Tennis Elbow Classroom

Learn How To Break Your Vicious Tennis Elbow Cycle!

  • Tennis Elbow Program
  • Golfer’s Elbow Program
  • Thumb Program
  • Success Stories
  • Treatment Strategy
  • Exercise Principles
  • Members Login Here
  • About Me
  • Consults
  • Contact
Home » Tennis Elbow Causes » Could Antibiotics Be The Cause Of Your Tennis Elbow, Golfer’s Elbow Or Other Tendon Injury Pain?

Could Antibiotics Be The Cause Of Your Tennis Elbow, Golfer’s Elbow Or Other Tendon Injury Pain?

July 14, 2023 By Allen Willette, Neuromuscular Therapist Leave a Comment

Could there be a link between that course of antibiotics you took 6 weeks or even 6 months ago – And the Tennis or Golfer’s Elbow (or other tendon pain) you’re suffering now?

Yes, as strange as it sounds, there’s a class of antibiotics called ‘Fluoroquinolones’ that have been know for decades to cause various forms of tendon damage – (Cipro being the most well-known and commonly prescribed.)

“Tendinitis and tendon ruptures induced by fluoroquinolones, while uncommon, have been documented in the literature since 1983” [Ref: PubMed]

The official medical websites, pharma sources and research literature seem to downplay this link, while at the same time the FDA requires “Black Box” label warnings on these drugs. (The most stringent caution level.)

AND the FDA also now advises Doctors NOT to prescribe systemic Fluoroquinolones to patients unless there are no other options for their serious infection, (including certain Acute Bacterial Sinusitis, Bacterial Bronchitis and urinary tract infection cases)…

Because the risks of these tendon-damaging effects (and other side effects we’ll get to) otherwise outweigh the benefits. [Source: FDA updates]

Podcast Episode

Visit my Subscribe To Podcast page to subscribe via Android, Apple Podcasts, etc.

The Fluoroquinolone Antibiotics That Cause Tendon Damage

The role of antibiotics in tendon disorders, including Tennis Elbow

“As of July 2008, the FDA mandated that all FQ products have a black-box warning indicating an increased risk in adverse events including tendon rupture.”

“The FQ [Fluoroquinolone] products affected by the labeling changes include:”

  • Ciprofloxacin (Cipro)
  • Extended-release Ciprofloxacin (Cipro XR, Bayer; Proquin XR, Depomed)
  • Gemifloxacin (Factive, Oscient)
  • Levofloxacin (Levaquin, Ortho McNeil)
  • Moxifloxacin (Avelox, Bayer)
  • Norfloxacin (Noroxin, Merck)
  • Ofloxacin (Floxin, Ortho McNeil, and generic)
  • Enrofloxacin

The Risk of Fluoroquinolone-induced Tendinopathy and Tendon Rupture
J Clin Aesthet Dermatol. 2010 Apr; 3(4): 49–54

(This list above may not be conclusive. There are first, second, third AND fourth-generation versions of this class of drugs.)

Other Nervous / Musculoskeletal Symptoms

The side effects of these drugs are not limited to kidney and tendon damage – but are also linked to other musculoskeletal, nervous system and, even Psychiatric Disorders:

Muscular symptoms: Myalgia (muscle pain), muscular tension, rigidity and weakness

Joint symptoms: Arthralgia / Arthromyalgia (joint pain)

Nervous system symptoms: Tremors, dizziness, headaches and Paraesthesia (“pins and needles”)

Psychiatric symptoms: Insomnia, hallucinations, depression, anxiety Temporospatial Disorientation (mental confusion)

Front. Pharmacol., Volume 11 – 2020

(If you are still on any of these antibiotics and are experiencing any of these symptoms, be sure to contact your Doctor right away!)

In the most severe cases, tendon ruptures (massive tendon tearing of the majority of the tendon) can occur, (most often in the Achilles Tendon) – Which certainly won’t go unnoticed.

“The majority (>85%) of FQ-associated tendinopathies occur within a month of initial FQ therapy, with a 3-fold higher chance of tendon rupture within the first 90 days of exposure.”

“In rare cases of patients with pre-existing musculoskeletal disorders, FQ therapy has been linked to tendinopathy as early as a few hours after administration to as late as 6 months after discontinuing medication”

Nonantibiotic Effects of Fluoroquinolones in Mammalian Cells
J Biol Chem. 2015 Sep 4; 290(36): 22287–22297

These side effects are said to be “uncommon” even “rare” – but by what measure?

After all, how many “lessor” cases must surely exist where someone develops a case of Tennis Elbow, Golfer’s Elbow, a Rotator Cuff injury or other tendon disorder while taking – OR, more to the point, some time AFTER taking these drugs?…

Cases where neither the person nor their doctor makes any connection between their tendon pain and their recent course of Antibiotics?

The paper refers to “rare” cases of people who have “pre-existing musculoskeletal disorders”

Yet, musculoskeletal disorders, which include everything from back pain to shin splints to Tennis Elbow, are so common and mundane they’re practically the norm in modern society.

Almost everyone you know has some kind of “pre-existing” musculoskeletal disorder. (And chances are, you do, as well, if you’re here reading this!)

And when their knee, elbow or shoulder suddenly starts hurting a lot worse, who is going to think:

“Ah! This must be from the antibiotics I was taking earlier – I’d better see my Doctor right away!”

Yes, the majority (85%) reported the onset of their tendon pain within only a month of taking the drug…

But how many people “fall through the cracks” if they start experiencing mild to moderate tendon pain SIX months after taking these antibiotics!?

I’ve worked with tendon pain sufferers for over 20 years now, and, for what it’s worth, most Tennis and Golfer’s Elbow sufferers don’t bother even seeing their doctor about their injury, so how would they be assessed and “counted” as an antibiotic-injured case?

How Do These Drugs Damage Tendons?

First off, sadly, there can be other ‘Soft Tissues’ affected by these drugs along with tendons.

Ligaments and joints can also be damaged (and muscle pain is a less-serious – but still potentially disruptive symptom.)

When you have chronic (long term / persistent) damage to tendons (which connect muscles to bones) and ligaments (which connect the bones of a joint) you eventually get ‘Joint Instability,’ as well.

Meaning: When you have a persistent, non-healing breakdown of these tissues that move and support your joints – Then your joints themselves will start hurting and wearing out a lot faster.

The mechanism of Fluoroquinolone Antibiotic damage, according to the following study, will likely be too technically dense for anyone to follow – without the proper level of chemical / biological science training.

in the simplest of terms,

“Fluoroquinolones (FQ) are powerful broad-spectrum antibiotics whose side effects include renal damage and, strangely, tendinopathies. The pathological mechanisms underlying these toxicities are poorly understood.”

“inhibition of proline hydroxylation in collagen, respectively. These effects may explain FQ-induced nephrotoxicity and tendinopathy.”

Nonantibiotic Effects of Fluoroquinolones in Mammalian Cells
J Biol Chem. 2015 Sep 4; 290(36): 22287–22297

In short: These drugs can damage the Collagen your tendons are made of, causing pain, tearing and possibly full-blown rupture…

Especially in weight-bearing joints and their tendons and ligaments, which include the ankles, knees and hips.

The Achilles Tendon being the most common site of ruptures, according to the literature.

(And let’s not forget the risk of poisoning and damaging your kidneys ‘Nephrotoxicity.’)

Proposed Mechanism [of Damage]

“Fluoroquinolones have been hypothesized to compromise tendon function and increase risk of injury… These medications may cause direct tissue injury, including necrosis or exposure-dependent cellular apoptosis.”

“They may also induce toxicity indirectly by stimulating local release of tissue-damaging substances… that degrade collagen.”

Sakaan SA, Self TH. Minimizing the risk of tendon injury associated with fluoroquinolone use
Consultant. 2017;57(9):541-542.

The two key terms to focus on are: ‘Necrosis’ (tissue decay) and ‘Apoptosis’ (which refers to cellular death.)

If you haven’t already heard it on social media, online forums or YouTube, there’s a special lay term for these Antibiotic-induced collagen injuries often and used by their sufferers:

“FLOXED” (Slang term, meaning injured by Fluoroquinolone toxicity – Derived from the ‘floxacin’ in these drugs names.)

How Does This Differ From A “Typical” Tendon Injury? (Tendinopathy)

In the “typical” injury process that leads to Tennis Elbow, Golfer’s Elbow, Achilles Tendon pain and similar tendon injuries, a tendon will fail to heal and regenerate properly in response to the stresses (mechanical loads) placed on it…

Which could be from almost anything: Tennis, golf, Pickleball, computing, gardening, dog walking, playing a musical instrument – guitar, piano, ect.

And your tendon gradually breaks down to the point where it starts to become weak and painful.

(Although exactly WHY this happens isn’t well understood either!)

Later, if allowed to progress, this can result in a tear because the tendon becomes too weak to handle the load on it and fails.

If you already know you have a tear, here’s my detailed article on the big question of:

Can a tendon tear can heal without surgery?

This a gradual biological failure on a microscopic level (often referred to as a form of ‘Micro Tearing’ but more accurately as ‘Tendinosis.’)

Tendinosis being a slow, degenerative “rot.” (Dry Rot would be a crude way to characterize it if we were talking about wood.)

The antibiotic-driven “FLOX Rot” seems to be a very rapid chemically-induced biological failure…

One that begins on a microscopic, chemical level but which can very quickly escalate to the “macro” / big-damage level and result in a moderate-sized tear – or even a full-blow rupture!

Whereas, it would normally take many months – if not several years for the progression of the Tendinosis to weaken a tendon to the point where it tears.

Collagen Breakdown

All of these connective tissues; tendons, ligaments and joint capsules, are composed mainly of Collagen, the most common protein in the body.

And the essence of the problem is the breakdown / degeneration / damage to the Collagen in these connective tissues.

Whether it comes from mechanical stress (what’s often called “overuse”) Repetitive Strain Injury, Tendonitis, Tendinopathy, Tendinosis, etc.

Or whether it’s driven by the chemically-induced “side effects” of these antibiotics…

OR, possibly a combination of BOTH of these factors.

I would hazard a guess that for many sufferers who are mildly to moderately “Floxed” / suffering from an Antibiotic-Induced Collagen Injury…

There is an overlap – Or one factor has already “pre-weakened” a tendon or tendons and the other factor pushes it over the edge…

Such as months or years of playing tennis weakens the lateral elbow tendons (Common Extensor Tendon Origin) and the antibiotics cause further damage – compounding it to the point where it becomes a chronic, (persistent) painful injury.

Or the inverse, where the antibiotic damage sets one up for the sports injury or repetitive strain-type injury from some other activity.

How Do You Recover From An Antibiotic-Induced Tendon Injury?

Well, as I alluded to earlier, I don’t claim to have the answer! (At least, not a confident, comprehensive answer.)

But I do believe (or assume) it has to be much the same way you recover from a naturally-occurring tendon injury.

My focus, in my practice, is on tendon problems of the upper extremity – Tennis and Golfer’s Elbow – the Rotator Cuff, and some wrist, thumb and finger problems.

Whereas the majority of the focus in medically-based Physical Therapy (from what I can see online)…

Seems to be on the incredibly traumatic Achilles Tendon rupture cases. They’re sudden, dramatic – extremely painful and debilitating injuries.

And since these injuries require immediate medical care they’re not slipping under the radar.

But I certainly hope that’s not what you’re facing and instead have Tennis Elbow or something similar.

Again, that’s my focus – It’s what I have the most confidence in being able to outline a treatment strategy for.

Although, I’m not a Doctor – I’m just a Neuromuscular Therapist, which is basically just a Massage Therapist with extra training…

And this is just my opinion and not medical advice.

Whether your tendon is damaged by a drug, it’s caused by a sport or repetitive activity – OR due to some combination of the two…

The essence of the problem is a degradation and breakdown of the Collagen protein structure of your tendon.

It’s not a runaway inflammation problem – It’s not from a lack of ice – and it doesn’t need to be braced up and immobilized in order to heal.

(Unless there’s a rupture, of course, which would be followed by surgery and the need for a period of immobilization with a cast, boot or brace.)

It’s not that tendons simply don’t recover when injured. Tendons are perfectly capable of healing, regenerating and getting stronger.

It’s just that they have this mysterious tendency NOT to. Like a two-year old who has discovered the word NO! No, I don’t FEEL like healing.

WHY tendons often don’t heal like they’re supposed to is a question that has still not been properly answered by decades of medical research.

(Maybe they’re not looking in the right place.)

Again, I’m not a Doctor or even a PT, but based on my understanding of the biology and of the pathology of damaged tendons…

The word that sums up the whole picture…

The degenerative collagen breakdown – The failed healing state – The rot at the root of the problem:

Is stagnation.

Like a stagnant body of water that doesn’t have enough movement or oxygen and is collecting waste.

It seems we need to increase the activity in the tendon – To stimulate it in a way that encourages healing.

To break the vicious cycle of stagnation and degeneration by strategically nudging it with physical manipulation.

And increasing the circulation to some extent seems to be beneficial.

And, yes, at the extreme end of the medical spectrum of options, you have treatments like Prolotherapy, and PRP injections.

The goal of which is to stimulate healing by causing new trauma, bleeding and a subsequent inflammation response.

Because that’s the first stage of healing and without inflammation there is no healing.

I don’t think that’s necessary, however, except in severe cases where there’s a tear, or similar major damage.

I believe you can take a hands on approach to stimulating your tendons – as well as releasing tension and adhesions in your muscles, which seem to be a significant contributing cause.

Now, I can’t say I’ve personally worked with antibiotic-injured people.

(At least not knowingly – Again who knows how many people are unknowingly damaged by these drugs.)

I can say I’ve helped countless people recover from “naturally occurring” tendon disorders, both in person and through my courses here.

But I don’t have enough data – enough people with these drug-induced tendon injuries to go on.

The one thing I’m certain of, though, is that you have to be proactive.

There isn’t going to be a pill that fixes the damage from the other pills.

If you’re unfortunate to have suffered a tendon rupture, then I don’t think there’s an alternative to surgery.

(Sometimes lessor tears can heal without full, open surgery but sometimes you still need some kind of minimally-invasive procedure.)

And you’ll still need to work very diligently on your rehab exercises either way.

It’s just that there’s something missing from the standard treatment approach in Physical or Physio-Therapy.

It’s the manual therapy. The hands-on manipulation part.

Fortunately when it comes to Tennis and Golfer’s elbow, it’s possible to work on the muscles and tendons involved yourself.

I can’t make any promises but if that’s where your injury lies, then my programs might make sense for you.

But be prepared to work long and hard on yourself.

And that’s not to say there aren’t other treatments – medical or alternative out there that may aid in recovery.

I believe one of the most promising is Class 4 cold laser.

Chances are, you will need to find a Doctor to get that treatment. Some Chiropractors offer it.

Don’t waste your money on some cheap garbage claiming to be a cold laser on the Internet.

It’s probably just an infra-red device and even if it is a cold laser it won’t be a Class 4 device because they cost 10 to 30 thousand dollars.

Shockwave therapy is another possibility. I have very little confidence in that, though, to be honest with you.

But I think I need to toss it out there because it is a treatment that can stimulate tendon healing.

I still believe it’s more important to learn how to work on your own muscles and tendons.

That’s something you can do every day and you’re not limited by any budget concerns – or the need to schedule appointments.

Now, if you have an injury to a larger tendon – Especially a lower-body, weight-bearing tendon like your Achilles that’s more challenging to work on yourself.

If you have good insurance or can simply afford to get the help you need you may want to see if you can find a practitioner with a Class 4 laser and/or Shockwave Therapy.

Again, I’m wish I had more to offer solution-wise but I hope this at least helps you better understand the nature of the problem.

Learn To Treat And Heal Your Own Tennis Elbow Or Golfer’s Elbow At Home With This Video Program

Learn more about the Tennis Elbow programYou’ll get instant access to a complete VIDEO program designed by a professional therapist to help you take charge and break your vicious cycle of pain and frustration!…

I’ll be your personal tutor guiding you through step-by-step video lessons, where you’ll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home. (Without any special equipment.)

Have Tennis Elbow? – Learn more here

Have Golfer’s Elbow? – Learn more here

More “Cause” Related Articles

How Gardening Causes Elbow Injury

Gardener’s Elbow? How Gardening Causes Elbow Pain And Injury – And How To Treat It

Can gardening and landscaping injure you? It certainly can! Here’s how it causes Tennis Elbow, Golfer’s Elbow and other wrist and thumb tendon injuries – And how to treat it right, so you can keep digging, planting, pruning and enjoying!

Road, mountain and other biking-related elbow pain

Why Cycling + Mountain Biking Causes Golfer’s Or Tennis Elbow And How To Treat It

Overuse Sports Injuries are common among all kinds of cyclists, hence terms like “Mountain Bikers Elbow” and “Motocross Elbow.” Here’s how to treat and beat these injuries (which are usually Golfer’s or Tennis Elbow, technically) including bike fit and alignment tips for various bike types!

Tennis Elbow Causes Part 1 - (Video Prev. Img.)

How Stubborn Muscle Tension Causes Tennis Elbow

Very often it’s the gradual build-up of muscle tension that causes the relentless tightness that perpetuates the vicious pain and injury cycle. Could this be a part of what’s keeping you stuck in the Tennis Elbow Triple Trap?
The role of antibiotics in tendon disorders, including Tennis Elbow

Could Antibiotics Be The Cause Of Your Tennis Elbow, Golfer’s Elbow Or Other Tendon Injury Pain?

‘Fluoroquinolone’ antibiotics are unfortunately notorious for causing tendon damage – including Golfer’s and Tennis Elbow and, more seriously, Achilles Tendon ruptures. (Cipro being the most well-known and often prescribed drug in this class)

Tennis Elbow Causes Part 3 – (Video Prev. Img.)

How Muscle & Tendon Damage Causes Tennis Elbow

Tennis Elbow is caused by injury – by damage – to the tendons that connect to your outer elbow area (Lateral Epicondyle) and often damage to the muscles of those tendons – The tricky part is that the damage can come in several forms and they’re as different as night and day.

Filed Under: Tennis Elbow Causes Tagged With: Lateral Epicondylitis, Medial Epicondylitis, podcast, Tendinosis, video

About Allen Willette, Neuromuscular Therapist

I'm a Neuromuscular Therapist in Marin County, California, and my passion for treating and teaching about Tennis Elbow began in 1990 when I developed a terrible case of wrist/elbow Tendonitis. (Involving the infamous BEE-Sting Story!) You're laughing WITH me - Right? - Here's my full bio

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

How To END Your Tennis Elbow:

Are you tired of Tennis Elbow?

Sick And Tired Of Tennis Elbow?
If you're fed up with all the resting, hoping and waiting, and want to learn how to break your vicious Tennis Elbow cycle naturally, click HERE or above and watch the video.

Classroom Members-Only Links

  • Members Log-In
  • Tennis Elbow Program
  • Golfer’s Elbow Program
  • Thumb Program
  • Members’ Forum

More Tennis Elbow Causes Posts

Could Antibiotics Be The Cause Of Your Tennis Elbow, Golfer’s Elbow Or Other Tendon Injury Pain?

The Top Ten Causes Of Tennis Elbow

Why Cycling + Mountain Biking Causes Golfer’s Or Tennis Elbow And How To Treat It

Swimmer’s Elbow: Does Swimming Cause Tennis Or Golfer’s Elbow Or Can It Help You Recover From It?

Gardener’s Elbow? How Gardening Causes Elbow Pain And Injury – And How To Treat It

Guitar Elbow – How Guitar Playing Causes Tennis Elbow And The Keys To Treating It

How Muscle & Tendon Damage Causes Tennis Elbow

How Muscle Weakness Causes Tennis Elbow

How Stubborn Muscle Tension Causes Tennis Elbow

Search This Site:

Get Your Membership!

Get your Tennis Elbow Classroom membership and start breaking your vicious cycle today - Learn more here.

OR check out the Golfer's Elbow program here.

Most Recent Articles

  • 3 Quick Tests For De Quervain’s Syndrome Tenosynovitis / Mommy Thumb – Diagnose Yourself
  • What Is De Quervain’s Tenosynovitis? AKA, Mommy Thumb Or Gamer’s / Texter’s Thumb
  • Two Surgeons Talk Tennis Elbow – Why Cortisone, MRIs And Surgery Are Rarely Needed

Main Topic Sections

  • Home / Blog / Recent Articles
  • Better Treatment Strategies
  • Key Rehab Exercise Principles
  • What Causes Tennis Elbow?
  • What Is Tennis Elbow?
  • Golfer’s Elbow Treatment
  • News
  • Videos

Members Log In Here

Tennis AND Golfer's Elbow Program members log in to members area here.

Login Button For Gold Members of Tennis Elbow Classroom

Copyright 2023 · Tennis Elbow Classroom, All rights reserved   ·   Home | About | Contact | Terms | Consult Terms | Disclaimers | Testimonial Disclaimer | Privacy