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.
2 thoughts on ““-itis,” “-osis,” and “Tennis Elbow” Continued”
what do you recommend for those that have rsi injuries due to occupational requirements, ie long days on a computer typing.
As a dry needling practitioner, I use functional testing prior to and following the treatment to assess immediate change. In the case of lateral epicondylitis and traditional tennis elbow muscle testing as well as grip strength is most often used.
Recently I had the privilege of treating a colleague with long standing lateral epicondylitis. As a physical therapist he was using a brace to alleviate the constant dull ache and pain when treating clients with manual intervention.
Because of the accommodations made by muscles like brachialis to assist with movement the elbow, its role as stabilizing tissues was diminished. In fact with brachialis unable to perform its role to stabilize the elbow with movement and instead act as a power source for lifting, this structure became overactive and developed trigger points. In doing so the common extensor group as Ojas notes above works even harder to perform movement as well as stability. By using dry needling to release deep tissue trigger points and restore muscular balance, grip strength improved over 20 lbs from baseline within one treatment session.
While the appreciation of delayed onset muscle soreness is noted after FDN, pain reports from 24 and 48 hours post treatment indicated minimal pain without use of the brace and decreased symptoms when waking in the morning. Although FDN alone is not the entirety of treatment for lateral epicondylitis, it can effect an immediate change as well as allow for proper retraining of chronically neglected structures.