Tennis elbow and sensitisation.

A beaut topical review on tennis elbow (lateral epicondylalgia LE) emerged in the last Journal of Physiotherapy (Bissett, LM, Vincenzino B 2015 61: 174). I think it’s the best review of the status of our LE knowledge. Importantly, the reminder that LE is “not self limiting and it’s associated with ongoing pain and disability in a substantial proportion of sufferers”. The authors refer to evidence that “sensitisation of the nervous system” contributes at least to the ongoing pain.
As an old clinician, I think I have tried most of the interventions that are reviewed – exercise, manual therapy/manipulation, orthoses, laser, ultrasound, acupuncture, shock wave therapy and multimodal therapy and I agree with the general consensus that not much helps. The authors state that “mobilisation with movement and exercise” are likely to be superior to “wait and see”.
Given that most of these interventions do not target “sensitisation of the nervous system” perhaps the poor equivocal outcomes are understandable.
The clip presents my thoughts, takes and technique for lateral elbow pain which are related to sensitisation of the nervous system. Maybe there are more in this group than we realise.

www.noigroup.com
www.noijam.com