Lateral epicondylitis, commonly known as tennis elbow, is a frequent complaint that causes pain and functional limitations in the arm. This condition often leads individuals to search for non-surgical and conservative management options. Chiropractic care offers a distinct approach to managing tennis elbow by focusing on the mechanics of the entire arm and spine.
Understanding Tennis Elbow
Tennis elbow is a painful condition affecting the tendons on the outside of the elbow. This is where the forearm muscles attach to the lateral epicondyle of the humerus. Despite the name, most cases result from occupational or recreational activities involving repetitive gripping and wrist extension, not tennis. This overuse leads to micro-tears and subsequent degenerative changes, or tendinosis, in the common extensor tendon. The extensor carpi radialis brevis muscle is most frequently involved.
The condition typically presents as localized pain and tenderness directly over the bony prominence on the outer side of the elbow. Simple actions like gripping an object, shaking hands, or lifting a coffee cup can trigger sharp discomfort. Patients commonly report reduced grip strength and a persistent ache that may radiate down the forearm. While the body attempts a healing response, the repetitive strain often outpaces the repair process, leading to chronic symptoms.
The Chiropractic Approach to Treatment
A chiropractor addresses tennis elbow by looking beyond the immediate area of pain. They evaluate the function of the entire upper body kinetic chain. This comprehensive assessment identifies underlying biomechanical imbalances or joint restrictions contributing to the overload on the elbow tendons. The diagnostic process includes examining the wrist, shoulder, and cervical spine (neck) for proper movement and alignment.
Restoring normal joint mechanics in adjacent areas is a foundational part of the chiropractic strategy. Joint mobilization or specific spinal adjustments may be applied to the wrist, shoulder, or neck if restricted movement is found. By ensuring these associated joints function optimally, the chiropractor aims to reduce undue strain and compensatory movements that exacerbate the elbow injury. The goal is to correct the source of the mechanical stress, not merely treat the localized pain symptoms.
This approach recognizes that nerve irritation originating from the neck or upper back can sometimes mimic or contribute to arm pain. Addressing these potential neurological contributors helps ensure a complete recovery. Once the broader mechanical factors are managed, the focus shifts to hands-on techniques directly targeting the injured tendons and muscles.
Specific Manual and Soft Tissue Techniques
Chiropractors utilize several hands-on techniques designed to stimulate healing in the compromised forearm tendons and muscle tissue. One common method is soft tissue mobilization, which includes deep friction massage applied directly to the injured tendon attachment. This technique aims to reorganize collagen fibers, improve local circulation, and break down scar tissue or adhesions that may impede movement and healing.
Many practitioners employ instrument-assisted soft tissue mobilization (IASTM), such as the Graston Technique, or manual methods like Active Release Technique (ART). ART involves applying specific tension to the muscle or tendon while the patient actively moves the limb from a shortened to a lengthened position. This precise method is effective at separating fibrotic tissue and releasing muscle knots that cause chronic tension and pain in the forearm.
Joint manipulation and mobilization are also applied directly to the elbow and wrist joints when their movement is restricted. Specific manipulation techniques to the elbow have been shown to help improve grip strength and reduce pain. Furthermore, adjunctive modalities may be incorporated to enhance tissue repair.
Adjunctive Modalities
Adjunctive modalities include therapeutic ultrasound or cold laser therapy. These treatments use specific wavelengths of light to reduce inflammation and promote cellular healing in the tendon.
Home Care and Rehabilitative Strategies
Recovery from tennis elbow relies heavily on the patient’s active participation outside of the treatment office. Chiropractors typically prescribe a structured home program focused on both stretching and strengthening the affected forearm muscles. Stretching exercises, particularly for the wrist extensor muscles, are recommended to improve flexibility and reduce resting tension in the tendon.
Strengthening is introduced gradually, with a strong focus on eccentric exercises. These involve lengthening the muscle while it is under tension. A common eccentric exercise involves slowly lowering a light hand weight with the affected wrist over the edge of a table. This helps remodel the tendon structure and increase its load tolerance. These exercises are often performed in sets of 10 to 15 repetitions, three times per day, and are slowly progressed by increasing the resistance.
Ergonomic adjustments are also a necessary component of the rehabilitation plan, as poor daily habits often initiate the injury. Chiropractors provide guidance on modifying daily activities to minimize strain on the upper limb.
Ergonomic Guidance
Guidance includes:
- Modifying computer keyboard and mouse placement.
- Adjusting grip techniques for tools or sports equipment.
- Ensuring proper posture.
The use of a counterforce brace or strap, worn just below the elbow, may also be recommended to temporarily dissipate force away from the injured tendon attachment during activities.