Treating (Tennis) Elbow Pain Through Regenerative Therapies

Jonathan Vellinga, MD -


Tennis elbow is a chronic condition that occurs from repetitive overuse of the elbow (1, 2, 3). While the injury is common to tennis players, more than 1 million people develop tennis elbow each year, so it follows that less than 10% of those treated for tennis elbow actually have tennis-related injuries (3). In fact, work-related movements and equipment use are more often the culprit, with tennis elbow comprising over 11% of all work-injury claims (3).

Tennis elbow is such a widespread problem because the condition may not resolve over time, even with conventional treatments. However, there is hope: there are a number of non-surgical functional treatment options called regenerative therapies that are all safe and effective at treating tennis elbow!


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But first - what is tennis elbow?


Tennis elbow, also called lateral epicondylitis, occurs when the tendons that roll over the elbow are damaged due to improper form or overuse (1, 2). It is called tennis elbow because it was initially linked to damage to the muscles and tendons of the elbow that is caused by the motion and force of using a tennis racket backhand to hit the tennis ball (2). When a motion is repeated with enough force, it leads to compounded, unhealed microtrauma to the tendon that attaches the forearm muscles to the bony part of the elbow, which causes inflammation and reduced performance (3). The most common causes of tennis elbow include (1, 2, 3, 4):


  • Repetitive movements in professions involving painting, plumbing, carpentry, butchering, athletics, music, and dentistry

  • Frequent use of hand-held tools like racquets, chain saws, paint rollers, drills, etc.

  • Improper form while conducting repetitive movements (such as not using core muscles to stabilize and depending solely on arm muscles or the elbow for force)

  • Using incorrectly sized or prepared tools or equipment

  • Weak shoulder or wrist muscles


How do I know if I have tennis elbow?


The main symptoms of tennis elbow include pain, burning, and/or an aching feeling along the outside of the arm and elbow (1, 2). Oftentimes, pain will get worse with time, even while at rest, and may spread down to the wrist. You could experience pain or a weak grip, especially when lifting the arm or holding something relatively small, like a cup or doorknob. Working in any of the industries listed above (or doing any other work or hobbies that require repetitive arm movements) puts you at risk for tennis elbow, along with (3, 4):


  • Being over the age of 30 (though the risk increases even more after 40)

  • Larger body mass index

  • History of rotator cuff disease, de Quervain’s disease, or carpal tunnel syndrome

  • Not stretching and warming up before repeated use of the arms

  • Use of some medications, such as certain antibiotics

If you suspect you have tennis elbow, it is certainly worth making an appointment with your doctor to confirm. They may do a physical examination or suggest an X-ray, MRI, or electromyography to look at the bones, tendons, or nerves in order to rule out other conditions and get a good sense of how much damage and inflammation there is to the elbow(s) (2).


Treatment Options for Tennis Elbow


Conventional treatment options are varied and, unfortunately, there is not one gold standard medicine or treatment plan that has been successful across the board. Normally, physicians will prescribe a mixture of treatment options including rest, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, orthoses (straps or braces), acupuncture, topical nitrates, or surgery for chronic tennis elbow (1, 2, 3, 5).


However, each of these has varying success, and many of these medication-based treatment options have side effects or limitations. NSAIDs, for example, increase the risk of GI bleeding, adverse cardiovascular events, peptic ulceration, eye impairment, and stroke (6). Corticosteroid injections, such as cortisone, hydrocortisone, and prednisone, can cause cartilage damage, joint infection, nerve and bone damage, insomnia, temporary flares of pain and inflammation in the injected joint, thinning of nearby bone, and issues with the skin and soft tissue around the injection site (7, 8). These risks increase with larger doses and repeated use, which is why they are usually only administered 3-4 times per year. Though, unfortunately, the positive effects of each shot may only last for one month (7) and may increase the chance of chronic recurrence.


Regenerative Therapies


Alongside the non-medication-based treatments listed above such as physical therapy, exercises, and orthoses, functional medicine offers some incredible regenerative therapies. These therapies help boost the body’s natural healing processes to reduce the chronic dysfunction, inflammation, and pain caused by conditions such as tennis elbow, arthritis, and various soft tissue-related dysfunctions.


Platelet Rich Plasma Therapy


The first of these therapies is called platelet-rich plasma (PRP) therapy. The process for PRP therapy involves drawing your blood and then putting it into a centrifuge, which spins the blood at high speeds to separate the liquids and solids based on density. The goal is to isolate the platelets (which aid clotting and contain growth factors that promote healing and regeneration) and plasma (the liquid part of blood), which is then injected into the site of injury. Over the next 24 hours, PRP stimulates the body’s natural healing processes to repair the tendon and/or joint to a greater degree than the body had previously. This is why we consider PRP to be generally superior to cortisone shots: while cortisone shots do reduce inflammation and pain, they also reduce the natural processes of healthy cells and don’t work to regenerate or heal the damaged cells.


Studies have also shown that PRP injections have higher effectiveness and promise than other types of injections for long-term management of tennis elbow. Because tennis elbow symptoms and dysfunction are likely not caused by inflammation, but rather by an interrupted or abandoned healing response, treatment options that focus on stimulating the body’s healing response will naturally be more effective than those that focus on suppressing inflammation. Especially since those that suppress inflammation also have the potential to damage healthy tissue (3, 9). In certain studies, PRP injections have improved both pain and function for patients with tennis elbow at both the 3 and 6 month mark at higher percentages than similar treatment options, including corticosteroid shots (3, 9). In one study, patients’ pain rating on a scale of 1-10 reduced from an average of 7.8 to 0.9 after just two injections, and a third round brought pain down to a 0.0 (9)! The majority of the patients (79%) were relieved of their pain even during strenuous activity, which is especially amazing considering that the patients from this study had little to no progress with conventional treatments (9).


Pulsed Electromagnetic Field Therapy


Pulsed electromagnetic field (PEMF) therapy works with the electrical currents that exist in our body. When our cells (which are all specialized to conduct electric current) are disrupted or have a lowered charge, they are not able to function properly and our bodies can experience chronic pain, fatigue, and illness. PEMF therapy seeks to bring our cells’ charge back to optimal levels by placing a ring, paddle, or pad that emits a resonating magnetic field over the site of injury or illness. The device emits a low-level electromagnetic pulse, which boosts cellular metabolism, creating an energy boost in the cell. This not only improves overall cell and tissue function but allows for greater healing of damaged tissue.


This is also true in the case of tennis elbow. Studies in 2013 and 2015 have demonstrated that tendon cell proliferation is enhanced after PEMF therapy, meaning that cell metabolism, growth factor production, and development of new blood vessels all increased in cells treated with PEMF therapy (10). Overall, the positive effect of PEMF therapy on tennis elbow, even after several months, is significant (10).


Ozone Therapy


Another regenerative therapy currently offered at Temecula Center for Integrative Medicine is ozone therapy, which utilizes ozone to increase red blood cell processes, increase oxygen flow to the injected area, and activate the immune system (11). It can be used for a number of diseases and disorders, such as infection or viral diseases, circulatory disorders, degeneration, arthritis, cancer, and even tennis elbow (11).


In one study seeking to determine the effectiveness of ozone injection in the treatment of tennis elbow, ozone injections improved pain and function for longer than 6 months (12). Another study that focused on those who had not responded well to other treatments found that ozone injection therapies were able to reduce pain better after 9 months compared to those who had received corticosteroid injections (13).


These regenerative therapies, combined with physical therapy and preventative measures (such as employing proper form, keeping arms flexible and strong, avoiding repetitive movements if possible, warming up and stretching, and using properly set up and sized equipment) can all work together to bring you greater health and healing than other treatment options (2).


If you suspect you or a loved one have tennis elbow, have not found lasting relief with other treatments, or are interested in regenerative therapies for other dysfunction or pain that you have, please reach out! It would be our joy to set up a consultation with you to determine how we can best partner together to bring you greater health and healing.


 

Jonathan Vellinga, M.D.

Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.​


Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.

info@tcimedicine.com

951-383-4333

www.tcimedicine.com


 

Sources:

  1. Mayo Foundation for Medical Education and Research. (2021, February 25). Tennis Elbow. Mayo Clinic. Retrieved December 8, 2021, from https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987#:~:text=Tennis%20elbow%20(lateral%20epicondylitis)%20is,people%20who%20develop%20tennis%20elbow.

  2. Lateral Epicondylitis (tennis elbow). Johns Hopkins Medicine. (n.d.). Retrieved December 8, 2021, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/lateral-epicondylitis-tennis-elbow.

  3. Lai, W. C., Erickson, B. J., Mlynarek, R. A., & Wang, D. (2018). Chronic lateral epicondylitis: challenges and solutions. Open access journal of sports medicine, 9, 243–251. https://doi.org/10.2147/OAJSM.S160974

  4. Nikhil Verma, M. D. (n.d.). Tennis elbow causes and risk factors. Sports. Retrieved December 8, 2021, from https://www.sports-health.com/sports-injuries/elbow-injuries/tennis-elbow-causes-and-risk-factors.

  5. Johnson, G. W., Cadwallader, K., Scheffel, S. B., & Epperly, T. D. (2007, September 15). Treatment of Lateral Epicondylitis. American Family Physician. Retrieved December 8, 2021, from https://www.aafp.org/afp/2007/0915/p843.html.

  6. Pamela Gorczyca, P. D. C. 2016 M. M. (2016, March 17). NSAIDs: Balancing the risks and Benefits. U.S. Pharmacist – The Leading Journal in Pharmacy. Retrieved December 8, 2021, from https://www.uspharmacist.com/article/nsaids-balancing-the-risks-and-benefits.

  7. Mayo Foundation for Medical Education and Research. (2021, May 20). Cortisone Shots. Mayo Clinic. Retrieved December 8, 2021, from https://www.mayoclinic.org/tests-procedures/cortisone-shots/about/pac-20384794.

  8. Mayo Foundation for Medical Education and Research. (2020, December 16). Prednisone and other corticosteroids: Balance the risks and Benefits. Mayo Clinic. Retrieved December 8, 2021, from https://www.mayoclinic.org/steroids/art-20045692.

  9. Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg Am. 2003 Mar;28(2):272-8. doi: 10.1053/jhsu.2003.50041. PMID: 12671860.

  10. Rosso, F., Bonasia, D. E., Marmotti, A., Cottino, U., & Rossi, R. (2015). Mechanical Stimulation (Pulsed Electromagnetic Fields "PEMF" and Extracorporeal Shock Wave Therapy "ESWT") and Tendon Regeneration: A Possible Alternative. Frontiers in aging neuroscience, 7, 211. https://doi.org/10.3389/fnagi.2015.00211

  11. Elvis, A. M., & Ekta, J. S. (2011). Ozone therapy: A clinical review. Journal of natural science, biology, and medicine, 2(1), 66–70. https://doi.org/10.4103/0976-9668.82319

  12. ​​Raeissadat, S. A., & Abdollahzadeh, M. H. (2018, July 13). Comparison of the effects of ozone versus steroid injection, in treatment of patients with tennis elbow. Annals of Physical and Rehabilitation Medicine. Retrieved December 8, 2021, from https://www.sciencedirect.com/science/article/pii/S1877065718304561.

  13. Ö;, U. G. R. B. A. Ö. (n.d.). Comparison of corticosteroid injection and ozone injection for relief of pain in chronic lateral epicondylitis. Acta orthopaedica Belgica. Retrieved December 8, 2021, from https://pubmed.ncbi.nlm.nih.gov/31677627/.

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