Chronic lateral (outside) or medial (inside) elbow pain
- The use of diagnostic musculoskeletal ultrasound (or other imaging modalities) can help better define your injury, which may be more severe than you think. This may be why you are not improving as expected. Steroid injections and other anti-inflammatory medications (such as ibuprofen) fight inflammation. However, inflammation is not typically the problem after a period of time. The inflammatory aspect of these conditions does not typically persist after 3-4 weeks. Animal studies confirm that the tissue is degenerative. Specifically it is mucoid degeneration. (Mucoid describes tissue that is like mucous, which is not a very good quality in a tendon!) There are no White Blood Cells (WBCs) in this mucoid degenerative tissue. The WBCs are present in inflamed tissue. The tendon may also have a tear, either across the tendon (transverse) or, more typically, along the length of the tendon (longitudinal or interstitial tear). Steroid injections are known to cause further degeneration of tissue (tendons, ligaments, cartilage, facia) despite often providing temporary relief of pain. Ibuprofen or other anti-inflammatory medications alter the normal healing response after an acute injury, causing abnormal healing of the tendons or ligaments…although they do provide pain relief. Ice and/or acetaminophen are good alternatives that do not cause further degeneration. For ice, consider using frozen corn or peas for 15 minutes out of every hour.
You should stretch the injured associated muscle. For tennis elbow (pain on the lateral or outside of the elbow), the stretch will involve the wrist extensors (bending your wrist down). For golfer’s elbow (pain on the medial or inside of the elbow), the stretch will involve the wrist flexors (bending your wrist up). Hold the stretch for 30 seconds. Repeat 3 times several times daily.
- Commonly known as “negatives” in weight lifting terminology
- For tennis elbow, start with a 1 pound weight in your affected arm with the palm facing down. You can rest the forearm on a table. Use the unaffected hand to bring the affected wrist into extension (bend the wrist back). Then slowly (over 3 seconds), lower the wrist without assistance. Repeat. Work up to 30 repetitions 3 times daily.
- For golfer’s elbow, start with a 1 pound weight in your affected arm with the palm facing up. If you don’t have a 1 pound weight fill a 16oz water bottle and use that. You can rest the back of your forearm on a table. Use the unaffected hand to bring the affected wrist into flexion (bend the wrist up). Then slowly (over 3 seconds), lower the wrist without assistance. Repeat. Work up to 30 repetitions, 3 times daily.
- These exercises should not be hard. The goal is not to build muscle but stress the tendon. If you have a slight amount of pain with these exercises, that’s okay. If you have more pain than a slight amount, you need to discontinue the exercise and try again in 2-3 days. It’s best to do these stretches after warming up for 10-15 minutes, such as on a stationary bike.
- Only consider steroid injections if stretching and exercise do not work.
- Regenerative medicine can dramatically help the healing of golfers or tennis ellbow. Read more about regenerative medicine here. (link to RM page)