Common extensor tendinosis/tendonopathy, as discussed previously before, is one of the more frustrating conditions for both patients and clinicians alike. Part of the frustration has to do with incorrect labeling of the condition, which research has shown to be more of a tendinopathy/tendinosis. Another reason for lack of improvement is failure to perform a thorough differential diagnosis and evaluate for cervical spine involvement, radial nerve entrapments, and other conditions that may be the source of pain.
However, let’s assume that we evaluated the cervical spine and found that it was not the primary culprit. Traditional conservative treatments for extensor tendinopathy have been modalities, external strapping, taping techniques, exercises, and manual interventions-all of which I have used in the past and continue to integrate when necessary in treatment. The primary purpose, however, of this post is to introduce a few different treatment techniques that I found particularly helpful in treating common extensor tendinopathy. Both of these techniques will have separate articles written about them soon, and I have not done both together on the same day, but here is a short introduction and how I have found them to be useful with common extensor tendinopathy.
ASTYM—The theories regarding mechanisms of action for Astym® treatment were developed based on the foundation of recent histologic research identifying the primarily degenerative nature of tendinopathies, and the investigations into the use of cellular mediators, growth factors and related products to assist in the healing and regeneration of tissues. ASTYM utilizes a series of specific movements with instruments that are run firmly along the skin following the direction of the muscle, tendon, or ligament with the goal of removing unwanted scar tissue and regenerating healthy tissue. A recent study at the American Society for Surgery of the Hand’s annual meeting showed that Astym treatment was an effective tennis elbow treatment by resolving 78.3% of chronic lateral epicondylitis (tennis elbow) cases. Here is the case study they presented: http://astym.com/blog/2011/10/07/effective-treatment-for-tennis-elbow-presented-at-hand-surgeons-meeting.html
Trigger point dry needling: APTA defines dry needling as using thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. The needle is typically inserted in the area that causes pain and has a palpable “trigger point.” As mentioned in the previous post, all the major extensor muscles of the elbow have an attachment point at the lateral epicondyle, and all form into the common extensor tendon. Typically, when a patient complains of pain, that pain can be palpated at the common extensor tendon. The extensor carpi radials brevis (ECRB) is the most commonly affected tendon, however the other tendons can also be affected. With dry needling for common extensor tendinopathy, I am usually able to palpate for taut bands and trigger points to the elbow and forearm and treat several areas. The most common areas I have encountered and treated are the ECRB, Supinator, Brachioradialis, Triceps, ECRL and extensor digitorum. Although research on dry needling and trigger points are still relatively new, the results thus far have been pretty promising.