Mount Sinai Health TIP: Alternative Treatments for Tennis Elbow

February 13, 2017

Welcome to the Mount Sinai Health Beat, a feature with the official medical provider of USTA Eastern, USTA, and the US Open. This month, Houman Danesh, MD, Assistant Professor, Anesthesiology, Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai and Director of Integrative Pain Management for The Mount Sinai Hospital, talks about tennis elbow.


They may be two of the most feared words for tennis enthusiasts: tennis elbow. Just about every player knows that feeling of tenderness on the outside of the elbow that seems to get worse and worse, to the point where you have to put the racquets away and wonder when you can return to the court. Or you have a tennis partner who has struggled with it. It’s not your imagination: About half of all players suffer from tennis elbow at some point.



What can be so mystifying is that, unlike twisting your ankle or knee in one slip or fall, it can be hard to figure out what actually caused your tennis elbow.


Normally you develop tennis elbow over time and through repetitive motions that can make it hard to notice what actually caused the problem in the first place. Many players assume the problem stems from the way they swing the racquet. But doctors believe one contributing factor is gripping the racquet too tightly, placing greater strain on the tendon and elbow joint, which can happen if you are using a grip that’s too small.


You can even develop tennis elbow off the court. Any repetitive twisting and turning motion, like using a keyboard with poor ergonomics, can damage that tendon. Between 1 and 3 percent of the general population will develop tennis elbow in their lifetime. Both genders are affected, and it can strike at any age.


So how do you know if you have tennis elbow? You will normally feel pain on the outside of your elbow, and the affected area is very tender to touch. The severity of the pain can vary dramatically. Many patients report the pain gets worse with twisting movements, like shaking hands, squeezing an object, or opening a jar.  However, sometimes a trapped nerve can cause a similar set of symptoms, so it’s important to have elbow pain evaluated.


Fortunately, about 80 to 90 percent of patients get better on their own. For these patients, taking over-the-counter pain killers like ibuprofen and naproxen is often sufficient. The main question for patients is how long are you willing to wait until the healing process is complete.


If you don’t want to wait, or if your injury is very painful, then you should consult your physician about treatment options. Physicians have a battery of effective therapies for tennis elbow. These range from more traditional options like physical therapy and steroid injections to alternative therapies like acupuncture, platelet-rich plasma therapy, and stem cell treatment.


For years, the standard treatment for tennis elbow has been physical therapy, possibly accompanied by wearing a simple brace or steroid injections. However, we now take a more nuanced view toward these injections because, while they do temporarily relieve pain, they actually weaken the tendon. We also know that they provide no long-term benefit. Insurance companies do cover this procedure, and it does get rid of pain in the short term.


There is an increasing consensus in the medical community that alternative therapies can provide a lot of benefit for tennis elbow. Acupuncture, for instance, has helped many of my patients manage their pain. It’s a gradual healing process that usually takes four to six sessions. There’s a mystical element to acupuncture, and there’s a lot we still don’t understand about it from the perspective of Western medicine. The key is to visit an acupuncturist who is well trained and will take the time to get to know you, because acupuncture treatments must be tailored to the individual patient.


On the other end of the spectrum is platelet-rich plasma therapy (PRP), which involves taking the patient’s own blood, spinning it down to extract the platelets, and then injecting them back into the site of injury, in this case the elbow tendon. In the long term, the platelets help accelerate healing in the area, although the procedure does cause inflammation in the short term and can cause some pain for a few days. This is still a new treatment option, but the research we have shows a trend toward benefit.


Stem cell therapy is an offshoot from PRP. In this option, you are injected with your own stem cells, which have been extracted from the bone in your hip or your back. The extraction carries more risk than PRP, but the stem cells have even more powerful healing properties than other platelet-rich plasma options.


Whatever treatment option you pursue, it’s important not to rush back onto the court; otherwise, you’re going to set back your recovery. I tell my patients to ease into it. Perhaps start off hitting against the wall for ten minutes. Once that feels okay, try 30 minutes. Then try casually hitting with a partner, then playing for an hour.


So there’s little reason to fear a diagnosis of tennis elbow. We now have a better understanding of the problem plus a host of treatment options that can speed your recovery and your return to the court.


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