Acupuncture for tennis elbow
In some cases, acupuncture may also be helpful for tennis elbow, as it can not only reduce the pain but also directly counteract the inflammatory reaction.
Osteopathy
Osteopathy represents an alternative or supplement to conventional medicine in the treatment of tennis elbow. After a detailed discussion with the patient, the osteopath tries to feel and detect the functional disorder only through his hands. The disturbed function is also treated with the hands only.
From an osteopathic point of view, a functional disorder of the elbow in the sense of tennis elbow cannot only be caused by overloading or incorrect loading of the tendons of the forearm extensor muscles, as is assumed in orthodox medicine. When treating tennis elbow, the osteopath also looks for causes that lie, for example, in the cervical or thoracic spine and attempts to correct them in order to eliminate the cause of tennis elbow. A possible cause of tennis elbow from an osteopathic point of view is, for example, a malposition of the ribs, which leads to a malposition of the shoulder, which ultimately manifests itself in an incorrect posture of the elbow joint and thus promotes overloading of the tendons. It is also conceivable that the cervical spine is blocked in the area of the nerve roots C5-C7, from which, among other things, the nerves of the arm originate. A blockage at this point will be released by the osteopath to allow the tennis elbow to heal.
When is a plaster necessary?
As one of the last measures, a patient with tennis elbow can be given an upper arm cast (elbow cast), which must be worn permanently and should prevent any movement in the joint. However, this is already a considerable restriction for everyday life and therefore not a permanent solution. Studies on tennis elbow and plaster have not shown convincing results.
When is an operation necessary?
If all of the above mentioned treatments do not improve the symptoms within 6 months, or if they possibly even worsen under the therapy, there may be an indication for surgery. This is only done in individual cases and must be carefully considered. Surgery can normally be performed on an outpatient basis and has good chances of recovery.
Depending on the surgical technique, either the affected muscles are detached from their origin (Hohmann’s operation) or the nerves supplying the area in question are sclerosed (Wilhelm’s operation). Both can also be performed together during one operation. A new option is minimally invasive surgery, which requires only a very small skin incision, takes only a few minutes and the risks are minimal.
However, this technique is still quite new and is not yet offered in many medical practices. After this mini-operation, the patient is immediately mobile again. According to the standard procedures, a cast must be worn for a certain period of time and the arm is then slowly returned to its normal position.
Under certain circumstances, postoperative physiotherapy may also be useful. In general, the therapy of tennis elbow shows very good success rates and patients are able to move again without restrictions if they conscientiously take measures to prevent a relapse afterwards.Tennis elbow is the most common disorder, which is why a tennis player must consult a sports orthopedist. About 20% of all tennis players have had an episode with tennis elbow, 3% suffer from a chronic variant.
In general, a distinction is made between tennis elbow with a traumatic (accident-related) etiology and tennis elbow, which is the result of wear and tear (degeneration). In the younger generation, problems at the muscle-tendon junction dominate, while the older generation has problems at the tendon-bone junction, directly at the elbow. The causes of tennis elbow are manifold.
In most cases, no actual cause for the development of tennis elbow can be identified. The combination of several factors such as: are disease causing.
- High intensity tennis (e.g. : Medenspiel season or LK tournaments)
- Faulty technique (especially on backhand and serve)
- Change of club material (change to harder frame hardness)
- Changing the stringing (polyester strings must be mentioned as causing the disease, as well as increasing the stringing hardness)
- Increasing age (the tendon attachment at the elbow becomes more sensitive to stress due to a natural aging degeneration) and an unsatisfactory stretching ability of the forearm muscles
Treatment is more difficult for tennis players suffering from tennis elbow than for non-tennis players, as tennis is considered to be the cause of the disease.
In most cases, the affected person would like to give up his sport with a healed tennis elbow, therefore it is plausible that the recurrence rate (risk of relapse) is particularly high among tennis players. Besides an optimized therapy, causal prevention (elimination of risk factors) is particularly important. The therapy of tennis elbow contains three elementary parts.
Passive components must always be combined with semi-active and active components. The passive elements include the transverse friction of the inflamed tendon attachment (special physiotherapeutic therapy procedure). Semi-active components include the targeted stretching of the forearm muscles.
Furthermore, the muscles and the tendon attachment must be actively strengthened through training. In parallel, this three-step therapy scheme is flanked by medime-catalytic measures (administration of anti-inflammatory drugs orally or locally by infiltration (injection)) and physical measures such as stimulation current (TENS), cold laser therapy and, for chronic cases, focused shock wave therapy. There is no general therapy guideline that tennis elbow should be treated.
The experienced sports orthopedist will include the following factors in the recommendation of the therapy measures: The decisive factor in the therapy of tennis elbow is the application of the respective measure at the right time. While stretching in the inflammatory stage (tennis elbow hurts particularly badly) is counterproductive, this measure becomes particularly important in the healing phase and during prevention. In general, anti-inflammatory measures help very well in the acute phase of the disease.
However, they lose their effectiveness with increasing duration of the disease. In the chronic phase, regenerative therapy measures are used. While tennis elbow in the acute phase can often be treated within a few days to freedom from symptoms, treatment in the chronic phase usually takes weeks or even months.
Surgical measures for tennis elbow only play a minor role and are usually only used in cases of severe tendon damage. Here too, there is a wide range of open and minimally invasive measures. Which one should be used follows the same analysis as for conservative therapy.
Once the tennis elbow has healed, it is important to reduce the factors that trigger the tennis player. The strain can be reduced by an elbow brace. Furthermore a change of the tennis racket to a softer frame and a reduction of the stringing hardness should be discussed.
Finally, technical defects should be checked and improved by a tennis instructor. An interesting fact in passing is that golfers also suffer more often from tennis elbow than from golf elbow. Typically the right-handed golfer gets tennis elbow on the left side.
With the left-handed golfer it is accordingly reversed. The treatment strategy is the same for tennis players and golfers.In general, golfers heal faster because the elbow load is lower due to the lower stroke rate in golf.
- Duration of the disease (up to three months acute, up to six months sub-acute and over 6 months chronic)
- Intensity of the complaints
- Other stress factors for the elbow, e.g. craft profession
- Degree of damage (inflammation of the tendon, inflammation of the bone, inflammation of the joint, partial tear of the tendon attachment)
