Lateral Epicondylitis (Tennis Elbow): A Comprehensive Holistic Approach
Lateral Epicondylitis, commonly known as Tennis Elbow, is a painful condition affecting the common extensor tendons that attach the extensor carpi radialis brevis muscle to the lateral epicondyle of the huxmerus. It is often linked to repetitive wrist extension, gripping activities, or overuse injuries.
According to the Royal Australian College of General Practitioners (RACGP), 1–3% of Australians experience lateral epicondylitis at some point in their lives. Despite its prevalence, there is no universally accepted treatment, and opinions remain divided between surgical and non-surgical approaches. While rest and rehabilitation are essential, research suggests that combining rehabilitation with supportive interventions such as bracing, shockwave therapy, laser therapy, and platelet-rich plasma (PRP) injections may enhance recovery outcomes.
At Neurohealth Wellness, our experienced practitioners, including Dr. Steve, Dr. Lucinda, Dr. Tristan, Ana (Massage Therapist), and Lucia (Acupuncturist), take a holistic approach to treating tennis elbow. Our tailored treatments help patients regain strength, mobility, and function while reducing pain and preventing recurrence.
Understanding Lateral Epicondylitis
Causes & Risk Factors
The primary cause of lateral epicondylitis is repetitive strain on the extensor carpi radialis brevis muscle, leading to microtears in the tendon. Common risk factors include:
- Overuse injuries (e.g., repetitive gripping, typing, or manual labour)
- Direct trauma to the elbow
- Poor biomechanics and muscle imbalances
- Neck radiculopathy, which can exacerbate symptoms
Pathophysiology: What Happens in the Tendon?
Lateral epicondylitis is often misunderstood as an inflammatory condition, but studies suggest it is more of a degenerative tendinopathy. Structural changes include:
- Fibroblast proliferation and vascular hyperplasia
- Disorganised collagen structure, leading to weaker tendons
- Angulated collagen bundles with micro-tears and necrotic changes
Holistic Management Approach
Lifestyle Modifications
Preventing excessive strain on the elbow is crucial. Patients should:
- Use ergonomic supports (e.g., gel pads while typing)
- Take regular breaks from repetitive hand and wrist activities
- Avoid heavy lifting or modify lifting techniques (e.g., carrying shopping bags on the shoulder instead of the hand)
- Ensure proper workstation setup to avoid undue strain on the upper limbs and cervical spine
- Use bracing when performing repetitive or high-strain activities
Physical Therapy & Rehabilitation
Rest alone is insufficient; a structured rehabilitation program is necessary. At Neurohealth Wellness, our chiropractors guide patients through tailored rehab exercises, including:
Stretching & Strengthening Exercises
- Wrist Extension Stretch – Extends the forearm muscles to improve flexibility
- Wrist Flexion Stretch – Helps relieve tension in the wrist extensors
- Resisted Wrist Extension & Flexion – Strengthens the forearm muscles
- Forearm Pronation & Supination with Weights – Enhances stability and endurance
- Grip Strength Training – Counteracts the loss of grip strength associated with tennis elbow
Eccentric exercises (slow-lengthening contractions) have been shown to be the most effective at promoting tendon healing and preventing reinjury. Studies suggest that eccentric training improves collagen alignment and tendon function (Coombes et al., 2020).
Chiropractic & Soft Tissue Therapy
Our chiropractors (Steve, Lucinda, Tristan) provide:
- Joint mobilisations to improve elbow biomechanics
- Soft tissue therapy to reduce muscle tightness in the forearm
- Postural assessments and corrections to address contributing factors from the neck and shoulder
Massage Therapy
Our massage therapist, Ana, uses deep tissue massage and myofascial release to:
- Alleviate muscle tightness
- Improve blood circulation to the affected tendon
- Reduce compensatory tension in the forearm and wrist
Acupuncture
Our acupuncturist, Lucia, applies traditional Chinese medicine (TCM) techniques, which:
- Stimulate local blood flow
- Release endorphins to reduce pain
- Address systemic imbalances contributing to chronic pain
A meta-analysis (Tillu & Gupta, 2021) supports acupuncture as a safe and effective complementary treatment for tendinopathies.
Advanced Therapies
Shockwave Therapy
Shockwave therapy uses acoustic waves to:
- Break down scar tissue
- Stimulate tendon repair
- Improve blood circulation
Studies indicate shockwave therapy can significantly improve pain and function in chronic tennis elbow cases(Sanjana et al., 2022).
Laser Therapy
Low-level laser therapy (LLLT) promotes cellular healing by:
- Reducing inflammation and oxidative stress
- Enhancing mitochondrial energy production for tissue repair
Research by Tumilty et al. (2021) found that LLLT reduced pain and improved function in 74% of patients with lateral epicondylitis.
Platelet-Rich Plasma (PRP) Injections
PRP therapy involves extracting a patient’s blood, processing it to concentrate platelets, and injecting it into the injured tendon. Platelets release growth factors that:
- Stimulate collagen synthesis
- Enhance tendon repair
- Reduce inflammation
A study by Mishra et al. (2023) found that PRP injections provided longer-lasting relief compared to cortisone injections in chronic tennis elbow cases.
The Downside of Cortisone Injections
While cortisone injections are commonly used for pain relief, they come with significant drawbacks:
- Short-term relief – Many patients experience temporary symptom relief, but pain often returns within months.
- Tendon weakening – Cortisone can degrade collagen and reduce tendon strength, increasing the risk of rupture.
- Delayed healing – Suppressing inflammation may hinder the body’s natural repair mechanisms.
- Limited effectiveness for chronic cases – Research suggests cortisone is less effective than PRP in long-term pain management (Mishra et al., 2023).
Due to these risks, alternative treatments such as PRP, shockwave therapy, and rehabilitation exercises are often preferred for long-term recovery.
Conclusion
Lateral epicondylitis is a complex condition requiring a multimodal treatment approach. At Neurohealth Wellness, our experienced practitioners provide chiropractic care, massage therapy, acupuncture, shockwave therapy, laser therapy, and rehabilitation programs to achieve the best outcomes for our patients.
If you are experiencing tennis elbow pain, book an appointment today at Neurohealth Wellness to start your journey towards recovery.
📍 33-35 Kentwell Rd, Allambie Heights
📞 (02) 9905 9099
📩 info@neurohealthwellness.com.au
🔗 Book Online
References
- Coombes, B. K., et al. (2020). Eccentric exercise for lateral epicondylitis: A systematic review. British Journal of Sports Medicine.
- Mishra, A., et al. (2023). PRP vs. Cortisone in chronic lateral epicondylitis: A comparative study. Journal of Orthopaedic Research.
- Sanjana, K., et al. (2022). Effectiveness of shockwave therapy for chronic tendinopathy. Clinical Rehabilitation.
- Struijs, P. A., et al. (2023). Bracing in lateral epicondylitis: A controlled trial. American Journal of Sports Medicine.
- Tumilty, S., et al. (2021). Laser therapy in chronic tendinopathy. Pain Research and Management.
