Massage Therapy for Tennis Elbow

Massage Therapy and Tennis Elbow

Massage Therapy

A Review of Tennis Elbow

Rehabilitate The Whole Person, Not Just Injured Tissues

Tennis Elbow

The presentation of pain in a tendon, does not always mean that the tendon is the primary contributor to pain. There research that suggests that a majority of nerves are found outside in peritendinous tissue, which is likely contributes to the complex clinical picture of tendon pain.

This is why clinicians should be thoughtful and skilled in managing the load on the tendons and supporting structures through a number of rehabilitation considerations including, but are not limited to:
• Manual Therapy (nerve mobilizationsoft tissue massage, triggerpointIASTM)
• Education on psychosocial factors such as fear avoidance
• Loading Programs (eg. concentric, eccentric, isometric)

Why Does Massage Therapy Work for Elbow Pain?

A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to: neuroplasticity, contextual effects, mechanical effects, and affective touch.

Structures to be Aware of When Treating Elbow Pain

A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. There may be times that focal irritability (ie. nerve irritation, triggerpoints, nervous system sensitization) co-exists with common extensor tendinopathy.

Massage therapists are uniquely suited to incorporate a number of rehabilitation strategies for patients with Elbow Pain. Structures to keep in mind while assessing and treating patients suffering from elbow pain may include neurovascular structures and investing fascia of:
• scalene muscles
• pectoralis minor
• biceps brachii muscle
• bicipital aponeurosis
• anterior interosseous membrane
• common extensor tendon (extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris)
• common flexor tendon (pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, flexor carpi ulnaris)

These exercises focus on both concentric and eccentric strengthening of the common extensor tendons affected in lateral epicondylalgia.



More to Explore

Arias-Buría et al. (2019). Ultrasound-Guided Percutaneous Electrical Stimulation of the Radial Nerve for a Patient With Lateral Elbow Pain: A Case Report With a 2-Year Follow-Up. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/30658050

Blanchette, M.A., & Normand, M.C. (2011). Augmented soft tissue mobilization vs natural history in the treatment of lateral epicondylitis: a pilot study. J Manipulative  Physiol Ther.
https://www.ncbi.nlm.nih.gov/pubmed/21334545

Bordachar D. (2019). Lateral epicondylalgia: A primary nervous system disorder. Med Hypotheses.
https://www.ncbi.nlm.nih.gov/pubmed/30696578

Campbell et al. (2013). Sports-related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury and management. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/24096897

Cook et al. (2016). Revisiting the continuum model of tendon pathology: What is its merit in clinical practice and research? British Journal of Sports Medicine. 
https://www.ncbi.nlm.nih.gov/pubmed/27127294

Cook, J., & Docking, S. (2015). “Rehabilitation will increase the ‘capacity’ of your …insert musculoskeletal tissue here….” Defining ‘tissue capacity’: A core concept for clinicians. British Journal of Sports Medicine.
http://www.ncbi.nlm.nih.gov/pubmed/26255142

Coombes et al. (2015). Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. Journal of Orthopaedic & Sports Physical Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/26381484

Coombes et al. (2016). Economic evaluation favours physiotherapy but not corticosteroid injection as a first-line intervention for chronic lateral epicondylalgia: evidence from a randomised clinical trial. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/26036675

Cullinane et al. (2014). Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clin Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/23881334

Drew et al. (2014) Do structural changes (eg, collagen/matrix) explain the response to therapeutic exercises in tendinopathy: a systematic review. Br J Sports Med. 
https://www.ncbi.nlm.nih.gov/pubmed/23118117

Duchesne et al. (2017). Impact of Inflammation and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic. Phys Ther. 
https://www.ncbi.nlm.nih.gov/pubmed/28789470

Fernández-Carnero et al. (2007). Prevalence of and referred pain from myofascial trigger points in the forearm muscles in patients with lateral epicondylalgia. Clin J Pain.
https://www.ncbi.nlm.nih.gov/pubmed/17449997

Fernández-Carnero et al. (2008). Bilateral myofascial trigger points in the forearm muscles in patients with chronic unilateral lateral epicondylalgia: a blinded, controlled study. Clin J Pain.
https://www.ncbi.nlm.nih.gov/pubmed/18936598

Joseph et al. (2012). Deep friction massage to treat tendinopathy: a systematic review of a classic treatment in the face of a new paradigm of understanding. J Sport Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/22234925

Latef et al. (2018). Injury of the Radial Nerve in the Arm: A Review. Cureus.
https://www.ncbi.nlm.nih.gov/pubmed/29666777

López-de-Celis et al. (2018). Effectiveness of diacutaneous fibrolysis for the treatment of chronic lateral epicondylalgia: a randomized clinical trial. Clin Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/29086586

Lucado et al. (2018). Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis. J Hand Ther.
https://www.ncbi.nlm.nih.gov/pubmed/29705077

Magnusson, S.P., & Kjaer, M. (2019). The impact of loading, unloading, ageing and injury on the human tendon. J Physiol.
https://www.ncbi.nlm.nih.gov/pubmed/29920664

Mallows et al. (2017). Association of psychological variables and outcome in tendinopathy: a systematic review. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/27852585

Mallows et al. (2018). Cognitive and contextual factors to optimise clinical outcomes in tendinopathy. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/28993403

Page, P. (2010). A new exercise for tennis elbow that works! N Am J Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/21589674

Piper et al. (2016). The effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities: A systematic review by the Ontario Protocol for Traffic Injury management (OPTIMa) collaboration. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/26386912

Rio et al. (2016). Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med. 
https://www.ncbi.nlm.nih.gov/pubmed/26407586

Rio, E., & Docking, S.I. (2018). Adaptation of the pathological tendon: you cannot trade in for a new one, but perhaps you don’t need to? Br J Sports.
https://www.ncbi.nlm.nih.gov/pubmed/28724715

Segretin et al. (2016). Rehabilitation and auto-exercises protocol in patients with chronic lateral epicondylitis: 6 months follow-up. Ann Phys Rehabil Med.
https://www.ncbi.nlm.nih.gov/pubmed/27676721

Sims et al. (2014). Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand (N Y).
https://www.ncbi.nlm.nih.gov/pubmed/25414603

Shmushkevich, Y. & Kalichman, L. (2013). Myofascial pain in lateral epicondylalgia: a review. J Bodyw Mov Ther.
https://www.ncbi.nlm.nih.gov/pubmed/24139000

Spang, C. & Alfredson, H. (2017). Richly innervated soft tissues covering the superficial aspect of the extensor origin in patients with chronic painful tennis elbow - Implication for treatment? J Musculoskelet Neuronal Interact. 
https://www.ncbi.nlm.nih.gov/pubmed/28574416

Sutton et al. (2016). Multimodal care for the management of musculoskeletal disorders of the elbow, forearm, wrist and hand: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
http://www.ncbi.nlm.nih.gov/pubmed/26955466

Tyler et al. (2014). Clinical outcomes of the addition of eccentrics for rehabilitation of previously failed treatments of golfers elbow. Int J Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/24944855

Uygur et al. (2017). Dry needling in lateral epicondylitis: a prospective controlled study. Int Orthop.
https://www.ncbi.nlm.nih.gov/pubmed/28828509/

Vicenzino, B. (2015). Tendinopathy: Evidence-Informed Physical Therapy Clinical Reasoning. J Orthop Sports Phys.
https://www.ncbi.nlm.nih.gov/pubmed/27136285 

Yi et al. (2018). Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis. Hand (N Y). 
https://www.ncbi.nlm.nih.gov/pubmed/28719982