have a full, comfortable tennis session. I now treat myself once per week to prevent any flare-ups from occurring, allowing me to continue playing the sport that I love . 

How can Acupuncture and Dry-Needling Alleviate My Tennis Elbow?

Acupuncture works to treat tennis elbow by reducing inflammation and increasing blood flow to the target area, in this case the outside of the elbow and forearm, relieving pain and restoring mobility and strength. The process and mechanism at play is fairly simple – specific acupuncture points around the damaged area are targeted and as needles are put into place at these points they trigger a series of internal reactions throughout the body. 

Your brain (more specifically the pituitary gland and hypothalamus) releases pain-killing and mood balancing endorphins, which act to not only ease pain and tension, but also regulate stress and anxiety giving treatment the added benefit of calming your mind and body.(7) Simultaneously, your body also releases cortisol from the adrenal gland which acts to reduce general inflammation. When triggering points near the target treatment area, blood flow to the region increases – propelling the extra endorphins and cortisol to where it’s needed most.(8)

Dry-Needling functions similarly but with one main difference in technique and approach. Whereas in traditional acupuncture the goal is to use specific points to trigger a system wide response that targets a specific region nearby said points, dry-needling focuses on the specific muscles and tendons injured with a more physical approach designed to provide faster, more immediate relief. In dry-needling, the needles are physically manipulated in a fashion that causes muscles to produce a small twitch or spasm which, when combined with the endorphins and cortisol released by needling, allow muscles to relax from their tightened, injured state.

Figuring which form of acupuncture, traditional or dry-needling, is right for you is simple- if you seek a more immediate, back on the court tomorrow remedy, or have developed sudden, acute symptoms of Tennis Elbow, dry-needling is your best bet. However, if you’ve been struggling with Tennis Elbow for some time and other preventative measures and treatments have produced little relief or results, your best bet is a routine regiment of traditional acupuncture. For some cases a mixture of dry-needling and traditional acupuncture may be recommended, but each case is unique and should be discussed with your acupuncturist! Regardless of which, best results are produced with repeated, consistent treatment- after all, acupuncture and dry-needling function as preventative measures in addition to remedies and are more effective as either when done routinely.

 

Tennis Elbow Treatment

Preventative Measures work in Synergy with Acupuncture & Dry-Needling

Staying on top of Tennis Elbow is easier than one would think – in fact, it comes down to how you play the sport itself! Or, in the case of non-tennis situations, how you perform the repetitive tasks which caused your tennis elbow in the first place. Regardless of cause, ultimately it comes down to four factors- your own innate muscle strength and overall health, your swing technique and form, the equipment you use, and consistent preventative treatment. 

Like having a winner’s mentality, preventing Tennis Elbow begins long before you even step foot on the court, namely through physical readiness, proper equipment selection and proper technique. Physical readiness is multifaceted beyond your game and extends to all facets of life- including your diet, exercise routine, how you prepare your body to play, and how you live your life in general. Living a holistic lifestyle and the synergy of your efforts will help you stay as healthy as possible. Combining diet and exercise, overall awareness of how you live your life, what goes into your body and how you exert energy will have you not only thinking in the proper context of how everyday decisions can improve your chances of preventing Tennis Elbow, but will also physically improve your chances of prevention.

The next level in tennis elbow prevention comes on the court and within your game – equipment, technique and form. Equipment is a simple but critical element – always be sure your racket is precisely the right weight and style for both your skill level and strength. If you have any feeling it may be off, seek a trainer or racket shop – they will be able to guide you to a racket that’s properly balanced for your body, technique and strength. Using a racket that’s too heavy or improper for your play style can lead to complications beyond a poor serve and weak returns- such as carpal tunnel and other injuries.

Technique is directly impacted by equipment here – the wrong racket will have even the best techniques damaging your body, so it is of the utmost importance your equipment checks out! Technique is more nuanced than any of the above prevention factors however, and requires a far more conscious effort. It can be difficult to keep health and safety at the forefront of one’s mind in the heat of a match, but all the more reason to be on top of it! Unfortunately, remedying poor or improper technique is a bit more involved than the previously mentioned forms of prevention – and frankly is best handled through the guidance of a trainer. If you feel your play style is causing damage to your body in any capacity, your main priority should be to seek a trainer. As good as your game may be, if it’s causing unseen or obvious damage it will have a resoundingly negative impact on your skill eventually. 

While these measures and methods will help keep tennis elbow at bay, ultimately you will still be prone so long as the repetitive movement continues. Tennis players (and folks prone to tennis elbow by other means) will want to engage in preventive measures as often as they can – and one’s best bet in preventing tennis elbow will be the combined effects of said measures. Acupuncture and dry-needling are known to work fantastically when combined with proper equipment, technique, diet, exercise and holistic living. Only you can give yourself the best opportunity to beat and prevent tennis elbow and enhance your performance on the court!

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Sources

  1. Winston, J., & Wolf, J. M. (1970, January 1). Tennis elbow: Definition, causes, Epidemiology. SpringerLink. Retrieved January 6, 2023, from https://link.springer.com/chapter/10.1007/978-1-4899-7534-8_1# 
  2.  Mackinaw Surgery Center. (2021, April 20). Can I get tennis elbow without playing tennis? common causes of elbow pain. Mackinaw Surgery Center. Retrieved January 6, 2023, from https://mackinawsurgerycenter.com/orthopedic/can-i-get-tennis-elbow-without-playing-tennis-common-causes-of-elbow-pain/#:~:text=Weight%20lifting%2C%20basketball%2C%20volleyball%2C,can%20eventually%20develop%20the%20condition.
  3. Cutts, S., Gangoo, S., Modi, N., & Pasapula, C. (2019, August 10). Tennis elbow: A clinical review article. Journal of orthopaedics. Retrieved January 6, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926298/
  4. Tennis elbow. ucsfhealth.org. (n.d.). Retrieved January 6, 2023, from https://www.ucsfhealth.org/conditions/tennis-elbow#:~:text=The%20exact%20tendon%20most%20commonly,of%20manipulating%20a%20computer%20mouse. 
  5. Ma, K.-L., & Wang, H.-Q. (2020, May 5). Management of lateral epicondylitis: A narrative literature review. Pain research & management. Retrieved January 6, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222600/#B43   
  6. Ma, K.-L., & Wang, H.-Q. (2020, May 5). Management of lateral epicondylitis: A narrative literature review. Pain research & management. Retrieved January 6, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222600/#B43
  7. Han, S.-P., & Han, J.-S. (2020, December 1). Acupuncture and related techniques for pain relief and treatment of heroin addiction: Mechanisms and Clinical Application. Medical acupuncture. Retrieved January 10, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755848/
  8. Lee, S.-C., Acupuncture Research Committe and Department of Medical Research, Yin, S.-J., Lee, M.-L., Tsai, W.-J., Sim, C.-B., Zhang, X.-N., Tian, J. Z. and Z., Feinstein, D. C. and D., Lin, M.-L., Coyle, M., Yu, J.-S., Ahsin, S., Christopher A. Brown and Anthony K.P. Jones, Tan, E. K., Jaung Geng Lin and Wei Liang Chen, Roberts, J., Cassu, R. N., Li, A., … Sternfeld, M. (n.d.). Effects of acupuncture on serum cortisol level and dopamine beta-hydroxylase activity in normal Chinese. The American Journal of Chinese Medicine. Retrieved January 10, 2023, from https://www.worldscientific.com/doi/10.1142/S0192415X82000117?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed