Traditional methods of treatment
Unfortunately the findings coming from new research take time to be integrated into clinical practice. For that reason, the focus of many medical practitioners on treating lateral epicondylitis as an inflammatory problem will persist for years. Often there is a desire to find anything that provides relief, even if only temporary. Some individuals seek the short-term pain relief offered by anti-inflammatory medications, including corticosteroid injections.

Anti-inflammatory medications are effective at reducing pain; however, their benefits for a condition that isn’t truly a result of inflammation are questionable. In fact, their use may be detrimental to overall tendon healing because corticosteroids in particular have been shown to cause degeneration of connective tissues over time.

Ideally, treatment should focus on getting the damaged collagen fibers back to a state of proper function. The tendon needs time to heal and to rebuild the collagen matrix. Therefore one of the most important factors in the rehabilitation process is to reduce the offending stress on the tendon. This can come from either modification or elimination of activities that have caused tensile loading on the tendon in the first place. In many cases, though, the individual can’t stop the activity altogether (such as in an occupational injury), but activity may be modified in a way that will reduce stress on the tendon.

Rehabilitative exercise is frequently used to address epicondylitis. The goal of rehabilitative exercise is to improve overall strength and endurance of muscles throughout the kinetic chain. The idea behind strengthening these muscles is to make them more resistant to developing fatigue. However, use of strengthening activities when the tendon is already damaged can be detrimental. These methods appear to be most effective as a preventive measure or when the condition is caught early on. Other physical-therapy modalities, such as ultrasound and electrical stimulation, are also used to treat this condition.

If conservative treatments are ineffective, surgery may be performed. In surgical treatment the pathologic tissue is removed. Physicians are also experimenting, and finding some success, with laser treatment for lateral epicondylitis, although more research is needed. However, despite the wide number of treatments commonly used for lateral epicondylitis, many don’t have adequate physiological rationales to support their continued use.

References