Lateral epicondylitis, commonly known as tennis elbow, is a frequent musculoskeletal complaint affecting the tendons on the outside of the elbow. This painful condition can significantly interfere with work, sport, and daily activities like gripping or lifting. Doctors of Chiropractic (DC) are trained as primary contact practitioners who manage a wide variety of neuromusculoskeletal conditions, including those affecting the extremities. This information explores the role of chiropractic care in diagnosing, treating, and managing this common tendinopathy.
Understanding Lateral Epicondylitis
Lateral epicondylitis is an overuse injury resulting from the repetitive eccentric loading of the common extensor tendon origin, primarily involving the Extensor Carpi Radialis Brevis (ECRB) muscle. This repetitive microtrauma leads to a degenerative process within the tendon, often referred to as tendinosis, rather than simple inflammation. The condition is characterized by pain and tenderness centered on the bony prominence on the outside of the elbow. Symptoms worsen with activities that require wrist extension, forceful gripping, or lifting, and a weakened grip is a common complaint.
Chiropractic Assessment and Differential Diagnosis
A Doctor of Chiropractic begins the assessment with a thorough patient history to identify the onset, aggravating activities, and mechanism of the injury. They then perform a physical examination that includes palpation and specific orthopedic maneuvers to confirm the diagnosis. Commonly used orthopedic tests include Cozen’s test and Mill’s test, which reproduce pain by resisting wrist extension or passively stretching the extensor muscles.
The chiropractor examines the entire kinetic chain, looking beyond the elbow joint itself. Pain in the elbow region may be referred from other sources, such as nerve root irritation in the cervical spine (neck) or radial nerve entrapment in the forearm. Assessing the neck’s range of motion and performing neurological testing helps the DC differentiate true lateral epicondylitis from these other causes. This comprehensive evaluation ensures the treatment plan targets the source of the patient’s pain and dysfunction.
Specific Treatment Approaches for Elbow Pain
Chiropractic treatment for lateral epicondylitis is active and multimodal, focusing on reducing pain and restoring function to the tendon and associated joints. Soft tissue mobilization is a primary technique used to address degenerative changes and scar tissue within the ECRB tendon. Techniques like Active Release Technique (ART) or Instrument-Assisted Soft Tissue Mobilization (IASTM) are applied to the forearm musculature to improve tissue health, increase blood flow, and stimulate cellular repair.
Joint manipulation, or adjustments, may be performed on the elbow, wrist, and potentially the cervical or thoracic spine. Evidence suggests that manipulation of the elbow joint, such as the Mills manipulation, can provide immediate short-term pain relief and improve grip strength. Addressing joint restrictions in the neck or upper back ensures optimal nerve signaling to the arm and reduces compensatory strain on the elbow.
Rehabilitation exercises form the cornerstone of long-term recovery, aiming to improve the tendon’s load tolerance. These exercises begin with gentle isometric contractions and progress to eccentric strengthening, such as the “Tyler twist” exercise, designed to promote healing and strength in the extensor tendons. Ergonomic advice is also provided to modify the patient’s work or sport environment to prevent re-injury, including guidance on grip size, tool use, or workstation setup.
Expected Recovery Timeline and Outcomes
Recovery from lateral epicondylitis depends on the condition’s chronicity; symptoms persisting for many months require a longer treatment period. For mild or acute cases, significant relief is felt within six to twelve weeks of consistent conservative care. Chronic cases may require three to six months of steady, progressive treatment, emphasizing adherence to the home exercise program.
Most patients respond favorably to non-surgical management, with symptom resolution expected within six months to a year, though pain relief can occur much sooner. Factors that accelerate recovery include early intervention, consistency with rehabilitation exercises, and adjusting aggravating activities. If symptoms fail to improve after a reasonable period of conservative care, the Doctor of Chiropractic may refer the patient for co-management with another specialist for further diagnostic imaging or alternative interventions.