What’s Really Wrong? « Tennis Elbow: A Resource of Medical Evidence & Research

Tennis Elbow: A Resource of Medical Evidence & Research

What’s Really Wrong?

What causes tennis elbow:

There are believed to be several known causes: too much stress on a tendon (either from overuse, or from a sudden change in use that traumatizes the tendon), and injury-related, disease-related or age-related changes in a tendon. All of these conditions may be associated with a tendon’s lack of ability to properly heal itself.1

It has been recently discovered that a cause of some tendinopathy may be fluoroquinolone antimicrobial drugs (a kind of antibiotic). The FDA recently issued a warning that fluoroquinolone antimicrobial (antibiotic) drugs may increase the risk of tendinitis and tendon rupture. Many of the reported cases seem to involve the Achilles tendon.

Historical thinking:

Historically, most health care providers and lay people have used the terms "tendonitis" or "tendinitis" to apply to all tendon dysfunction (painful structures in and around tendons) and the term lateral epicondylitis to refer to tennis elbow (pain coming from ECRB tendon in the elbow). By definition, the suffix "itis" indicates inflammation or an active inflammatory process. With this in mind, conventional management often was, and still is, aimed at reducing or controlling the inflammatory process (rest, ice, anti-inflammatory medications, splinting/immobilization, etc.).

Conventional management of tennis elbow has not been very successful. Most cases of tennis elbow are resistant to treatments that try to reduce inflammation. What is often seen with these conventional treatments is that during the treatment process the patient’s activity is usually limited and the patient may feel a little better. However, once they return to the activity, the symptoms return. This sets up a vicious cycle of taking time off from activity to decrease symptoms, followed by a return of symptoms when activity is resumed. With each recurrence of symptoms, the patient typically gets even worse and more frustrated.

Latest research and science:

We now know that most cases of chronic tennis elbow and other chronic tendinopathies are mainly degenerative (worn or broken down) in nature rather than inflammatory2; there is rarely any inflammation present in the involved tendon. That is why treatments that focus on trying to reduce inflammation don’t have much of an effect. The problem is that most treatments have not caught up with the latest research showing us that the cause of most chronic cases of tennis elbow are degeneration, or a wearing/breaking down of the tendon. We now know that in order to effectively treat chronic tennis elbow, the focus must be on regenerating or re-healing tendons rather than on reducing inflammation.