I think anyone who has suffered with tennis elbow will agree that it is one of the most frustrating conditions to have. The constant gnawing ache in your elbow, worse at night and when trying to do any activities. No external evidence that you are suffering with constant pain and continuous “false dawns” when you think it is getting better and you decide to push it just a bit too much and find yourself “back to square one”.
Tennis elbow, a constant gnawing ache in your elbow.
I know it is not much consolation, but I really do feel your frustrations. While I cannot guarantee that this blog will give you an answer to managing your tennis elbow, I hope it will give you a better understanding of the condition and the treatment options available to you.
Tennis elbow is a repetitive strain injury affecting the tendons.
Tennis elbow is a repetitive strain injury affecting the tendons that attach to the outer side of your elbow. You do not have to play tennis to get it with most patients describing some form of exertional activity as the start of their issues. Common lockdown triggers have been gardening and DIY! The problem lies with microtrauma in the tendon, which the body fails to heal adequately. This means that patients may feel that it has improved, only to find that it has not when they try to increase their activities. In general, most patients will improve over a year, but that is a long time!
The best treatment option for tennis elbow has been a conundrum for years. Physiotherapy, braces, anti-inflammatory medication, rest, injections, surgery. They are all options and like with most conditions you should always start simple. Rest, anti-inflammatory gel and avoiding the aggravating activity may be all that is required. Physiotherapy can also be very effective and the exercises are simple. It is important to get the exercises right though, so if you are trying to do them yourself, pay particular attention to the instructions as to how to do them! I would recommend searching for “eccentric exercises for tennis elbow”.
If your symptoms have persisted for longer than 6-12 weeks then you may want to consider taking the next step in treatment. Traditionally, steroid injections were used for tennis elbow. This is now not recommended. The main issue with tennis elbow is not inflammation but poor healing. The steroid stops the body healing the tendon. Commonly, you will get short term benefit from the injection but symptoms then return and are much more resistant to treat. The medical evidence strongly advises against steroid injections.
Traditionally, steroid injections were used for tennis elbow.
While surgery remains a very successful (>80% improvement) treatment option, many patients want a less invasive solution. So if you can’t inject steroids, what can you inject? Over the last 3 years I have offered patients with tennis elbow an injection of hyaluronic acid (Orthovisc T). This is naturally present in joint fluid and has properties that promote tendon healing. There is good medical evidence to demonstrate its effectiveness and my own results support this, with over 90% of patients improving over a 6 month period. All patients had symptoms lasting longer than 6 months and had failed to respond to previous non-surgical treatments including steroid injections. Previously, the next step in their management would have been surgery but due to the introduction of hyaluronic acid (HA) I have been able to avoid this for the majority of patients.
So what’s the catch? Well you do have to be patient. Those who have received the HA injection, generally don’t find it has changed their symptoms during the first 6 weeks but by 12 weeks they have noticed a significant improvement. The reason it takes longer is because it is treating the cause of the issue, the tendon damage. The majority of patients, however, find that once the symptoms start to resolve there is continued improvement and life can start to return to normal. So if you don’t want to wait for your tennis elbow to get better on its own, perhaps a hyaluronic acid injection is the right thing for you.