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  • Q&A with Australian Health Practitioners

    I have had tennis elbow pain for many years

    Related Topics
    Complex Regional Pain Syndrome Musculoskeletal Health Orthopaedics
    I've had a tennis elbow injury now for 2-3 years. Sometimes it is just a dull ache. Sometimes I can barely use a mouse or even sleep. Normally it is somewhere in the middle. Lately, I've just been trying to ignore it, but that (not surprisingly) hasn't helped either. I work in IT and train in martial arts twice a week. Things I've tried: Total rest for 4 months. (mouse in left hand. Not using the arm at all in exercise) Seen a physio for many appointments. Followed recommended exercises. Physio said it wasn't really helping and sent me back to the GP. GP recommended and tried Cortisone injection. That relieved the pain fantastically well for about 2 months. But then it wore off. So.. what now? I feel I need to be seeing an orthopaedic surgeon. However, most of what I read and hear about tennis elbow is that surgery doesn't really help and can hurt. However, I'm starting to think I should have done it earlier... Hoping for some advice on what to try next?
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    Nathan Wong

    Physiotherapist

    Unfortunately I don't know your name but nevertheless hi! As a physiotherapist who specializes (not in the clinical but in the business sense) on treating chronic pain and injuries, I'll answer the best I can but will have to be brief as I have no information about your medical history nor have I assessed you. 

    So to be brief - You're on the right track to say that an orthopedic surgeon is unlikely to help you at this stage if it is a true tennis elbow injury that you have. Tennis elbow is a condition of overuse of certain tendons in the elbow, which will heal and de-sensitize once what your body perceives as a threat is removed and the tissues are re-modeled properly.

    It is common at this stage that there are both compensations in the way you use the affected upper limb and soft tissue changes around the neck, shoulder, elbow, wrist and hand that may be delaying the proper recovery of your elbow.

    Before considering surgery I would recommend seeing a physiotherapist who specializes in the upper limb, a manual therapist or an osteopath (a profession I highly respect with their holistic view of the body). They would be able to give you a good idea of what you need to do. 

    Another thing to look out for are practitioners who have been certified in the Selective Functional Movement Assessment, Neurokinetic Therapy, or Dr Spina's Functional Range Release.

    If you have anymore questions, please don't hesitate to contact us at siloamphysiotherapy@gmail.com or Neeta City Medical Dental & Specialists Center in Fairfield, NSW.

    Hope it helps and that you'll find the answers you're looking for!

    Nathan Wong BHSc MPhty Grad. Dip. Div

    Physiotherapist, Sports Trainer

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    Helen Potter

    Physiotherapist

    As a Specialist Musculoskeletal Physiotherapist, with extensive experience and highly advanced qualifications, as well as excellent communication skills, I can help you to: Become informed … View Profile

    As you are obviously very frustrated and wasting lots of money trying to get better I will provide you with a few thoughts to follow up.

    When tennis elbow pain becomes chronic, acute treatment methods are unlikely to work. Once you have had a problem for more than 12 weeks the mechanism of pain changes and you are more likely to respond to an accurate diagnosis combined with a bio psychosocial approach.

    There are more than just tendons in the area of pain.

    • Thereis the joint underlying the tendons which may now be restricted from poor use
    • the tendons may beinflamed 
    • or have smalldegeneration tears, 
    • Thenerve nearby might be hypersensitive

    A Musculoskeletal Physiotherapy Specialist (Check the APA FIND A Physio site) will examine you thoroughly. As poor biomechanics and chronic postural dysfunction may be contributing to your problem then the physio will assess your neck and shoulder and particularly your motor control and technique.

    If you are overusing your forearm, due to weak core scapular control, then this needs to be improved to take stress off the arm tissues.

    An experienced sports coach can also advise you.

    A sports medicine specialist will probably refer you for an ultrasound scan to identify any tears. You stated that the cortisone worked but pain recurred so this tells me you need to look more at the cause and what you can change.

    There is hope. Seek out the most experienced clinician to get optimal treatment, Good luck

    Helen Potter FACP Specialist Musculoskeletal Physiotherapist MAPA

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    Christine Guirguis

    Acupuncturist, Chinese Herbal Medicine Practitioner

    Christine Guirguis studied at the University of Sydney and the University of Technology Sydney, obtaining degrees in medical science and health sciences in acupuncture and … View Profile

    In the short term acupuncture can give you relatively fast relief from tennis elbow by reducing pain and local inflammation. In the medium term acupuncture provides more sustained relief by targeting trigger points in muscles in the forearm, arm, shoulder, upper back and neck that contribute to the tennis elbow. But for long-term results, acupuncture needs to be combined with physio exercises to strengthen weak muscles and stretch tight muscles which left unchecked produce jerky (even if subtle) movements of the joint which along with overuse cause the tennis elbow. 

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    Kirsty Woods

    Exercise Physiologist

    Hi I’m Kirsty Woods,I would like to use my experience, expertise and passion to help you reach your weight, energy and health goalsI have been … View Profile

    I would try dry needling, bowen therapy and rock tape or a combination of all these as many clients have reported improvement with tendiopathies using these modalities when they have exhausted other options. All the best!

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    Lyn Craven

    Bowen Therapist, Naturopath, Nutritionist, Western Herbal Medicine Practitioner

    I specialise in gastrointestinal health problems, (leaky gut syndrome, allergies, bloating, candida, IBS, constipation, dysbiosis, reflux), women's health, back/neck pain, RSI, carpel tunnel syndrome, rotating/tilting … View Profile

    Bowen Therapy is excellent for all types of RSI - carpel tunnel syndrome, tennis elbow, frozen shoulder and cubital tunnel syndrome.   If you have not tried this therapy over a period of time I think you can benefit.  For very chronic cases it will take longer to improve.  If disorders like this are left untreated or not treated properly then it will not resolve in 1-2 sessions.

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