Inflammation: It's the ultimate, unspoken sacred cow of Tennis Elbow also known as 'LATERAL Epicondylitis' or 'Epicondylopathy' or 'Epicondylosis'...
But, if you’re still fighting, treating or otherwise chasing it, here's why you can stop right now – You're chasing a ghost – A sacred "ghost cow."
What IS Tennis Elbow exactly? – Here's an article/video overview on it
Learn how to test, assess and diagnose yourself – Understand the cause and true nature of Tennis and Golfer’s Elbow – And discover a better treatment strategy: Get your free intro video course 'Tennis Elbow 101' here
Podcast: Smashing The Tennis Elbow Inflammation Myth
Here's part one of two short podcast episodes on the "Tendonitis / inflammation" myth:
Here's the long version of this podcast that you can download and keep by clicking the "download" link under the player below - And subscribe on your favorite platform:
No Real Evidence Of Inflammation In Tennis Elbow
It's time to stop chasing inflammation
Medical researches first started finding evidence decades ago that the original persistent or Chronic inflammation / “Tendonitis” theory on Tennis Elbow was incorrect.
(And this goes for most other tendon problems, generally known as ‘Tendinopathies,’ as well.)
Since that time, it’s been conclusively proven that the vast majority of Tennis Elbow cases do not involve any significant inflammation (especially long-term/chronic cases)...
And therefore should not be classified as TendonITIS, EpicondylITIS – Or anything ending with “ITIS” that would suggest an inflammatory condition.
Is There Any Science Out There? “Besieged By Myths”
“As orthopaedic surgeons, we are besieged by myths that guide our treatment of lateral epicondylitis, or "tennis elbow."
…The term epicondylitis suggests an inflammatory cause; however, in all but 1 publication examining pathologic specimens of patients operated on for this condition, no evidence of acute or chronic inflammation is found”
Lateral Tennis Elbow: "Is there any science out there?" - J Shoulder Elbow Surg.
And yet, a large number of Doctors, medical websites, Physical Therapists and other professionals, seemingly unaware of their sacred cow’s demise, continue to perpetuate the inflammation fallacy...
By writing prescriptions, making therapeutic recommendations and performing treatments based on it.
Here’s more from a paper in the British Medical Journal, entitled:
“Time To Abandon The ‘Tendinitis’ Myth”
“Most currently practicing general practitioners were taught, and many still believe, that patients who present with overuse tendinitis have a largely inflammatory condition and will benefit from anti-inflammatory medication.
Unfortunately this dogma is deeply entrenched. Ten of 11 readily available sports medicine texts specifically recommend non-steroidal anti-inflammatory drugs for treating painful conditions like Achilles and patellar tendinitis despite the lack of a biological rationale or clinical evidence for this approach.”
Time To Abandon The “Tendinitis” Myth – British Medical Journal
Just Because It FEELS Inflamed Doesn't Mean It Is
Yes, I understand your Tennis Elbow may feel like it’s inflamed to you!...
Those burning sensations, that achy, swollen feeling, and the occasional jolt of searing pain would lead any sensible person to think that there must be inflammation in there somewhere!
It’s just that the research doesn’t support it. (It sure sells a lot of anti-inflammatories and boosts big pharma’s bottom line, though.)
The symptoms, in this case, are extremely misleading and rest assured there’s nothing sensible or straightforward about Tennis Elbow.
What researchers started discovering decades ago (and I’m only citing a fraction of them) is that inflammation is actually missing in action (most of the time) and there’s a sneaky, insidious degeneration process going on in the tendon, which, I’m sorry to have to say, is a lot worse than a little inflammation.
It's TendinOSIS, Not Tendinitis
“Numerous investigators worldwide have shown that the pathology underlying these conditions is tendinosis or collagen degeneration.
…One factor that may interfere with optimal treatment is that common tendinopathies may be mislabeled as tendonitis.
…An increasing body of evidence supports the notion that these overuse tendon conditions do not involve inflammation.”
'Overuse Tendinosis, Not Tendinitis' - The Physician And Sportsmedicine; 5/28/2000
I first wrote about this and quoted some of these sources over ten years ago in my ebook “Escaping The Tendonitis Triple Trap”
(I still referred to it as Tendonitis in the title, because it seemed like so few, outside the medical research community, were aware of Tendinosis at the time.)
These past couple of years I’ve been encouraged to see more and more correct references to the true nature of Tennis Elbow in the mainstream, by Gretchen Reynolds, in the NY Times, for instance.
And I just did a quick check and saw that WebMd no longer cites inflammation as the main issue with Tennis Elbow…
That's a big change, BUT, they talk about the need to "reduce it" on at least one page, and they STILL recommend ice, anti-inflammatories and Cortisone shots in several places.
Mixed Medical Messages - Is My Tennis Elbow Inflamed Or Not!?
"Even though inflammation isn't usually present in long-term (chronic) tennis elbow..."
"To reduce the pain and inflammation of tennis elbow, try:"
[List, including ice, rest, pills and shots - WebMD]
Not a big surprise. There is clearly still widespread support for this inflammation fallacy out there.
Not Just Chasing A Ghost And Wasting Time - But Worse: Interfering With Your Healing Process!
I think it’s a tragedy that many if not most Tennis Elbow sufferers are still told to chase the inflammation ghost…
Still encouraged to ice repeatedly, rub lotions and creams all over your elbow, take ridiculous amounts of anti-inflammatories – and then resort to painful Cortisone shots if the first two interventions don’t banish the ghost.
That’s not to say that these treatments don’t work. They do often work very effectively – When it comes to relieving, or should we say, “suppressing” symptoms temporarily.
(That’s probably one of the reasons it’s so hard to kill this sacred inflammation cow!)
But the problem is all three of these treatments have increasingly higher risks of slowing your healing process down or even causing significant harm or damage, Cortisone shots in particular!!...
Although those seemingly innocuous pills can be pretty harmful, too, when taken for weeks on end.
To top that off, neither your Doctor nor the medical websites will tell you the simple fact that inflammation is a natural and necessary part of your healing process.
Which means you’re essentially trying to stop your own healing process!
Inflammation = Step 1 In Your Healing Process
You see, any time there’s injury to tissue, including muscle, tendon, skin and bone, inflammation is the first stage of the healing process – Without it there is no healing.
“Acute human tissue response is characterized by three phases:
- Acute vascular-inflammatory
- Repair-regeneration;
- And maturation.
In normal tissue healing, inflammation plays an important role in this complex dynamic process. ...In this context, inflammation is often defined as a normally occurring, localized protective response…”
To Simply Sum Up The Inflammation Facts:
- There is no significant inflammation present in Tennis Elbow, (usually) so it’s not Tendonitis or Epicondylitis…
- Inflammation is not a bad thing anyway! (when it comes to muscle and tendon healing) and it NEEDS to happen long enough to kick off the healing process…
- So, don't risk harming yourself with pills, ice and shots attempting to chase away something that isn’t even there in the first place – And which you actually NEED!
But don't be too hard on yourself if you didn't have a clue about any of this until now, and you've been following the "common wisdom" and the advice everyone's been giving you about "reducing" your inflammation.
How bizarre is it to find out that inflammation is something you didn’t know you wanted, because you can’t have healing without at least a bit of it!
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I want to first state that my extensive history of dealing with tennis elbow in one and often both of my elbows, because of golf, and on one occasion, carpentry work, over 15-20 years, has lead me to believe that I suffer from tendonosis, not tendonitis (per your diagnosis). You helped me cure the tennis elbow in my right elbow last year, and while I had to go to a PT for my left elbow, I still believe whole-heartedly that it was the hands-on physical therapy that cured me, not any anti-inflammatory therapy (I didn’t do much).
However, when I read your attached article, you contradict yourself. Your first state, “it’s been conclusively proven that the vast majority of Tennis Elbow cases do not involve any significant inflammation.” However, then you later state, “inflammation is a natural and necessary part of your healing process.”
It can’t be both.
I’m not emailing you because I’m not convinced. I believe that your ideas on the cause of TE are correct. I know I’m being a little nit-picky, but I think it would be more accurate for you to stress, not that TE doesn’t **involve** inflammation, but rather that it isn’t **caused** by inflammation, and that it isn’t cured by making the inflammation go away. From my perspective, it clearly does **involve** inflammation. I had a cortisone shot once, and it clearly made the pain go away (for a week). I have a golf buddy who is regularly getting a cortisone shot (to my chagrin), and he does this because the shot definitely affects his TE (I’ve forwarded your article to him).
Well, that’s my two cents worth. Keep up the good work.
I understand your point about (lack of) inflammation and (redundancy of) RICE. However, is it OK to apply some ice after I go through your recommended therapy, stretching and exercises? It seems to reduce the burn…
Sure, it’s OK to ice a little after going through a session of the program, if it feels right to you. (I would recommend 5 mins. or less, so as not to cause too much vasoconstriction. And no direct ice to skin contact. I like those gel packs you put in the freezer.)
My big point with icing is not to do it over and over every day thinking that it’s going to “reduce inflammation” and somehow help the injury heal. For simple pain relief when you need it, it’s fine in moderation.
Maybe I should have said that in the video. (I wish YouTube let you replace your video file with an updated version the way Vimeo does.)
Do you treat trigger finger and do you think splinting is appropriate for trigger finger as opposed to your concerns about splinting and “Tennis Elbow/Golfer’s Elbow”
Have you put together programs for DeQuervain’s and Trigger Finger the same way you have for Tennis Elbow?
Phil
I treat Trigger Finger in my office but I don’t have videos for it yet. (Sorry about that.) No. I don’t think splinting is appropriate for any chronic tendon problem.
I’m a fairly new member and I was just wondering if taking anti-inflammatory supplements (like Omega-X) is a good idea to go along with your therapy techniques. I have a feeling you probably don’t like them because you say that inflammation is not present if there is chronic pain. But I thought I’d ask—just in case.
What do you think of Iontophoresis? I have had tennis elbow for a year and not healed. Had MRI, have done exercises etc. Still can’t play pickleball and barely can play golf.
I rarely hear anything about Iontophoresis. Are you here in the States? I think I’ve only ever had 1 client in all my years treating this who had received that treatment. I have a feeling they use it more in Europe.