Many of us unfortunately live with chronic pain in one or multiple areas in our body. One of the most common areas in our body susceptible to chronic pain/inflammation are the elbow joints.
Elbow pain can be due to many different conditions. Tendinopathy (tendinitis or tendinosis) is the most common condition affecting the elbow and can be difficult to control. Two of the most common elbow injuries, specifically tendinopathies, are Golfer’s elbow (also known as medial epicondylitis) and Tennis elbow (also known as lateral epicondylitis). In Golfer’s elbow, there is an injury to the inner elbow tendon. In Tennis elbow, there is an injury to the outer elbow tendon. Both of these conditions are brought on by repetitive injury to the elbows, and are often found in athletes and skilled laborers, such as plumbers, painters, carpenters, and butchers – professions that require heavy use of the wrist and forearms muscles. Repetitive and forceful use of the elbows can cause acute local swelling and pain in the elbow and its surrounding tissues; and if remained untreated, the pain can become chronic. I have seen patients with Tennis elbow or Golfer’s elbow deal with years of chronic pain despite undergoing various treatments.
The symptoms of Tennis elbow or Golfer’s elbow are often found in the dominant arm and they include: pain on either side of the elbow (inner or outer) that radiates up or down, weakness of the forearm muscles, sudden or delayed onset pain, and difficulty with the use of the arm and elbow (i.e. with grip and lifting). Often the symptoms of Tennis elbow are worse with the forearm rotated such that the palm faces down, and relieved when the palm faces up; Golfer’s elbow manifests the opposite way.
According to WebMD, “Tennis elbow is the most common reason that people see their doctors for elbow pain. It can pop up in people of any age, but it’s most common at about age 40.”
In all of medicine, diagnosis is more important than treatment. If you have elbow pain, be it acute (i.e. it just started) or chronic (i.e. you have had it for a while), you must first have your pain properly diagnosed by a physician (your naturopathic doctor or conventional medical practitioners). A comprehensive history and physical exam are key to proper diagnosis of any condition, including elbow injuries. You may need imaging tests, such as an X-ray or MRI, for a definitive diagnosis. Elbow pain could be due to numerous conditions, depending upon what side of the elbow the pain is on: Anterior (front) side, posterior (back) side, medial (inner) side, or the lateral (outer) side of the elbow. The differential diagnosis (i.e. different possibilities) may include biceps tendinopathy, gout, arthritis, olecranon bursitis, ulnar collateral ligament injury, or metastatic bone cancer, just to name a few.
There are many treatment options for Tennis elbow and Golfer’s elbow. In most cases, treatment involves a team approach. Primary care doctors (NDs and MDs alike), physical therapists, and, in some cases, surgeons work together to provide the most effective care. Nonsurgical treatments include: home care with ice, rest, activity modification, herbal anti-inflammatories, over-the-counter NSAIDs (pharmaceutical anti-inflammatories), physical therapy, brace or strap, and steroid (i.e. cortisone) injections. Steroid injections are only recommended if the other therapies are unable to address the problem.
Since Tennis elbow and Golfer’s elbow can inflict months of pain on their victims, some patients resort to long-term use of NSAIDs. However, such use of NSAIDs should be avoided to protect against negative side effects such as drowsiness, stomach aches, liver and kidney damage, and elevated blood pressure.
Straps and braces both are used for home care treatment of both conditions. They can provide any of the following benefits to the patient: 1) They can help spread pressure across a larger area and take stress off the painful area, 2) They can be used to prohibit certain motions, or to provide support and increased comfort while performing an activity, and 3) They can help control the pain by taking the pressure off the inflamed tendon when placed around the proximal forearm (i.e. immediately below the elbow). While straps should feel comfortable on the area covered, they need to put pressure either on the muscle attached to the tendon on the inner elbow (for Golfer’s elbow) or on the muscle attached to the tendon on the outer elbow (for Tennis elbow). Braces can also provide compression. This is helpful to manage mild swelling around the painful area and keep blood flowing to the muscles that support the elbow.
If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your doctor may recommend surgery as a last resort. As with any surgery, there are risks associated with Tennis elbow surgery. According to American Academy of Orthopedic Surgeons, the most common risks include: Infection, nerve and blood vessel damage, possible prolonged rehabilitation, loss of strength, loss of flexibility, and the need for further surgery. Note that several months of rehabilitation at home and physical therapy are required, and these therapies begin about 6 weeks after surgery. Physical therapy involves different exercises to increase flexibility and strength. These exercises are usually performed at home.
Although the home care therapies for pain management can go a long way in helping with elbow pain, there are times when injections are completely indicated. Since the injections are administered directly into the site of pain/inflammation, they are often highly effective in helping with joint pain. There are two main types of injections that can be effective in treating both Tennis elbow as well as Golfer’s elbow. The first type are conventional steroid or cortisone injections. The second type are injections used by some alternative medical practitioners, and are called neural therapy injections. I use the HEEL homeopathic line of products (most commonly the injectable Traumeel product) from Germany for neural therapy injections. These injections are administered subcutaneously (i.e. immediately under the skin) either on the inner (Golfer’s elbow) or the outer (Tennis elbow) sides of the elbow. During each appointment, multiple shots are administered into and around the painful area.
Cortisone shots are administered into the inflamed area in order to directly reduce inflammation and swelling in the tissues surrounding the elbow. Although cortisone injections are considered safe, they are usually limited to two to three times a year. More frequent use of steroid injections will weaken the tendon and make it more likely to rupture. If positive results are not seen with the first injection, additional injections are also unlikely to work.
In contrast to cortisone injections, neural therapy injections do not forcefully reduce inflammation. In fact, they are not considered “anti-inflammatory.” As is the case with all homeopathic medicines, these injections stimulate the body’s own innate healing mechanisms. Even though neural therapy injections are typically highly effective for treating aches/pains throughout the body, I find them particularly effective for the treatment of both Tennis elbow as well as Golfer’s elbow. Based on many years of clinical experience with this therapy, I find that nearly all my patients with Tennis elbow or Golfer’s elbow report significant reduction of pain within minutes after the injections.
Fortunately, the neural therapy injections are so effective that typically no more than 1-2 appointments, with a series of injections administered during one appointment, are required for each location in pain. Even if the patient requires multiple series of injections during a few consecutive visits (typically spread out by a few weeks between visits) in order to achieve a higher degree of effectiveness, there is no limit on the number of neural therapy injections due to the benign nature of these injections. In the case of Tennis elbow or Golfer’s elbow, I have rarely needed to recommend more than a maximum of 2 series of injections (administered during two separate visits, spread out by a few weeks). In other words, if you suffer from tennis elbow or golfer’s elbow, 1-2 series of injections is likely all that is required to either completely or nearly completely take care of the pain in your elbow once and for all.
Neural therapy injections involve the subcutaneous (i.e. immediately under the skin) injections of Traumeel or other injectable homeopathic products into and around the site of musculoskeletal pain. The effect is often felt within minutes regardless of the site of administration. My office staff and I encounter numerous patients on a regular basis who suffer from pain in some part of their musculoskeletal system walking into our office, and are either completely pain-free or are experiencing much less pain on their way out of our office. The most common areas that we tend to offer neural therapy injections for include: Elbows, wrists, shoulders, knees, hips, ankles, fingers, toes, and anywhere in the back (upper, middle and lower).
Since these neural therapy injections are extremely superficial, they do not damage any structures deep under the skin and are therefore completely safe and nearly painless. Furthermore, since these injections are homeopathic, and by definition chemical-free, their ingredients are safe. Last but not least, the price for neural therapy injections is a fraction of the price for cortisone injections.
We have offered neural therapy injections at Whole Health Clinic for many years for treating a variety of musculoskeletal aches and pains with a high degree of patient satisfaction. If you have any questions, please feel free to ask the front desk staff at our clinic.