One of the most useful concepts I was taught about treating joint and muscle pain is that while a patient’s pain may be in one area, the problem usually involves a whole region, including the spine. This is true of tennis elbow. It’s rare that I see a case that does not involve the shoulder, neck and upper back.
It’s also rare that I see it in tennis players, but only because I don’t treat many of them. I do see a lot of office workers with this condition, as well as people who do repetitive work like hammering or even stirring. They show the typical tenderness at the point of the elbow and weakness in extending the wrist against resistance, but they also show problems in the neck and upper back.
In a recent study of patients with tennis elbow, 36 to 41 percent showed mechanical problems in the neck. The researchers also reviewed previous studies that estimated the number to range from 57 to 90 percent.
Subjects without any elbow pain were much less likely to have these neck problems. The researchers commented that the mechanical problems in the neck were found in patients “without obvious neck pain.”
This corresponds well with my experience. It is the unusual patient with any pain in the arm or hand that does not have something out of alignment in the neck. Even patients with no neck pain at all can still have “knots” in the neck muscles, and show what Dr. Janet Travell called “the jump sign,” meaning they jump when pressure’s put on the knot. Once I convince them that no, that spot in the neck isn’t supposed to hurt, and no, I’m not really pushing that hard, we can begin to treat the problem from a regional point of view, rather than just looking at the elbow.
In the beginning of care, treatment is focused on reducing inflammation and pain, so the patient can get some relief. As they improve, we can give exercises, especially stretches. As they improve further, the stretches will be alternated with gentle resistance. Tight, inflamed muscles typically resist stretching, but they briefly relax and stop resisting after the muscle is contracted. This technique is used at the elbow, but also may be needed at the shoulder and neck to release them as well. Many patients with sedentary jobs also need to work on their posture — actually, almost every patient needs this work, myself included.
A few of the more difficult cases benefit from eating an “anti-inflammatory diet,” because part of the problem is that their whole body is somewhat inflamed, it’s just worst at the elbow. My first recommendation in these cases is to stop eating wheat; many patients find just that one change helps. I also recommend getting off the anti-inflammatory drugs, except for occasional use. While they do help ease the pain temporarily, long-term use may actually interfere with the healing process.
Most tennis elbow patients just want the elbow tended to; they don’t want to do posture exercises, have the neck treated or, God forbid, change their diets. But the idea that elbow pain is only due to a problem at the elbow itself is too simplistic for most cases. For the best and most lasting results, the whole problem has to be treated and lifestyle changes made. I have seen many cases of tennis elbow persist for years if not properly treated.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at firstname.lastname@example.org.