Epicondylitis Treatments

Once your medical professional has diagnosed your condition, they will be able to recommend the most effective treatment for your tennis elbow or golfer's elbow injury. There are a variety of options available depending on the severity of your injury.

During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort in your elbow area until your pain and inflammation settle. Scar tissue will often develop as a result of a tennis elbow or golfer's elbow injury once acute inflammation begins to decrease. As your damaged arm tissues heal this dead, fibrotic tissue will develop instead of forming brand new healthy tissue. This tissue adheres to your muscle fibers, tendons, ligaments, fascia, nerves, and joints causing pain and preventing them from moving properly (this limits your range of motion, flexibility and strength).

Often you will notice a great improvement within 6 to 12 weeks; however it can take months to return to normal. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results. If you start using your arm before it has a chance to heal properly (even though it may feel better), you can end up doing a lot more damage than good!

Conservative Epicondylitis Treatment

The URICE Treatment for Pain, Inflammation and Fast Healing

Your initial treatment should involve relieving any pain and stress on your elbow, decreasing any swelling, and correcting any biomechanical dysfunction. Then you can focus on restoring strength and mobility to your injured elbow.

It is very important to follow any instructions you receive from your physician.

To decrease inflammation and relieve pain for a chronic or diagnosed elbow injury, adhere to the URICE philosophy within the first 48 – 72 hours:

• Ultrasound around your injured elbow for 5 minutes, 3 times per day. This is best accomplished with a personal, therapeutic ultrasound device
• Rest your arm and limit your activity (if you are able to move your arm)
• Ice the area 2-3 times/day for approximately 15 - 20 minutes at a time (do not apply ice directly on your skin) to reduce blood flow to the injured area
• Compress the area if possible by adding light pressure to minimize swelling (make sure the compress is snug; if too tight it could cause numbness, tingling or more pain)
• Elevate the injured area above chest level to relieve the pressure from swelling and allow fluid to drain from the injured part

If you do not have access to ultrasound therapy, or you have experienced an acute injury and/or have not been diagnosed, adhere to the RICE philosophy within the first 48 – 72 hours.

To increase your comfort and prevent further damage, you may want to use a tennis elbow strap or counterforce brace which will help support the area and reduce stress on the injured tissue; this is worn just below the elbow, around your forearm. These bands should only be used until the tennis elbow or golfer's elbow is gone, as they can cut off circulation and impede healing or development of your muscle tissue.

Gentle massage around the injured area or small flexing or extending elbow movements (if not painful) will also help increase blood flow, oxygen, nutrients and will prevent stiffness.

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Ultrasound Therapy

Heal Soft Tissue Damage and Break Down Scar Tissue

Ultrasound therapy is a great therapeutic option to decrease pain, inflammation and soft tissue (muscle, connective and nerve tissue) damage experienced with a tennis elbow or golfer's elbow injury.

This can be received using a portable, home ultrasound device (self-administered) or by seeing a physiotherapist. The treatment is safe, easy, painless, and generally requires between 5 – 10 minutes per treatment.

It is based on a form of deep heat therapy which is generated through high frequency sound waves (that we can not hear). These waves send vibrations deep into your body and raise the temperature of your soft tissue. The waves are delivered through a hand held transducer and medicinal conductive gel that are used together in a slow, circular motion on your skin over the injured area.

You may experience a slight tingling or warm sensation during the process as a result of the gel; this enhances the therapeutic effects of ultrasound (Phonophoresis).

Ultrasound therapy increases collagen and tissue elasticity, which in turn promotes circulation (blood flow) and brings oxygen and nutrients to your injured area. This cleans your tissue by getting rid of cell waste products and allows your injury to heal correctly.

If not treated properly injured tissue can heal with a weakened state, which can lead to scar tissue or calcification. If used on an ongoing basis, ultrasound will help to improve your range of motion by breaking down any scar tissue that may form in the injured area.

Ultrasound waves penetrate deep into your tissue, relax your muscles, decrease chronic inflammation and accelerate your recovery rate, so you can return to your daily activities as soon as possible.

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Blood Flow Stimulation Therapy

Help Your Body Heal Itself

You can help your body repair itself by speeding its natural healing process with Blood Flow Stimulation Therapy.

During normal activities, the movement promotes blood flow through our body. Our body responds to the movement by sending oxygen and nutrient-rich blood to the muscles, joints, tendons and other soft tissue in the body.

When at rest, the blood flow to your tendons is greatly reduced. Unfortunately, when your tendon is injured it requires rest but it also needs the blood flow to promote the healing process. Since you can't work your tendon without danger of further injury, you need to stimulate the blood flow another way.

The Inferno Wrap™ Advantage

Our innovative Inferno Wrap™ gives you the best Blood Flow Stimulation Therapy available.

The Inferno Wrap™ creates energy waves that stimulate blood flow by penetrating through the outer layers of your body. The energy waves reach deep into your muscles, tendons and cartilage, reducing your pain as they heal the inner tissue.

An Inferno Wrap™ gives you unparalleled blood flow stimulation to your injured tendon. Other therapy products can not come close to offering the comfortable, contoured fit and targeted energy treatment an Inferno Wrap™ provides.

You will experience a soothing, penetrating warmth deep in the tissue as it works to stimulate your blood flow, we guarantee it. Now you can reduce your pain and heal yourself anywhere with the comfortable, light weight Inferno Wrap™.

The Inferno Wrap™ provides effective, non-invasive, non-addictive pain relief with no side effects. You simply won’t find a comparable product on the market.

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Pain and Anti-Inflammatory Medication

NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

NSAIDs can be used if required to help manage your pain. However, these aren't recommended for long term use, as they can cause gastrointestinal difficulties.

Some health professionals also recommend natural supplements such as Glucosamine, MSM or Hyaluronic Acid to help strengthen the injured tissue.

The use of ultrasound in conjunction with NSAIDs can greatly improve the effect of this medication and can help to heal your elbow quicker.

Cortisone / Steroid Injections

If pain and inflammation persist, you can see your physician to investigate cortisone / steroid injections or topical medications, which may help reduce swelling and inflammation. However, these should be used with caution and never in conjunction with ultrasound therapy.

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Physical Therapy

Restoring Your Elbow's Flexibility and Strength

Physical Therapy is a beneficial way to help decrease pain in the soft tissue, restore atrophied muscles and improve elbow, forearm and wrist strength and mobility. The type of physical therapy and the duration will be dependent on the extent of your injury.

Once your pain starts to diminish, a physiotherapist will also set up an individualized arm and shoulder strengthening and stretching exercise program for you to perform at home or in the gym.

This will be based on your needs and abilities, and will help you return to performing your normal routines.

Individuals will often lift weights on their own, to try and build up their strength however, in doing so they can do more damage. It is extremely important to strengthen your muscles properly, as they may have weakened during the period of non-use.

A trained therapist will help to ensure your rehabilitation process is effective. For best, long term results use ultrasound in conjunction with physical therapy and an exercise program.

Once you return to your activities, it is beneficial for you to evaluate how you use your arm in these activities to determine if you can decrease stress on the injured tissue. This may involve changing your technique, for example using a two-handed backhand instead of a one-handed backhand in tennis, which will take stress off your forearm muscles. Or, it could also mean implementing ergonomically correct practices, structures and equipment to help you perform tasks more effectively and safely, such as using a properly weighted racquet, or taking more frequent short breaks at work to rest your wrist when using a hammer or screwdriver.

Speak with a professional in the specific activity or work setting to ensure you are using correct procedures and tools.

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Surgical Treatment

When Conservative Treatments Fail

About 85% of people with tennis elbow or golfer's elbow experience pain relief within 12 months of starting their preliminary treatments. A tennis elbow or golfer's elbow injury will usually heal without surgery.

However if you continue to suffer from persistent pain, weakness or recurring inflammation after trying the above conservative treatments, you may require a surgical option. Although rare overall, this is more common in tennis elbow than golfer's elbow.

The type of surgery you require will depend on the size, shape and location of your injury. This will be completed through day surgery; however it will require extensive rehabilitation utilizing the preliminary treatments noted above. Physical therapy and strengthening normally begin about 6 weeks after surgery.

Your surgeon should provide a treatment plan to help you regain normal use as soon as possible.

Elbow Arthroscopy

Elbow Arthroscopy involves making a small incision on the outside of your elbow and inserting a pencil-thin, fiber optic camera with a small lens and lighting system.

The surgeon will take a look inside your joint to investigate all the soft tissues and bones. These images will then be transmitted to a TV monitor, which allow the doctor to make a diagnosis and/or perform the repair under video control.

Your surgeon may repair tears or remove damaged tissue. He/she may have to cut the tendon at its attachment to the epicondyle bone and remove a small portion of the bone to increase blood flow to the area.

Afterwards, sutures (stitches and/or anchors that hold the tissue together after they have been severed) can be used to attach the tendon to the bone. At the end of surgery, your incisions are closed, a dressing is applied, and you are placed in a splint.

There are always some risks associated with any surgery, which include but are not limited to possible infection, allergic reaction to medications, and damage to surrounding nerves or blood vessels. However, modern techniques have significantly minimized the occurrence of these problems. Tenderness, pain, stiffness and weakness are very common after surgery, but with proper rehabilitation these should diminish.

Although surgery is often successful at repairing any damage and/or relieving pain, it does not necessarily return strength to your elbow or forearm. That is why a strong commitment to rehabilitation is essential. Healing and recovery time is generally dependent on the extent of your injury, your age, pre-injury level of function, and your commitment to rehabilitation.

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