Shockwave therapy for tennis elbow
Tennis elbow is one of the four musculoskeletal uses NICE has assessed, and it is also a condition that improves on its own in a large share of people given enough time. Both facts have to sit in the same decision.
What you're seeing
Understanding tennis elbow
Tennis elbow is pain at the outside of the elbow where the wrist extensor tendons attach to the lateral epicondyle. Its clinical name, lateral epicondylalgia, avoids the "itis" ending for the same reason the plantar fascia does: the tissue shows overload change rather than an inflammatory process. Gripping, lifting with the palm down and wringing out a cloth are the movements that reliably reproduce it.
NICE assessed shockwave for it in interventional procedures guidance IPG313, now HealthTech guidance HTG201, under the title "Extracorporeal shockwave therapy for refractory tennis elbow". Recommendation 1.1 concludes that the evidence "raises no major safety concerns; however, current evidence on its efficacy is inconsistent", with the same requirement for special arrangements for clinical governance, consent and audit or research that attaches to the other assessments.
There is a second thing to hold alongside that, and it is the part clinic pages tend to leave out. Tennis elbow has a strong natural history: a large share of cases settle over twelve to eighteen months whatever is done. That makes uncontrolled before-and-after results in this condition particularly hard to read, because time alone produces improvement that a treatment can easily be credited with.
The practical consequence is about sequencing. Progressive loading of the wrist extensors, alongside changes to grip and to the tasks that provoke it, remains the first answer. Extracorporeal shockwave therapy sets out what a course involves, and the evidence on whether shockwave therapy works covers why natural history complicates the trial picture.
Why it happens
What causes tennis elbow?
- A rise in gripping load at work or in sport that the tendon had not adapted to
- Repeated wrist extension under load, particularly with the palm facing down
- A new tool, racket, grip size or keyboard set-up that changed how the forearm works
- Reduced grip and forearm strength, so the attachment absorbs a greater share of the load
- A single unusually heavy task followed by a return to normal use too quickly
- A previous episode that eased before forearm strength had been rebuilt
Treatment approach
Where shockwave therapy fits for tennis elbow
FAQ
Shockwave therapy for tennis elbow
questions people ask
Does shockwave therapy work for tennis elbow?
NICE concluded that the evidence raises no major safety concerns and that the evidence on efficacy is inconsistent. Tennis elbow also improves on its own in many people over twelve to eighteen months, which makes uncontrolled results in this condition unusually difficult to attribute to any single treatment.
How long does tennis elbow usually take to settle?
Often twelve to eighteen months, and sometimes longer where gripping load has not changed. That timescale is the reason clinicians ask how long the pain has run before recommending anything. A problem three weeks old and a problem two years old call for different decisions about intervention.
What should I try before shockwave for tennis elbow?
A progressive loading programme for the wrist extensors, run for at least three months, together with changes to the grip, tool or task that provokes it. The NICE title uses the word refractory. Shockwave is assessed for the presentation that has already been through that and has not settled.
Does shockwave hurt more on the elbow than elsewhere?
The lateral epicondyle sits close under the skin with little tissue covering it, so the pulses are felt sharply there. The energy is set to what you can tolerate. Sessions run to about five minutes and the area is commonly sore for 24 to 48 hours afterwards.
Can I keep working during a course of shockwave?
Usually yes, and the tasks that provoke the pain are worth modifying while the tendon rebuilds capacity. Gripping with the palm down is the movement that most reliably aggravates it. Adjusting how a tool is held often changes the daily load more than any treatment does.
Get Started
Describe the problem and what has been tried.
UNTIL Health Concierge arranges the examination.
London Shockwave Therapy • UNTIL, 280 Bishopsgate, London EC2M 4RB
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