By: Dr. Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN
As orthopedic physical therapists we treat musculoskeletal disorders of all sorts. Living in a premier golf resort area like Myrtle Beach can lead to a couple disorders in particular. Two of the more common disorders we treat are "golfers elbow" (medial epicondylalgia/tendinosis) and "tennis elbow" (lateral epicondylalgia/tendinosis). Epicondylalgia is synonymous with tendinosis, which in its simplest description is defined as tissue breakdown of the tendon.
Collectively we will term both of these conditions elbow epicondylalgia, regardless of which side of the elbow the pain is on. One of the hallmark findings with these conditions is chronic degeneration of the musculotendinous junction (the attachment of the muscle to the bone). Tendons attach muscle to bone and are inherently hypovascular, meaning they do not get as good a blood supply as other parts of the body. As such, when they are injured, they take a long time to heal, or do not heal at all.
Symptoms of elbow tendinosis include tenderness to touch, increased pain with strenuous activities, and pain with gripping objects. Patients are normally between the ages of 35-50 and are usually participating in regular higher level activity that has a repetitive movement. Activities can include regular participation is sport or repeated movements done regularly at work.
Let me be clear in saying that you do not need to be a golfer or a tennis player to have either of these conditions. In fact, athletes, laborers, clerical staff, and anyone who reports repeated movements with the arms and hands can have either of these conditions.
Lateral epicondylalgia/tendinosis is associated with pain along the outside aspect of the elbow and is commonly seen in tennis players as a result of an inability to control backhand forces of the dominant arm. It is also seen in golfers in the leading elbow during the golf swing.
Medial epicondylalgia/tendonosis is associated with pain along the inside or medial aspect of the elbow. It occurs as a result of a sudden increase in stress or repetitive movements that strain the musculotendinous junction, subsequently leading to micro tears and degeneration.
Some of the more conventional treatment options include rest, ice, stretching, corrective exercise, ultrasound, and manual therapy. Patients commonly will report wearing a brace just below the elbow when performing activity. The problem with bracing is that the tissue is never fully recovered; bracing just moves the point of pull away from the irritated area. The problem never gets fixed! What we have found to be the most effective treatment for this condition in our office is the implementation of dry needling. Not only are we experiencing better results, but also faster results!
To understand how dry needling can be an effective technique to reduce pain and promote healing of elbow epicondylalgia/tendinosis we must first understand what happens when an injury is sustained. Injuries to tissues are caused by varying degrees of stress, ranging from repetitive overuse, to sudden high velocity traumatic forces.
When an injury is sustained, our tissues go through a healing process that starts with inflammation/swelling and ends with reconstruction of the injured tissue. It is during this healing process, where inflammation, contracture of tissues, formation of adhesions between neighboring tissues, and scar formation become the causes of chronic soft tissue dysfunction. These changes result in blockage of fluid into and out of an area, as well as a decrease in blood circulation. The tissues that we are speaking of include muscles, tendons, ligaments, bursae, capsules, fascia, nerves, blood and lymphatic vessels. Injured tissues eventually become weakened and deformed due to a lack of nutrition, resulting in increased pain, disuse, and altered movement patterns. These symptoms eventually become chronic, meaning they last longer than six months. They become painful most of the time, but more so with activities.
Dry needling is a process by which fine gauge solid filament needles are inserted into the symptomatic dysfunctional areas to create tiny lesions (micro trauma) in the underlying soft tissue. These lesions stimulate the body's natural response of healing by way of secretion of molecular proteins to the affected areas and stimulation of the central nervous system to create an anti-inflammatory reaction. In other words, the micro trauma that is caused to the tissue creates an environment that allows the tissue to remodel and repair itself. Because the needles are of an extremely fine gauge, the procedure has minimal to no pain associated with it.
We are very excited about the success thus far that patients are experiencing with dry needling. It is yet another method by which we can treat patients who may have otherwise had limited options to address their soft tissue injury and pain in the past and have just had to "learn to live with it."
At Professional Rehabilitation Services we pride ourselves in distinction, and one of our Board Certified Orthopedic Physical Therapists will pursue an individualized treatment approach to your needs. Less than 5% of physical therapists in South Carolina are board certified in orthopedics. All physical therapists at Professional Rehabilitation Services are board certified. So if you or someone you know is having elbow pain or another musculoskeletal problem and would like to know more about dry needling or other physical therapy options, seek the consultation of a physical therapist at one of our three locations or see your physician for a referral to one of our facilities. Physical therapy is a regularly covered service by most health insurance plans. Free 15 minute consultations are a great way to identify if you are a candidate for treatment!
At Professional Rehabilitation Services, we treat a wide variety of musculoskeletal conditions using the latest in evidence based therapies provided by highly credentialed physical therapists. In addition to being licensed physical therapists, our providers have additional specialty certifications in orthopedics, manual therapy, sports, strength and conditioning, and vestibular treatment. Professional Rehabilitation Services now has three locations, with the newest office located at 1301 48th Ave North, Myrtle Beach, SC. For further information on this or other related topics you can contact Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN at Professional Rehabilitation Services (Myrtle Beach) (843) 839-1300, Brian P. Kinmartin PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN, (Pawleys Island) (843) 235-0200, or Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN (Surfside) (843) 831-0163, or visit our website at www.prsrehabservices.com where you can learn more about the company and even download a referral form for you physician to fill out. You can also call and schedule a free 15-minute consultation!