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What is tennis elbow (lateral epicondylitis)?
Tennis elbow is pain on the outside of the elbow. It is usually experienced when performing activities that involve movements of the wrist and arm that involve lifting, twisting and gripping. The dominant arm is commonly affected and the pain can last between 6 months and 2 years, research showing that it appears to be more severe and long standing in women.
It is usually caused by excessive, quick, repetitive movements of the wrist and sometimes by gripping activities. The pain is initially caused by structural changes to the tendon. 4
Sometimes other problems can present similar to tennis elbow. It is very important that you have been given a definitive diagnosis of tennis elbow before commencing any shockwave therapy. Other conditions include: Bursitis, infection, osteoarthritis, gout, pain referred from the neck and nerve entrapment. 3
How can shockwave therapy help?
Shockwave therapy is a non-invasive treatment modality which uses acoustic pressure to reduce pain. The pain relief is gained though hyper-stimulation of the painful area and increasing the blood supply, it also aims to re-activate and/or facilitate the healing process.
Shockwave therapy is effective in reducing pain in people with tennis elbow, which has been shown by significant improvements in pain scores in studies1. A substantial improvement is achieved between 3-12 weeks after treatment and is maintained at 1 year follow up. Three months is the time reported that most, but not all, of the effects of shockwave therapy will appear. 2
Shockwave therapy is not widely known across the medical community so it may even be new to your GP, recent studies (2018) have shown that shockwave therapy can even reduce the severity of the pain and improve daily activity in newly diagnosed patients. 3
What will a usual course of shockwave therapy consist of?
You will be taught an exercise programme to work at for at least 12 weeks, this programme is integral to your recovery and must be done alongside the shockwave therapy in order to maximise the benefits.
The exercises and shockwave therapy are usually uncomfortable but this is completely normal and is not a sign of making the condition worse. There is a standard course of 3 shockwave therapy sessions over 3 weeks; this is usually enough for most people to notice significant effects. For those people who have had the problem for a long period of time it may take more sessions to alleviate the symptoms to a level in which you are happy to self-manage.
You may not be completely pain free when you are discharged but should be significantly better, as mentioned previously it can take up to 2 years for a full resolution of symptoms in some cases. 4
Appropriate activity levels during the treatment process will be discussed at your consultation.
Shockwave therapy can also be used on other tendon problems such as: Achilles tendinopathy, Golfer’s elbow, Patella tendinopathy and also plantar fasciitis.
Shockwave at Claremont
The initial course of treatment is offered at the package price of £200 for 3 sessions. This includes an initial assessment with shockwave and two further shockwave treatments. Any additional shockwave treatments are charged at £50 per session. For Shockwave through Insurance companies, the rates may vary.
1Comparison of treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy. C Wong et al. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 7 (2017) 21-26
2Resistant tennis elbow: shock-wave therapy versus percutaneous tenotomy. Y A Radwan et al. International orthopaedics (SICOT) (2008) 32:671-677
3The short term effects of shock-wave therapy for tennis elbow: a clinical trial study. Razavipour et al. Acta inform med. (2018) 26(1): 54-56
4Effectiveness of extracorporeal shock wave therapy for tennis elbow (lateral epicondylitis). D Stasinopoulos & M I Johnson. BJ Sports med. (2005) 39: 132-136
Copyright Joshua Jones-Greyson, Senior Physiotherapist