Tennis Elbow

[ginger]

Alophysio, there is a powerful construct that exists in the minds of most physios , provided at undregrad level and often further ingrained by the pathology driven attentions and answers provided by doctors of medicine. What must be resisted , is the slavish acceptance of medical diagnosis in areas where medical intervention has historically been a poor solution . I speak of course of MSK problems. It is important to understand that , by and large , we physiotherapists are the front line in MSK observations, handling and interpretation based on the steep learning curve provided by manual therapy interventions. We do= we observe=we learn=we modify=reinterpret.
This near perfect opportunity is mostly unavailable to those who treat with either exercise , pharmaceuticals, or modalities , either alone of as part of a multi treatment protocol.
It is clear to me having picked up the pieces so many times, after these kinds of interventions, after multiple attentions paid to the painfull structure(s) by others, after patients had suffered needlessly with referred events, when no-one had bothered to properly diagnose a referred event, that undergrads need better training . Both medical and physiotherapy.
The kind of thinking you display is perfectly reasonable, make a careful analysis of all before you, keep in touch with reality rather than dogma, eyes and senses alert to the origin rather than product of pain. In my own searches for and treatments of the cause of tennis elbow, I invariably find , when no direct trauma has been a part of a persons Hx, that the central spine is the cause . That by attention to the relevant upper thx and lower Cx facet joints/nerves and occasionall dural length, a full and speedy long term resolution is gained , usually within three treatments, to "tennis elbow". this is true for a long list of pain issues and neuralgic problems often mistreated with local rather than central interventions.
I am yet to come across a "tennis elbow " problem ,. in nearly twenty years of careful searching , that was not a referred pain event and eminently fixable in short order in the fashion I call Continuous Mobilisation. There is a temptation in the minds of those who have spent years digesting complexity as a student , to believe that MSK problems are also complex. This is rarely so. My first instruction to my own students is to think simply and observe with hindsight as a test of any method or diagnosis. What works and is safe is a good motto. Attention to the central spine with CM for "tennis elbow" is not a means to modify temporarlly pain behaviour, but a method whereby the cause of neuralgia is directly and effectively targeted and eliminated.
It is neither usefull or time effective to treat a possible referred event with a multi pronged multi target approach . Best to make the following observations.
Pain intermittant and variable ?
pain persistant over more than two weeks?
Pain increases with activity/fatigue ?
Pain decreases with rest/sleep?
Are the relevant facet joints positive for a. resistance and b. pain , when overpressures are applied when performing a unilateral mob ( grade three maitland)
When the percieved pain is in a cervical distribution ( "tennis elbow"), can this pain be reduced with traction rotations ( more on this if requested )
or stimulated with AP unilateral mobs of the relavant facet ( for "tennis elbow" , C5/6)
All the above are positive in a display characteristic of neuralgia.
When in doubt, mobilise and observe. It will only take five to ten minutes of Cm to firmly establish the relationship between central cause and distal pain, after which any attentions paid to the distal, is time wasting to say the least.