What is lateral epicondylitis?
Lateral epicondylitis is also known as tennis elbow. It is documented as being the most common overuse injury of the elbow. It is a tendinopathy injury of the extensor tendons arising from the extensor muscles of the forearm. The pain associated with this condition is often felt on the outside portion of the elbow.
According to NHS England, about 5 in every 1,000 people will visit their GP for tennis elbow. It affects men equally as much as women. The condition is common with adult between the ages of 40-60 years of age.
What are the causes of lateral epicondylitis?
Contractile overloads that chronically tension or stress the tendon near the attachment on the humerus are the primary cause of epicondylitis. These contractions or manual tasks require manipulation of the hand that causes maladaptions in tendon structure that lead to pain over the lateral epicondyle. Mostly, the pain is located anterior and distal from the lateral epicondyle (Pienimäki, 2002). It may develop from acticities from activities that involve repetitive wrist extension and/or supination of the forearm like tennis, typing or manual jobs.
How do we treat lateral epicondylitis?
Treatment of lateral epicondylitis can be conservative and as a last resort, surgical intervention may be considered if conservative measures have failed after 6 months.
Conservative management of lateral epicondylitis can include a variety of manual therapy techniques, acupuncture, bracing, oral non-steroidal anti-inflammatory medications, injections, and specific rehabilitation exercise program (Brukner, 2012).
Alongside these treatment modalities, Shockwave Therapy maybe an affective adjunct to treatment. Shockwave therapy is a treatment technique in which patients are exposed to strong mechanical wave impulses providing focal treatment.
How effective is shockwave therapy in the management of lateral epicondylitis?
Shockwave therapy has been demonstrated to elicit a significant improvement in pain, functionality and quality of life. (Dedes, 2018) These changes were seen after an average of 3 sessions.
How many sessions are recommended?
At Physio On The Green we follow the latest evidence-based recommendations for our shockwave protocols (see below). A minimum of three shockwave sessions approximately one week apart is recommended. Some patients require more than three sessions, but this will depend on how you respond to your initial treatment
Recommended dosage:
•Low energy SWT (focused or radial) <0.1.5 mJ/mm²
•2,000 shocks
•3 sessions, weekly intervals
How long does it take to recover from lateral epicondylitis?
This does vary from person to person depending on the exact nature and extent of the injury. It is not unusual to feel an immediate reduction in pain following your first shockwave session. The likely scenario is a gradual reduction in pain over the following weeks to months.
References:
Brukner P. Brukner & Khan’s clinical sports medicine. North Ryde: McGraw-Hill; 2012.
Dedes V, et al. Effectiveness and Safety of Shockwave Therapy in Tendinopathies. Mater Sociomed. 2018 Jun; 30(2): 141-146
Pienimäki, M.D Ph.D et al. Associations Between Pain, Grip Strength, and Manual Tests in the Treatment Evaluation of Chronic Tennis Elbow . The clinical journal of pain 18: 164-170 2002.
D. M. Walz, J. S. Newman, G. P. Konin, and G. Ross, Epicondylitis: Pathogenesis, Imaging, and Treatment, RadioGraphics, January 1, 2010; 30(1): 167 – 184.