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Nonoperative tennis elbow treatment is often misunderstood. This type of tennis elbow treatment is not designed to heal the problem but rather to “buy” time until the damaged tissue heals itself. In nonoperative tennis elbow treatment, our goal is to provide comfort, protection from further injury and rehabilitation to minimize future harm.
As you may recall from an earlier post, tennis elbow symptoms occur when the origin of a tendon on the outside of your elbow gets injured. This occurs from either overuse or direct trauma. This problem can often resolve without surgery. However, if the injured tendon is unable to heal, then the symptoms will often persist until the damaged tissue is surgically removed.
This post will review the nonoperative approach to tennis elbow treatment. Let’s take a look:
Protection is a critical component of tennis elbow treatment. Most often tennis elbow develops during middle age. As we age, the speed at which we heal slows. Our ability to heal is essentially a race between how quickly we heal and how much further damage the injured tissue sustains. The exact speed at which we will heal is unknown. So by limiting further damage, we have a better chance of winning this “race”. As a result, I often recommend two things:
Also very important. After all, it’s usually pain that brings you to the doctor. Tennis elbow sometimes can be very painful. Some people have “nagging” pain around the clock. If your symptoms are this severe, you may not be able to sleep, work, participate in your recreational activities or your rehab. You will not be able to give the time needed to heal this problem. Your tennis elbow treatment needs to address this. There are a number of techniques I use.
This is an often overlooked component of tennis elbow treatment. I frequently see patients who feel better, fail to rehabilitate their elbow, resume their activities and then “re-injure” their elbow and get recurrent symptoms. Your symptoms began because the injured tendons were unable to withstand the forces applied to them. Essentially, the activities you performed required greater elbow “conditioning” than your elbow had. After a period of injury and rest, your elbow tendons likely have become even weaker, stiffer and have less endurance than before the injury. If the elbow wasn’t in shape to perform your pre-injury activities, it surely won’t be in shape to perform these same activities after you recover unless rehabilitated. For this reason, I think PT is a critical component of tennis elbow treatment.
In the ideal world, our tennis elbow treatment would also involve methods to stimulate healing. It turns out that such treatments may exist. There are several substances being used for this purpose. PRP (Platelet Rich Plasma) and stem cells are two of the more common ones that you may hear about.
Their effect is controversial and we are in our infancy of understanding them. However, there is some evidence that they may have a beneficial effect. These substances come from your own tissues. PRP comes from your blood. Stem cells may come from your blood, fat or bone marrow. Both potentially contain “growth factors” that may stimulate healing. A needle or other minimally invasive technique is required to obtain the material. An injection is needed to administer the substances. Neither of them have been shown to cure all cases. Both have shown some benefit when compared to other treatments. Unfortunately, due to the controversy surrounding these substances, their use is not routinely covered by most health insurance policies.
There you have it, the nonoperative approach to tennis elbow treatment. Follow these recommendations and you have a very good chance of avoiding surgery. But should the tissue not heal and your symptoms not improve, surgery will be needed to resolve your problem. Fortunately, there are a number of very good techniques with good success should that be needed. I’ll discuss that in a future post.
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