Tennis elbow (lateral epicondylitis) 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,” 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 among carpenters, construction workers, painters, cooks and many other professionals that work with their hands or bodies.2
Studies have shown that tennis elbow impacts about 1-3% of adults at some point in their life, and around 50% of tennis players will develop symptoms.3
Clinical Identification
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 and is used when bending the elbow.
As this becomes overused, microtraumas form on the extensor tendon, causing pain to extend from the outside of the elbow down the forearm.
Background on Treatment
Over the years since its initial discovery, many nonoperative treatment methods have been applied to tennis elbow, with varying degrees of short- and long-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; use of various forms of medication to control pain and inflammation; and the practice of acupuncture and various forms of physiotherapy.
While no single treatment has been proven to be stronger than any other for long-term recovery, it has been noted that 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 for patients. The options beyond routine nonoperative treatment are surgery or medicinal injections, neither of which is a guarantee. Both also carry the potential for adverse reactions, which can cause long-term issues of their own.
Most patients who undergo surgery do see success; however, it can be costly and there is always a chance of relapse. Rehabilitation requires several weeks, sometimes months, of time off work and up to a year of 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, 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.
Why Acupuncture and Dry Needling for Tennis Elbow Work
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. Specific acupuncture points around the damaged area are targeted; as needles are put into place at these points, they trigger a series of internal reactions throughout the body.
The pituitary gland and hypothalamus release pain-killing and mood balancing endorphins, respectively, which act to not only ease pain and tension, but also regulate stress and anxiety. This gives treatment the added benefit of calming the mind and body.7 Simultaneously, the 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 they’re 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 systemwide 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. When combined with the endorphins and cortisol released by needling, this allow muscles to relax from their tightened, injured state.
General Guidelines for Clinical Use
Determining which form of acupuncture, traditional or dry needling, is right for a patient is simple. If they seek a more immediate, back-on-the-court-tomorrow remedy, or have developed sudden, acute symptoms of tennis elbow, dry needling is the best course of action.
But if your patient has been struggling with tennis elbow for some time, and other preventative measures and treatments have produced little relief or results, the best course is a routine regiment of traditional acupuncture.
For some patients, a mixture of dry needling and traditional acupuncture may be recommended, but each case is unique. Regardless of the type of stimulation, best results are produced with repeated, consistent treatment.
References
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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