Shock Wave Therapy and Tennis Elbow

SHOCK WAVE THERAPY AND EPICONDYLITIS

What is lateral epicondylitis?

Lateral epicondylitis, commonly known as tennis elbow, is a tendinopathy of the wrist extensor muscles at their insertion on the lateral epicondyle of the humerus. Despite its name, it affects people who perform repetitive movements at work (mouse use, manual labour, carrying loads) far more frequently than tennis players.

The pain is located on the outer aspect of the elbow and may radiate towards the forearm. It is aggravated by gripping, hand squeezing, or wrist extension against resistance.

Consultations take place at the clinic located at 9 Rue du Regard, 75006 Paris, in the 6th arrondissement.

PATHOPHYSIOLOGY OF CHRONIC EPICONDYLITIS

Chronic epicondylitis is now considered a degenerative tendinopathy (tendinosis) rather than a classical inflammatory condition. Histological studies show disorganisation of collagen fibres, disordered neovascularisation and an increase in nociceptive nerve endings within the affected tendon.

This degenerative process explains why conventional anti-inflammatory treatments (NSAIDs, corticosteroid injections) often provide only temporary relief. The tendon requires appropriate biological stimulation to restart a healing process.

MECHANISM OF ACTION OF SHOCK WAVES ON THE TENDON

Radial shock waves act on degenerative tendon tissue through several pathways:

• Stimulation of neovascularisation: improvement of local blood perfusion, promoting the delivery of growth factors and reparative cells.
• Reactivation of collagen synthesis: the mechanical stimulation promotes the production of type I collagen, which is essential for tendon restructuring.
• Pain modulation: shock waves act on nerve endings and contribute to reducing pain perception (substance P release, gate control theory).
• Destruction of pathological neovascularisation: the acoustic waves can contribute to the regression of abnormal neo-vessels associated with chronic pain.

TREATMENT PROTOCOL

A standard protocol consists of 3 to 5 sessions, spaced 7 to 10 days apart. Each session lasts approximately 5 to 10 minutes. The intensity is gradually adjusted according to the patient's tolerance. The point of maximum tenderness at the epicondyle is targeted by palpation before each session.

Shock wave therapy is considered when epicondylitis has persisted for more than 3 months despite first-line treatments (rest, elbow brace, physiotherapy, ergonomic adaptation).

ASSOCIATED OSTEOPATHIC TREATMENT

Epicondylitis is rarely a problem confined to the elbow alone. The osteopathic approach helps identify the biomechanical factors that perpetuate tendon overload:

• Cervical spine: the C5-C6 nerve roots innervate the wrist extensors. Restricted cervical mobility can contribute to altered neuromuscular control of the forearm.
• Shoulder: limited internal rotation or elevation of the shoulder may lead to compensatory patterns at the elbow and wrist.
• Elbow biomechanics: pronation-supination mobility, balance between wrist flexors and extensors, tension in the interosseous membranes.
• Workstation posture: wrist position, desk height, mouse usage.

ERGONOMIC ADVICE

In addition to treatment, simple adaptations can help reduce the strain on the wrist extensors:

• Use an ergonomic or vertical mouse
• Position the keyboard so that the wrists remain in a neutral position
• Avoid carrying heavy loads with the arm fully extended
• Take regular breaks and perform extensor stretches
• For sports practice (tennis, golf), check equipment (grip size, string tension)

FREQUENTLY ASKED QUESTIONS

Is shock wave therapy effective for tennis elbow?

Radial shock wave therapy has shown favourable results in the treatment of chronic lateral epicondylitis, particularly when conservative approaches have been insufficient. Several meta-analyses report significant improvement in pain and function at medium-term follow-up.

How many shock wave sessions are needed for epicondylitis?

The standard protocol consists of 3 to 5 sessions, spaced 7 to 10 days apart. The exact number depends on clinical progress. A reassessment is carried out at each session to adapt the treatment accordingly.

Can I continue working during shock wave treatment for the elbow?

Yes, in most cases. However, it is advisable to modify repetitive movements and prolonged wrist positions during the treatment course. Ergonomic advice is provided during the consultation.

References

• Defined A, Pavone V, Testa G et al. (2020). Efficacy of extracorporeal shock wave therapy for lateral epicondylitis: a systematic review and meta-analysis. Orthopedic Reviews, 12(2):8601. PMID 32309425
• Rompe JD, Decking J, Schoellner C, Theis C. (2004). Repetitive low-energy shock wave treatment for chronic lateral epicondylitis in tennis players. The American Journal of Sports Medicine, 32(3):734-743. PMID 15090392