Tennis Elbow aka lateral epicondylitis (LE) is a fairly common reason why people experience elbow pain and seek treatment from their doctor. (1,2). You don’t need to have been playing tennis for this condition to appear, essentially it arises form overuse of the flexor tendon which can happen when performing repetitive activities requiring grip strength like carpentry, knitting, typing, raking and racquet sports (1,2). Essentially it’s activity at the wrist and hand that usually leads to this condition which is actually more degenerative in nature then inflammatory (3). Some signs and symptoms of LE include:
- Pain to the outside bony bump of your elbow when:
- Applying direct pressure
- Making a fist / gripping an object with your hand
- Opening a door
- Wrist weakness
- Difficulty lifting
- Pain when fingers are straightened against resistance.
- Swelling of the elbow
LE can often be recalcitrant and difficult to heal, causing pain and discomfort for many months even despite routine physical therapy (4). When this is the case, further investigation is always warranted. Investigation of joint stability are crucial as well as assessment of muscular imbalances of the chest / back & triceps (5).
Joint laxity is a term used to describe an issue with connective tissue in the joint. The joint needs to be held strongly with ligaments to ensure an adequate platform for muscle attachment and function – so your body can effectively move. When your joint itself becomes unstable it will affect the muscles and integrity of the joint often creating or setting up a situation whereby tendinosis can happen – like LE (5)
Prolotherapy is an injection-based therapy that aims to reconstitute the integrity of the ligaments and tendons of a joint. It’s not actually fixing the structures directly but rather stimulating your body to fix itself – the quintessence of naturopathic medicine.
Treatments involve injection of substances into the joint space, specifically at the attachment sites of the ligaments and tendon, where they meet the bone. I use a combination of dextrose (sugar), procaine & Vitamin B12. Frequency of treatments depends on each person’s needs but are generally monthly and take between 3-4 treatments.
In studies looking at the benefit of prolotherapy for LE, results are positive in outcome measures as well as general contentment with the treatment (1,6,7). Many of these studies are dealing with that chronic elbow pain that is otherwise unresponsive to other treatment (1,6,7).
When assessing self reported elbow pain, measured grip strength / extension, one study found significant improvement in all parameters after 8 and 16 weeks for those in the group receiving prolotherapy than with a control group that did not receive the treatment (7). These were individuals who had suffered with LE for over 6 months and who experienced no benefit from other therapies including cortisone injection or NSAIDS. Follow up at 52 weeks showed results were maintained (7).
Another study found equal long-term results in patients who received either prolotherapy or cortisone injection for their LE with quicker benefit being yielded in the prolotherapy group (4). One study found high satisfaction and benefit with prolotherapy using difference injection solutions over a wait and see control group (7).
Is prolotherapy right for your LE? That’s a decision that you need to make in counsel with your health care provider. Like anything, assessing the treatment pros and cons, understanding potential side effects and having a rehabilitation game plan to prevent further LE in the future is critical. If you are interested and want to learn more, come chat with me to see if this is for you.
Dr. Sarah Kent is a licensed Naturopathic Doctor specializing in your health. She blends traditional knowledge with current scientiﬁc understanding to generate wellness within her patients. She has received specialized training in naturopathic sports medicine, applying the principles and tools of naturopathic care in treating athletes.
1. David Rabago, MD, Andrew Slattengren, DO, and Aleksandra Zgierska, MD, PhD. Prolotherapy in Primary Care Practice Prim Care. Mar 2010; 37(1): 65-80.
2.http://www.webmd.com/fitness-exercise/tennis-elbow-lateral-epicondylitis. ©2005-2014 WebMD, LLC. All rights reserved.
3. Francois Louw, MD, CCFP, DA(SA), MBChB(Pret) . The occasional prolotherapy for lateral epicondylosis (tennis elbow). The Practitioner. Can J Rural Med 2014;19(1).
4- Carayannopoulos A1, Borg-Stein J, Sokolof J, Meleger A, Rosenberg D. Prolotherapy versus corticosteroid injections for the treatment of lateral epicondylosis: a randomized controlled trial. PM&R2011 Aug;3(8):706-15.
5. Ravin, T MD. Principles of Prolotherapy. 2008. American Academy of Muskoloskeletal Medicine. Manitoba, Saskatchewan
6. The efficacy of prolotherapy for lateral epicondylosis: A pilot study M Scarpone, D Rabago, et al. Clin J Sport Med. May 2008; 18(3): 248-254.
7. Rabago D1, Lee KS, Ryan M, Chourasia AO, Sesto ME, Zgierska A, Kijowski R, Grettie J, Wilson J, Miller D.Am J Phys Med Rehabil. 2013 Jul;92(7):587-96 Hypertonic dextrose and morrhuate sodium injections (prolotherapy) for lateral epicondylosis (tennis elbow): results of a single-blind, pilot-level, randomized controlled trial. 4-Krogh TP1, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U, Bliddal H, Christensen R.Am Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials.J Sports Med. 2013 Jun;41(6):1435-46. Epub 2012 Sep 12.