Lateral epicondylitis, more commonly known as tennis elbow, is a muscle tendon injury located on the thumb-side of the elbow. While the condition can result from a single traumatic event, tennis elbow is typically caused by repetitive motions that involve gripping or extending the wrist that overload the forearm muscles. Initially, the tennis elbow patient may pursue self-care options such as ice therapy, compression, rest, elevation, and over-the-counter pain relief medications and analgesics. However, if these approaches fail to yield a satisfactory result, the patient may have several treatment options they can pursue.
Cortisone injections are commonly used to provide short-term relief for lateral epicondylitis; however, this treatment is not without risk. The Mayo Clinic notes the following potential risks associated with cortisone shots: cartilage damage, death of nearby bone, joint infection, nerve damage, short-term fascial flushing, short-term joint irritation, short-term increase in blood sugar, tendon weakening/rupture, whitening/lightening of skin at injection site, and thinning of nearby bone, skin, and soft tissue at injection site. Because of these risks, most physicians put a limit on the number of cortisone shots given per year, depending on the diagnosis and other factors.
The good news is that a 2024 systematic review that included twelve studies concluded that a physical treatment approach provides longer-lasting benefits than cortisone shots, with limited risks (such as potential bruising in patients using blood thinners), and a lower recurrence rate. Examples of physical treatments include electrotherapy, manual therapy, and exercises—all treatments commonly provided in a chiropractic setting. Additionally, a systematic review that included patients who failed to respond to injections reported that low-level laser therapy—a technology many doctors of chiropractic utilize—can provide significant improvements in pain, grip strength, pain sensitivity, and ability to carry out work activities.
When managing lateral epicondylitis, doctors of chiropractic will often employ a multimodal approach that combines several of these therapies, as often doing so yields superior results for the patient vs. one isolated therapy. Chiropractors will also look at the whole patient to identify any issues beyond the forearm that could potentially contribute to the patient’s symptoms. Some examples include carpal tunnel syndrome, golfer’s elbow, rotator cuff tendinitis, De Quervain tenosynovitis, bursitis, shoulder impingement syndrome, and trigger finger. If a patient fails to respond to treatment, they may be referred to an allied healthcare provider to pursue more invasive treatment options. Fortunately, many patients respond well to conservative care.
