Elbow Pain

Elbow pain is a common reason for clients to request acupuncture treatments at our Williamstown Chinese Medicine clinic. A majority of our clients who complain about elbow pain have tendinitis, an inflammation of the tendons around the elbow area. Tennis elbow and golfer’s elbow are examples of tendinitis. Both conditions are a form of  repetitive strain injuries (RSI), and can be effectively treated by acupuncture and Chinese herbal medicine.

Signs and symptoms of elbow pain

Elbow pain can present as sharp, dull, burning, shooting pain or pressure discomfort. Generally, elbow pain with a longstanding onset and increasing intensity are caused by chronic overuse straining the forearm muscles and tendons. Elbow pain with an immediate onset suggests a ligament, tendon or bone trauma. Elbow pain can also occur after shoulder surgery or injury.

Depending on the original cause or injuries, elbow pain can sometimes be accompanied by tingling, numbness and a bruising sensation. In some cases, the pain in the elbow extends into the forearm, wrist and hand, with weakness and swelling of the arms and hands. The nature and intensity of elbow pain vary, from being intermittent and getting better with rest, to being constant and debilitating. Some of our clients complain that their elbow pain becomes worse in the night, possibly aggravated by inappropriate sleeping posture.

FAQ: Am I having tennis elbow pain?

Tennis elbow is the most frequently seen elbow pain cases at our clinic. Tennis elbow pain usually starts as an intermittent dull ache or tenderness at the outer part of the elbow. The initial tennis elbow pain becomes better with rest. Some clients complain of weakening grip strength as well.

Tennis elbow is a form of repetitive strain injury. Acute tennis elbow occurs after a period of excessive or vigorous use of the forearm muscles and wrist. The acute pain may present as burning pain which radiates down the upper and lower forearm, accompanied by signs of inflammation. Tennis elbow pain generally becomes worse when using the hand, such as gripping a work tool, lifting the wrist, opening the door and shaking hands.

What are the causes of tennis elbow and golfer’s elbow?

Tendinitis is the most common cause of elbow pain cases seen at our clinic. Tendinitis is caused by repetitive gripping, lifting, flexing and rotating actions involving the heavy use of the forearm and wrist.

At our clinic, we have treated painters, carpenters, plumbers, bricklayers, gardeners, assembly line workers, cooks, butchers etc for their elbow pain. These clients get tendinitis at the elbow, presenting as either tennis elbow or golfer’s elbow, as a direct result of wear and tear injuries. The work-related activities of this group of clients require repetitive hand, wrist or arm movements, putting excessive pressure on the forearm muscles and tendons.  Repetitive strain leads to microscopic tears of the tendons, eventually resulting in pain and inflammation at the elbow joint. For these clients, the continual overuse of their forearm and wrist does not allow the body enough time to heal the existing microscopic injuries, before new ones are being sustained. We have also treated knitters who are very keen on their hobby.

Other causes of elbow pain

Apart from tendinitis, elbow pain can also arise from inflammation within the joint space of the elbow. Bursitis is another commonly seen elbow pain condition, presenting as inflammation in the small sac which contain fluid used to lubricate the elbow joint. In osteoarthritis of the elbow, brittle joint cartilage breaks apart and floats around in the synovial fluid within the joint, causing inflammation and pain. Other form of arthritis, such as rheumatoid arthritis and gout can also cause pain at the elbow.

Trauma in the form of dislocation, fracture, sprain and strain of the elbow joint, is another common cause of pain and inflammation in the elbow area. Occasionally, we also see elbow pain cases which are actually referred pain from other parts of the body, for example problem with the vertebrae at the neck area. Pinching of the radial and ulnar nerves as they pass through the cubital tunnel causes elbow pain which is accompanied by numbness and tingling along the forearm muscles.

Acupuncture treatment for elbow pain

At Joanne Vidich Chinese Medicine, our acupuncture treatments for elbow pain are aimed at settling the inflammation at the joint area, reducing pain and restoring the integrity of the forearm muscles. The elbow joint is held together by muscles, ligaments and tendons. The forearm muscles that cause elbow pain attach at the hand bones, across the wrist and elbow, and insert at the bony bump at the outer and inner sides of the elbow joint. The key to long term relief from elbow pain is to repair the injury at the forearm muscles.

From our experience, symptomatic treatment of numbing the pain at the elbow area is temporary and incomplete. The analgesic effect of acupuncture had been scientifically proven. Our acupuncture treatment program incorporates the analgesic effect of acupuncture with healing action for the muscles and tendons. If the injured forearm muscle is not treated, another muscle and joint will tend to compensate for its lack of function, causing incorrect use and further injuries.

FAQ: Can tennis elbow be treated with acupuncture?

Tendinitis can affect both the outer and inner elbow. Tennis elbow, or lateral epicondylitis, is a type of tendinitis with the pain felt in and around the outer elbow. Tennis elbow is caused by overuse of a specific forearm muscle, the extensor carpi radialis brevis (ECRB), and the subsequent inflammation of its tendons. ECRB is responsible for stabilising the wrist when the elbow is straight. Not everyone who has pain from tennis elbow develops the condition from playing tennis or any form of racquet sport. Any repetitive motion of the wrist, including painting, excessive use of a hammer or screwdriver, or activity the requires the hand to engage in constant gripping or squeezing can cause tennis elbow.

Acupuncture treatments has been shown to be effective in relieving chronic tennis elbow pain. Various research papers were published confirming the evidence that acupuncture treats tennis elbow. In a study conducted by The Mayo Clinic, 80% of tennis elbow pain patients participating in the study gained long term relief after receiving a series of acupuncture treatments. The other 20% reported marked improvement in their tennis elbow condition. All these patients suffered from chronic tennis elbow and had been seriously disabled by the condition for an average of 14 months prior to beginning acupuncture treatment.

Tennis elbow acupuncture protocol

Our acupuncture treatment protocol for tennis elbow are individually formulated for each client. The treatment protocols are based on our findings during physical examination, individual client’s presenting symptoms and the background of the injury. We utilise technique and treatment methods which had been time-tested and known to provide long term resolution to the tennis elbow condition.

In treating tennis elbow, we do not apply needling at the elbow area presenting with pain and inflammation. The pain spots and injured muscle in tennis elbow are located on the Large Intestine and Triple Warmer meridians. We begin with a manual palpation along meridians that have an energetic relationship with these two affected meridians. Tender points, nodules and subtle changes found in the muscle area will help us select the right spot to apply needling, in order to achieve the best therapeutic outcomes.

In the case of tennis elbow, we often needle points along the Lung meridian at the arm, and along the Stomach meridian at the leg. Acupuncture needles will be inserted at specific acupoints adjacent to the tendon and bone in body areas mirroring the tennis elbow location, such as the elbow and knee of the opposite limb. In addition, one or two points on the hand of same side to the tennis elbow location will be needled. The hand points serve as guiding points directing the healing factors, in the form of Qi (vital energy) and Blood (essential substances), to pass through the elbow and forearm affected by pain and inflammation.

Golfer’s elbow acupuncture protocol

Golfer’s elbow, or medial epicondylitis, presents in a slightly different way because the repetitive strain is affecting the muscle at the palm side of the forearm. The tendons of these forearm muscles attach at the bony bump around the inner elbow. Any repetitive action that requires gripping an object in the hand, at the same time flexing the wrist and throwing forward can cause damage to the muscle. Clients with golfer’s elbow have inner elbow pain that radiates down the forearm into the wrist.

Acute golfer’s elbow pain is caused by inflammation at the tendon area. Our acupuncture treatment protocols during acute stage golfer’s elbow are formulated using the same principles as the tennis elbow acupuncture treatment outlined above.

FAQ: What is the best treatment for chronic golfer’s elbow?

From our experience, clients presenting with chronic golfer’s elbow pain achieve more lasting treatment results by taking Chinese herbal formulas, in addition to receiving acupuncture treatments. Chronic golfer’s elbow is not a form of tendinitis. People with chronic golfer’s elbow has tissue degeneration in the tendons, as a result of wear and tear. Following repetitive strain and overuse, these tendon tissue cannot repair the microscopic tears in a proper manner, leading to formation of scar tissue. Thickening of tendon is seen in chronic golfer’s elbow, and the clients usually complain of feeling weakened and painful at the same time.

Chinese herbal formula for elbow pain

For clients with chronic elbow pain, especially those suffering from golfer’s elbow, we prescribe custom herbal formulas based on Juan Bi Tang (Notopterygium & Turmeric Combination). The formula is modified for individual clients to effectively target the symptoms and areas of discomfort.

The presentation of chronic golfer’s elbow pain, or any type of elbow pain, which is recurring in nature and characterised by weakness and pain, falls under the Bi (impediment) pattern in Chinese medicine. We find that most of the clients presenting with chronic elbow pain have a history of poor health combining with exposure to environmental wind, cold and dampness, in addition to overuse of their arms. The combination of these etiological factors allows the pathogenic wind-damp to penetrate the muscles and sinews at the arm and elbow areas. When entrenched, the pathogenic wind-damp will deplete the Qi (vital energy) and Blood (essential substances that nourishes the body tissue) in the local area. The weakness, pain and thickening of tendons seen in chronic golfer’s elbow are caused by blockages in flow of Qi and Blood, and poor nourishment of muscles and sinews.

Juan Bi Tang is an effective Chinese herbal formula for treating chronic pain and entrenched Bi patterns of the upper limb. The formula is balanced in composition, with simultaneous supplementation and attacking actions. In our clinic, we prescribe Juan Bi Tang and supervise the clients’ use of the formula for up to 6 months. The formula will be modified multiple times to suit the need of active treatment and maintenance stages of their elbow pain therapies.

Acupuncture Treatment Outcome for Elbow Pain

The best acupuncture treatment outcome for tennis elbow, or any form of elbow pain including trauma and bursitis, is achieved during periods where the client takes a complete break from the work or sport activities which caused the conditions in the first place. In fact, the first line treatment for any musculoskeletal conditions due to repetitive strain injuries is to rest the problem area. Tennis elbow and golfer’s elbow is characterised by microscopic tears and inflammation in the forearm muscles and tendons. Resting will prevent further muscle injuries while allowing acupuncture treatments to heal the problem area.

The desired treatment outcome for elbow pain using acupuncture, or a combination of acupuncture and Chinese herbal medicine, is the return of pain-free grip and an absence of pain when rotating the forearm and moving the elbow joint.

FAQ: How long does it take for tennis elbow and golfer’s elbow to heal?

Our Chinese medicine tennis elbow therapies are formulated based on 6 acupuncture sessions per course of treatment, to be repeated until the elbow pain is resolved. For chronic elbow pain cases, we recommend the taking of Chinese herbal medicine to reinforce the treatment effect of acupuncture sessions. An assessment will be conducted following the completion of every treatment course.

The treatment effect of acupuncture is cumulative, similar to the taking of conventional medication, and requires repeated doses before a therapeutic result can be sustained. Generally, elbow pain conditions caused by repetitive strain injuries will take between 3 to 6 months to completely heal. For a client who responds to acupuncture treatment, signs of improvement will be seen after 3 or 4 acupuncture sessions. During the initial stage of acupuncture treatment, taking a break from the activities which causes the overuse of forearm muscles helps to establish the responsiveness to treatments.

For tennis elbow and golfer’s elbow, we recommend a treatment frequency of twice per week during the first 6 weeks of acupuncture treatment. The treatment frequency can be reduced to once per week after an initial treatment effect is established. Clients who engage in manual labour which involve heavy use of forearm muscles will continue to produce new microscopic tears in muscles fibres and tendons, while the existing ones are being treated. From our experience, these clients will benefit from more frequent treatments for a longer period of time, to get on top of the chronic muscle injuries. For these clients, we recommend long term maintenance treatments, in the form of acupuncture monthly or once every fortnight, to preserve the integrity of their forearm muscles and maintain the healthy functioning of their elbow and wrist joints.