Nothing strikes fear in the heart of a golfer like a diagnosis of Medial Epicondylitis, better known as Golfer’s Elbow.
Golfer’s Elbow belongs to a family of conditions including:
Lateral Epicondylitis (Tennis Elbow)
Plantar Fasciitis
Patellar Tendinitis
Achilles Tendinitis
Rotator Cuff Tendinitis
What is the common denominator in all of these conditions? They all end with the suffix -itis.
What does that mean?
In medical terminology -itis means inflammation, therefore all of these conditions are considered to be inflammatory in nature. In the case of Golfer’s Elbow/Medial Epicondylitis, your doctor will tell you that you have inflammation of the tendon of the elbow.
Unfortunately that terminology is incorrect, therefore traditional treatments that address inflammation are likely unhelpful and possibly harmful.
Why is it wrong?
Over 15 years ago researchers discovered that most tendinitis conditions are actually tendinosis conditions.
Tendinitis, tendinosis – who cares? They are practically the same word!
When it comes to medicine, words matter. The researchers looked at the tendons of people with tendinitis conditions and did not find inflammatory cells. So no inflammatory cells means no inflammation.
Then what is wrong with the tendons?
What the researchers did find was degeneration of the collagen of the tendons (as well as other cellular changes). When viewed under a microscope the tendons appeared brown, dull and soft, whereas normal tendons are white, glistening and firm. In other words, the tendons appeared abnormal and diseased and that’s exactly what the suffix -osis in tendinosis means. Furthermore, tendons that are subject to mechanical overuse or repetitive strain typically show this type of cellular change.
Why does this matter?
What matters is how these terms are used to determine treatment. If your doctor says you have a tendinitis condition, he or she will likely recommend a treatment to address inflammation (such as cortisone shots). However, anti-inflammatory treatments should not be indicated for these conditions. And here’s the kicker – they may actually interfere with tendon repair.
So let me get this straight, it’s likely my doctor knows this but is recommending cortisone shots anyway?
In defense of doctors, most offer cortisone shots because they don’t have anything better to offer. There is some evidence that cortisone shots can sometimes help, but the evidence only supports a short term benefit. The long term outcome is fairly grim, which is why most doctors will limit the number of shots in one area to three. Also, there is research showing that repeated cortisone injections into tendon tissue leads to cell death and tendon atrophy. This is a clear example of risk vs. reward. You may be that lucky person who receives tremendous relief from one injection and have no adverse effects (now or in the future) and never have an issue in that area again. Or you may not.
Then what treatments do work without all the risk?
Rest: Most medical professionals do not emphasize the importance of rest and what constitutes an appropriate rest schedule. This is compounded by the fact that most people either can’t or won’t adhere to an appropriate schedule of rest, even when it is recommended. Here’s a hard fact to swallow, it takes a tendon three months to rebuild collagen. If you are constantly loading that damaged tendon by continuing with your activities, you can be sure it will take much longer than 3 months to rebuild collagen.
Massage/Manual Therapy: Massage and other related manual therapies address the excess muscle tension and myofascial trigger points that are major contributors to pain that can take a tendinosis condition and make it even worse. In my clinic I have seen symptoms of Golfer’s Elbow resolved in one or two visits, leading me to believe there are instances where excess muscle tension and myofascial trigger points were the culprits and no actual tendinosis existed.
A qualified therapist, particularly one who specializes in Orthopedic Massage, should be able relieve some (if not all) of your pain by restoring normal muscle resting lengths and addressing myofascial trigger points. This type of therapy is a low-risk, high-reward treatment option that is definitely worth exploring.
Notes
1. E Bass, “Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters,” International Journal of Therapeutic Massage & Bodywork 5, no. 1 (March 2012): 14-17.
2. KM Khan et al., “Histopathology of common tendinopathies. Update and implications for clinical management,” Sports Medicine 27, no. 6 (June 1999): 393-408
3. KM Khan et al., “Overuse tendinosis, not tendinitis, part 1: a new paradigm for a difficult clinical problem,” Physician and Sportsmedicine 28, no. 5 (May 2000): 38-48.
4. P Ingraham, “PainScience.com: The Science of Stubborn Aches, Pains, and Injuries.” PainScience.com RSS. Accessed May 3, 2015. https://www.painscience.com/.
5. P Ingraham, “PainScience.com: Repetitive Strain Injuries Tutorial.” PainScience.com RSS. Accessed May 3, 2015. https://www.painscience.com/.