Tennis Elbow, a.k.a Lateral Epicondylitis, affects 1-3% of people globally. Despite its name, Tennis Elbow isn’t just for Tennis players. In fact, the numbers from recent research show that only 10% of cases can be directly linked to playing Tennis. A long list of professions or activities involving repetitive hand and wrist movements can cause Tennis Elbow. Whether you’re constantly typing on your computer, painting walls, bowling, or playing cricket like it’s a religion, there’s a legitimate chance of developing Tennis Elbow.
Treating Tennis Elbow successfully requires a combination of treatment methods aimed at reducing pain and restoring function in the affected arm. Exercise and manual therapy continue to dominate physiotherapy treatment. Dry needling is fast becoming a popular treatment method for Tennis Elbow, thanks to its growing adoption by Physiotherapists and other healthcare professions.
This article sets out to answer three key questions:
- How does it work?
- Does it really work?
- Is there any credible scientific evidence to back its usage?
We’ll start with a quick look at what Tennis Elbow is, along with treatment methods available. After that, we’ll lock in on dry needling in terms of what it is, how it works, and whether it’s worth your time and effort in light of current scientific evidence.
What Exactly is Tennis Elbow?
Tennis Elbow is an overuse injury that affects a tendon connecting your forearm muscles to a bony prominence on the lower, outer surface of the upper arm bone.
The Tendon is called “Common Extensor Tendon” while the bony prominence is known as “Lateral Epicondyle”. This partially explains the condition’s medical name; “Lateral Epicondylitis”.
As pointed out earlier, activities involving repetitive wrist and forearm movements are a major culprit here. These movements require repetitive contraction of the extensor group of forearm muscles which are connected to this tendon. The result is repetitive loading of the Tendon, which may cause injuries within its structure, eventually leading to pain and other associated symptoms of Tennis Elbow.
But What Really Happens Within the Tendon?
The underlying mechanism may seem obvious but there’s been some debate on what exactly happens inside the Tendon during the condition’s development. Let’s take a quick look at some of the most plausible propositions:
1. Inflammation: This school of thought looks at Tennis Elbow as a response to injuries inflicted on the Extensor Tendon due to repetitive loading over time. This “response” is what’s known as inflammation. Injuries to the tendon trigger a series of biochemical and physiological processes aimed at protecting and repairing the structure. This is marked by familiar signs and symptoms of the condition i.e pain, swelling, and loss of function.
2. Tendon Degeneration: This looks at Tennis Elbow as something more than just the Tendon’s basic response to cumulative injury. Researchers propose that it’s actually a degenerative process in which the body struggles to repair the injured tissue, which results in further weakening of the Tendon.
3. Compromised Blood Supply: The Extensor Tendon does not really have an extensive network of blood vessels to ensure a good supply of Oxygen and other nutrients in its entire structure. This compromises its ability to heal efficiently after injuries, which increases the risk of long term issues.
Treatment Options
In most cases, treating Tennis Elbow successfully comes down to the right combination of a number of treatment methods or techniques.
Medical and Surgical Management
- Oral Medication: Non-steroidal anti-inflammatory drugs i.e Ibuprofen, Naproxen.
- Injections: Steroids and Hyaluronic Acid.
- Surgery: Used only as a last resort. The surgeon may choose between open and arthroscopic surgery depending on the condition.
Physiotherapy
- Exercise Therapy: The use of various forms of exercise to reduce symptoms and optimize movement and function. Stretches and eccentric strength training routines have been shown to improve pain and restore proper movement.
- Manual Therapy: Use of various hands-on techniques like deep friction massage to improve pain, promote function, and facilitate the healing process.
- Dry Needling: An emerging treatment method in physiotherapy with growing research evidence for its usage.
What exactly is Dry Needling?
Dry Needling is a treatment technique used by Physiotherapists and other professionals to reduce pain and improve function in muscles and other soft tissue structures like tendons. The technique involves inserting specialized needles into a body part to improve symptoms. The needles come in different sizes, and can be inserted superficially or deep within a muscle. In Tennis Elbow, these needles are inserted around the Lateral Epicondyle and within associated muscle groups.
1. Local Twitch response: Dry Needling triggers a reflex twitch response in a muscle. This stimulates pathways within the spinal cord which block incoming pain signals from the affected Tendon.
2. Enhanced Blood Supply: Dry needling has been shown to increase the production of substances that promote the widening of blood vessels in the affected area. This means more blood supply to the area, which improves overall healing capacity.
3. Effects on the Brain: Needling stimulates the Brain to produce substances that promote the blocking of pain signals from the affected structure or area. These are considered the body’s “natural painkillers”, and include Endorphins, Norepinephrine, and Serotonin.
Scientific Evidence
The past decade has seen a growing base of scientific evidence in favour of the method’s usage in clinical settings. Let’s take a quick look at what it currently looks like:
- The most recent major study is a 2024 research review (meta-analysis), which analysed 17 previous studies with around 979 participants. Researchers observed significant improvement in pain intensity and general function within a week.
- Earlier on in 2021, a similar study looked at 7 studies with around 320 participants. Dry needling was associated with significant improvements in pain intensity and function, especially when combined with other physiotherapy treatment methods.
Conclusion
Dry Needling is a safe, convenient, and highly effective treatment method for managing Tennis Elbow. A growing body of research evidence continues to prove its place as a great tool for dealing with pain and offsetting related complications like muscle tightness and impaired elbow joint mobility.
Struggling with persistent Elbow pain? Dry needling and other physiotherapy treatment methods might be all you need.
Talk to us and book an appointment today. We’re here for you!
