The inflammatory myth of tennis elbow

You probably know someone who’s complained about tennis elbow in the past. And their doctor probably mentioned epicondylitis or tendinitis. And if you’ve been alive long enough to hear “-itis” a few times, you know that that suffix means there’s inflammation, and you should ice the heck out of it.

Guess what? Research shows that tennis elbow ISN’T about inflammation. In fact, the pain from repetitive motions isn’t from inflammation at all!  Whether it’s typing, tennis, or track and field…

…numerous studies have shown, persuasively, that these overuse injuries do not involve inflammation. When animal or human tissues from these types of injuries are examined, they do not contain the usual biochemical markers of inflammation. Instead, the injury seems to be degenerative. The fibers within the tendons fray. Today the injuries usually are referred to as tendinopathies, or diseased tendons.

via Do cortisone shots actually make things worse? –

So why is it important to know that repetitive strain injuries aren’t actually problems with inflammation? Because it means treatment has to be totally different!  Ice won’t help reduce inflammation if isn’t there, and yet treatment protocols for tennis elbow (and typist’s syndrome) still include icing the site of pain! Does that make sense? Only if you think that numbing the nerves in your elbow or arm and reducing blood flow is the best way to get some momentary relief from the pain.

Tennis elbow is really a build up of micro-trauma.  You are gradually fraying the cables that move your arm.  How are you fraying them? Well, I’m not a trained medical professional or a scientific researcher, but in my mind, fraying means friction.

With tennis elbow, you get friction right where some tendons (extensor carpi radialis brevis and extensor digitorum communis in many cases) pass by some bones and other tendons (Current Concepts Review – Tendinosis of the Elbow).

These tendons and bones are very close together, and the slightest imbalance can throw off how these tendons and bones interact.

Proper movement at the elbow depends on what’s going on above and below the joint.  You have muscles and tendons that run into your fingers as well as up into the shoulder girdle. As tensions become imbalanced from what you might call “overtraining” certain muscle and tendon groups, you throw off the mechanics of your elbow joint.

Do that long enough, and your body tells you that the fraying from the friction in your elbow is not a good thing.  And it will tell you that with the signal of PAIN.  That pain tells you that there are some major problems happening that, if you leave them long enough, will develop into some very interesting changes on a cellular level to the soft tissues in the area.

Of course, when you realize that movement of the shoulder joint affects the elbow joint, you have to think about what affects proper movement at the shoulder joint (hello, spinal muscles, pelvic stabilizers, etc.)…and that’s why you need to think about the rest of your body and not JUST focus on the elbow when dealing with “tennis elbow.”


About the Author

Matt Hsu is a trainer and orthopedic massage therapist. He fought a long battle with chronic pain all over his body and won. He blends the principles he learned in his journey, empirical observations with clients, and relevant research to help others get their lives back.