Tennis elbow is technically a Repetitive Strain. Strain = Tear. That’s right. The achy soreness that you feel after playing is actually a tear in either the muscle or the tendon. Sometimes it’s a lot of tearing and sometimes it’s just a little tearing (microtears) that just adds up over time.

This tearing leads to inflammation (tendonitis), weakness, soreness, swelling, bleeding and eventually scarring (adhesion / fibrosis). The typical treatments for tennis elbow address only the inflammation and weakness.

The key to fixing tennis elbow, though, is to reduce or eliminate all of the above symptoms plus the adhesion / fibrosis that comes from the tearing process. The adhesion and fibrosis is what keeps the elbow from healing properly and is usually involved in the high re-occurrence rate of tennis elbow.

What are fibrosis and adhesions and how do they occur?

The formation of fibrosis/adhesions or scar tissue is the body’s response to healing a tear (see figure 2a). What actually occurs is that the spread of sticky fibrin, which is the sticky substance you feel when you bleed, seeps throughout the layers of the muscle and leads to scar tissue formation (see figure 2b). The scar tissue and adhesion that forms is made up of collagen. This creates a strong bond and binds the injured tissue back together (see figure 2c).

What goes wrong?

The scar tissue that binds injured tissue back together also binds the healthy tissue together. This causes decreased circulation and tightening of the muscle resulting in inflammation and lack of oxygen to tissues, creating biochemical changes, increasing fibroblasts and resulting in fibrosis/adhesion. More and more fibrosis and adhesions develop within the muscles causing the muscle to become less elastic (like a rubber band) and more leathery (like a belt). The more leathery the muscle becomes the more stress is placed at the tendon (where muscles inserts into bone). Too much load or force can create tearing of the tendon!

Different grades of tearing

There are different grades of tears that occur in the muscle and tendon. The most common is a Type I muscle strain or ‘Repetitive Strain’. This basically consists of micro-tears. The other grades of tearing are Type II and Type III, which can result in complete rupture of the muscles and ultimately require surgery.

How do you determine the degree/grade of tear? There are many things involved in determining the grade or type of tear that has occurred. In general, the degree of tearing can be based on the extent of bleeding that will create swelling and bruising on the surface. It is important to note that the degree of tearing is NOT based on the level of pain!!!

How can daily activities affect the injury if there is no pain? Common daily tasks/activities, such as cleaning, picking up milk, combing hair, and more can easily aggravate and create further injury. In other words, a Type I tear can become a Type II and so on.

Sequence of Injury

Treatments – What are your options?
There are many forms of treatments for tennis elbow. They can include:

• Active Release Technique (A.R.T.)
• Self-Treatment
• NSAID’s (Non-steroidal anti-inflammatory drugs)
• Cortisone shot
• Shockwave/OssaTron
• Physical Therapy
• Surgery  

What is Active Release Technique (A.R.T.)?
A.R.T. addresses the scar tissue (adhesions & fibrosis) and makes leathery muscle elastic again. It is the most effective way to breakdown scar tissue.

How does A.R.T. work?
The doctor locates the scar tissue and traps the scar tissue with hand/thumb while the patient actively lengthens the involved muscle. The trapped scar tissue is held back as the muscle moves through. A.R.T. is so effective because it makes the muscle elastic again and gets to the root of the problem by increasing circulation to the injured muscle and tendon.

Pros and Cons of Traditional Therapies

Clinic Results with Active Release
We have a greater than 90% success rate for all forms of tennis elbow and less than 10% re-occurrence rate. Most people get better and we never need to see them again!

Overview of Ideal Treatment
Plan While ART is not a cure-all, removal of scar tissue is a key to a majority of cases. It addresses all hindrances to healing such as faulty mechanics of swing, racquet choice, poor ergonomics at work, hobbies (gardening, knitting, woodworking, etc.), and allows proper rest and recovery. Most importantly, A.R.T. addresses the scar tissue.