If it hurts when you go to open a door, shake a hand, and you’re limited from working out like you want to, then you know just how debilitating chronic tennis elbow can be. On average tennis elbow or lateral epicondylitis will take 12-18 months to go away on it’s own (PMID: 28461918). When it comes to treatment options your regular doctor is going to only have a few options that really don’t work well. So what do you do when the anti-inflammatory medications, braces, physical therapy and cortisone injections just don’t work?
Let’s dive in.
What is tennis elbow?
Tennis elbow (lateral epicondylitis) is where the forearm muscle tendons which originate on the outside of the elbow bone get overloaded and eventually damaged and degenerated. This causes the tendons to be painful and any use of those muscles that extend the hand is also painful. Tennis elbow happens in about 1 in 100 people and it generally happens in middle age. Tennis elbow is what we call a “repetitive use” injury. It can resolve on it’s own but that generally takes 12-18 months of living in constant daily pain.
Why does tennis elbow take so long to heal?
Traditionally it’s been thought that tennis elbow is caused by inflammation hence the tern -itis at the end of later epicondylitis. But if you dive into the research studies, they have shown this to be inaccurate. What they do show is that the tendon is degenerating (PMID: 2149254).
So tennis elbow really isn’t inflammation at all like most doctors think, it’s degeneration of the tendon from being overloaded. This also causes nerve irritation.
The problem with tendons is they don’t have their own blood supply – they get their oxygen and nutrients from the surrounding tissues and blood vessels. This in turn doesn’t allow them to heal as quickly as say a muscle or skin tissue. These tendons also have a great deal of tension on them. When you combine that with repetitive use and overload you get a recipe for pain and long healing times without the use of the appropriate intervention.
Why Steroid Shot’s Don’t Work – And A Better Strategy
The treatment with steroids won’t help tennis elbow for most peopl. all cortisone steroids do is calm inflammation down. With degeneration of a tendon- you have to do something to make the tenons actually heal and regenerate.
- The best way to do this is to treat trigger points with dry needling in the muscles that make up the tendon to offload tension on the tendon.
- Then we need to stimulate where the tendon is degenerated to help alert your body that this area needs to heal.
- Then we need to treat the irritated nerves and help neuromodulate their function (a skill that requires advanced dry needling techniques a physical therapist does not learn in a 52 hour weekend certification).
A review of the research on Dry Needling vs Steroid Injection for Tennis Elbow
It would be clear to your doctor if they took 5 minutes to read the research that dry needling is a better option than cortisone injection, even at 6 month followups. This study was titled “The use of dry needling vs. corticosteroid injection to treat lateral epicondylitis: a prospective, randomized, controlled study” and the results are profound and showed how effective dry needling is for tennis elbow.
The problem is your regular doctor cannot get paid by your insurance company for doing dry needling, they will only get reimbursed by doing a cortisone injection. So they are incentivized to offer the treatments they actually get paid for.
Finding Dry Needling Near Me for Tennis Elbow
It’s important that you find someone who has experience and education with dry needling. Did you know that there are 2 different types of dry needling needling providers?
There are acupuncturists who specialize in orthopedics (like me, Dr. Josh Hanson, DACM) who have 4+ years of schooling specific to using needles as a tool, who see 15-20 patients a day for years, who have performed 30,000+ procedures over the last 10 years. Who has consulted with all of the major sports teams in the region. Who only use needles (both dry needling & advanced regenerative injection procedures).
Then there are physical therapists who only take a very brief 52 hour weekend course. Who only have to learn to needle a few muscles and essentially just learn simple, general protocols. Who on average only use dry needling a couple of times a day.
Finding the right dry needling provider is very important to receiving a comprehensive and thorough treatment. You really need to do your homework so you get a proper treatment.
The Good News
Chronic tennis elbow is a real pain, especially because tradition treatments like physical therapy, braces and steroid shots generally don’t help much.
For you to get the best treatment for your specific condition, sometimes you have to go outside of your insurance network and seek out a skilled provider of dry needling like Dr. Hanson in Tampa, FL. At this point in my clinical career, I’ve successfully treated over hundreds of tennis elbow cases. You don’t have to wait 12-18 months and live in constant daily pain – there are options!