Tennis elbow is pain and chronic inflammation of the outer elbow which is exacerbated by repeated activity, particularly resistive movements of the muscles of the forearm which pull the wrist back [132]. It may arise secondary to sport-related injuries or chronic repetitive injury.

Diagnosis

Diagnosis is made solely from the patient’s history and clinical examination [127].

Evidence based summary for manual therapy [53]

There is moderate quality evidence (on a scale of low, moderate and high) that elbow mobilization with exercise works less well than corticosteroid injections in the short term but is superior in the long term for lateral epicondylitis [133]. There is other evidence to support a manual therapy approach to patient care [134].

The guidance from the Committee of Advertising Practise (CAP) to chiropractors is that chiropractors can say they can treat tennis elbow providing it is arising from an associated musculoskeletal condition of the spine.

Other effective non-invasive physical treatments or patient education

Laser therapy, acupuncture [135-137].

Back-in-Action clinical comment

To help people with a tennis elbow problem chiropractors generally look for any joint, muscle, nervous system or postural factors that might be contributing to an increase in stress around the elbow. Chiropractors may be able to help a tennis elbow if the source of the problem is associated with a musculoskeletal problem of the spine.

In the local area the aim of treatment is to reduce inflammation, promote soft tissue healing, relieve pain, increase pain-free range of motion, decrease pressure on the area, prevent reoccurrence and restore strength, flexibility and stability to the local area.

In our experience treating the symptoms and underlying causes that sustain the symptoms of tennis elbow is more effective with a combination of treatment techniques. We find it is especially useful to help correct muscle imbalances and optimise muscle tone.

Our approach often incorporates spinal manipulation, mobilisation, muscle release techniques, acupuncture, neck exercises, referral for massage therapy, diet and nutritional advice, functional neurological exercises, cryotherapy (heat and/or ice), postural improvements, breathing techniques, ergonomic advice and relaxation counselling.