Body Sense

Like most chronic overuse tendon disorders, tennis elbow is not an inflammatory condition caused by fiber tearing. Instead, the primary dysfunction appears to be collagen degeneration within the tendon. 2 We have a better understanding of the actual physiology of tendon breakdown in these conditions now, but we still don't have a good understanding of why the collagen degeneration occurs. There may still be some minor inflammatory activity at certain stages of the problem. However, framing the condition as one of fiber tearing and inflammation encourages a problematic treatment strategy. One of the primary treatment methods for reducing inflammation in soft tissues is corticosteroid injections. Unfortunately, corticosteroids have detrimental effects on long-term collagen synthesis within soft tissues and are a known factor in tendon weakening. The corticosteroid injections are effective at pain relief, which gives them the impression of healing the condition, but are detrimental in the long run. MASSAGE FOR RELIEF So what role does massage play in epicondylitis treatment? One of the most commonly used massage treatment strategies is deep transverse friction (DTF). Originally it was thought that the primary benefit of DTF was helping to realign scar tissue from the torn tendon fibers. However, that idea has now fallen out of favor as it has become clear that torn tendon fibers rarely play a role in epicondylitis. It could be that pressure and movement on the impaired extensor tendons could be encouraging rebuilding of the damaged collagen structure within the tendon. Another possibility is that the key benefits of friction massage are not only mechanical (pressure and movement), but also help in pain reduction through neurological processes. Reducing hypertonicity is another important role that massage can play in treating epicondylitis. Applications that appear particularly effective are compressive warming strokes and broad sweeping cross-fiber strokes. As treatment progresses, deeper longitudinal stripping methods are very effective, and active engagement lengthening techniques appear to bring good results as well. Engaging the muscle in an eccentric contraction involves greater neurological input along with the massage technique. This greater neurological input may serve to enhance a pain-reducing process called descending modulation. We know this treatment is particularly effective. Lateral epicondylitis can become a debilitating condition, and because it is often related to occupational injuries, the condition can provoke significant anxiety. When caught early, activity modification and reduction of the mechanical load can halt the progression of the condition. If it has progressed further, massage is an ideal intervention for enhancing physiological change, as well as managing psychological and social impacts of this common malady. Notes 1. Wilson C. Lai et al., "Chronic Lateral Epicondylitis: Challenges and Solutions," Open Access Journal of Sports Medicine 9 (October 2018): 243–51, https://doi.org/10.2147/Oajsm. S160974. 2. Evelyn Bass, "Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters," International Journal of Therapeutic Massage and Bodywork 5, no. 1 (March 2012): 14–17. Whitney Lowe is the developer and instructor of orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at www. academyofclinicalmassage.com. Treatments The most common strategies employed for tennis elbow include physical therapy, nonsteroidal anti-inflammatory drugs (NSAID), shockwave therapy, kinesiology taping, biologics, corticosteroid injections, and massage. Biologics—A general term used to refer to several new treatment techniques, such as autologous blood transfusion (the collection of blood from the patient and re-transfusion of that same blood back into the patient). Platelet-rich plasma (PRP) injection therapy—PRP injections use a method where platelets, which play a major role in tissue repair, are extracted from the individual and reinjected to stimulate tissue repair processes. Corticosteroid injections— It is surprising that corticosteroid injections are still used as a treatment strategy even though their potential danger and damage of tendon tissue has been well documented for decades. They aren't used anywhere near as often as they used to be, but they are still used in some cases. 14 Body Sense

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