When people experience elbow pain, they may not think it’s a condition suitable for

chiropractic care. But surprisingly, lateral epicondylitis, also known as “tennis elbow”, is a

common condition often seen in a chiropractic office; and with proper treatment and

management, can respond well with conservative care.

Despite its name, tennis players only make up about 10% of annual tennis elbow cases. Sports or occupations involving repetitive wrist extension as well as activities involving frequent grasping and gripping motions (like weightlifting) can result in this type of injury. I have also seen this condition in office workers caused by long hours of typing with the wrist in extension. Overtime, this generally harmless activity overloads the common extensor tendon along the outer aspect of the elbow, leading to symptoms.

In athletes, symptoms are typically caused by poor mechanics or technique, as well as the use of new, altered, or improper equipment. Small changes like tightening the strings or getting a new grip on your tennis racket can create new demands on the tendon leading to overuse. Symptoms can range from mild discomfort, only presenting with heavy lifting or more vigorous activities, or more severe pain, where patients struggle from simply holding a cup of water or coffee mug.

Current research has changed how we think about lateral epicondylitis, which is now

understood to be a degenerative tendon injury rather than an exclusively inflammatory injury. This means that anti-inflammatories and rest alone are typically not enough to create a long-term fix. When evaluating a patient with elbow pain, it is critical to rule out other conditions that could mimic the symptoms of lateral epicondylitis. Conditions affecting the neck or shoulder could also cause elbow pain. Nerve irritation coming from the neck or rotator cuff tears of the shoulder could also mimic symptoms, so a thorough physical examination is critical in determining the root cause of symptoms. If moving the neck or shoulder does not reproduce symptoms, it helps to rule out those regions as a primary source of symptoms.

Once neck and shoulder involvement has been ruled out, there are several common signs

I look for to determine a true case tennis elbow: pain along the lateral elbow with resisted wrist extension, tenderness over the lateral elbow, and decreased grip strength. 

But how can chiropractic care help with tennis elbow?

Addressing the motion of the elbow, as well as the regions above and below is often a good starting point. Extremity adjustments can help restore joint motion at the shoulder, elbow and wrist. Assessing the spine for areas of limited motion is also important since the nerves coming from the neck supply the muscles of the arm and forearm, and spinal motion can also influence extremity movement and position in space. Manual therapy of the muscles along the outer aspect of the forearm is also commonly performed and can help reduce the stresses placed on the common extensor tendon. Instrument-assisted soft tissue mobilization can help increase blood flow to the region, helping to promote healing and collagen remodeling within the tendon. Patients have also responded well with dry needling, helping to reduce local pain. But these are all passive therapies, requiring no physical effort or participation on the part of the patient. In my experience, the most important part in resolving this condition is active therapy, where the patient actively participates in their treatment through exercise, stretching and activity modification. Research has consistently shown that exercise helps improve tendon healing and load tolerance. One go-to exercise is eccentric wrist extension, where the wrist slowly lowers a weight under control, helping to stimulate tendon repair. 

If there is one thing I have found, it is that lateral epicondylitis can be very stubborn and

frustrating for patients due to the persistence of symptoms. Most patients will experience

symptom relief within 6-12 months, so being consistent with therapeutic exercises is

important because it helps to stimulate tissue repair and remodeling, all of which take time, effort and consistency. Modifying activities as needed, warming up prior to exercise, and rest when symptoms worsen are also important in preventing worsening of symptoms. If you have ever wondered how chiropractic care can help with your elbow or other extremity symptoms, don’t hesitate to reach out!