A beaut topical review on tennis elbow (lateral epicondylagia or LE) emerged in the recent Journal of Physiotherapy (Bissett and Vicenzino 2015, Physiotherapy management of lateral epicondylalgia, open access). I think it’s the best review of the status of our LE knowledge. Importantly, it reminds us that LE is “not self limiting and it’s associated with ongoing pain and disability in a substantial proportion of sufferers”. This suggests to me that people experiencing lateral elbow pain deserve a bit of attention and shouldn’t be shunted to the outside courts to wait it out. The authors of the review suggest that “sensitisation of the nervous system” is “one plausible reason for persistent pain in LE”.
As an old clinician I think I, and the patients I was treating over the years, have tried most of the interventions that are reviewed in the paper – exercise, manual therapy/manipulation, orthoses, laser, ultrasound, acupuncture, shock wave therapy and multimodal therapy, and I agree with the general consensus that not much helps. Although, the authors do state that “mobilisation with movement, and exercise” are likely to be superior to “wait and see”.
But, consider that most of these interventions do not target (or even consider) “sensitisation of the nervous system”. Perhaps the poor, equivocal outcomes are understandable?
The clip below presents my current thinking and some techniques for approaching lateral elbow pain – they’re all very much related to a sensitive nervous system. Maybe there are more in this group than we realise?
Thoughts, comments and your own experiences with lateral epicondylagia welcome in the comments below.
EP3 By the sea… Adelaide, Australia, 1-3 April 2016
EP3 2016 is expanding the international flavour, adding another speaker and delivering the most diverse EP3 line up yet – combining neuroimmunology, psychology, sensory processing research, education psychology, conceptual change science, brains, bodies, space and clinical pain science.
Three quick points for EP3.
- Glenelg. We’re taking EP3 to Adelaide’s premier seaside destination. The Grand Ballroom of the Stamford Grand Hotel will provide the best in hospitality and magnificent floor to ceiling ocean vistas. After hours – stroll over to Moseley* Square, tram into the city, enjoy internationally renowned local food and wine, or just soak up the sights and sounds.
- PainAdelaide. Described as ‘probably the best little pain meeting in the world’, PainAdelaide will be held on April 4, the day following EP3. We’re offering exclusive pre-sale packages so that you can lock in your PainAdelaide tickets (they will sell out quickly once released) and give yourself the treat of the 4 biggest and best days in clinical pain science happening in 2016!
- Early bird. Purchase your tickets before 16 December 2015 and pay this year’s price for next year’s event. Bundle in a PainAdelaide ticket to get the whole four days for only $1145. With the Aussie dollar not performing so well at the moment, there’s never been a better time
Head over to EP3 2016 for more details and to purchase your tickets now.
*Yes… although Lorimer doesn’t like to admit it