Most treatments for tennis elbow fail because they don't address the root problem.
Tennis elbow is technically a Repetitive Strain. Strain = Tear. That's right. The achy soreness that you feel after playing is actually tearing 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, but not the adhesion / fibrosis.
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 (oxygen), inflammation and tightening of the muscles. The decreased oxygen and tightness causes more biochemical changes eventually leading to more and more fibrosis and adhesions. As adhesions develop within the muscles, they cause 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!
Sequence of Injury
Different grades of tearing
There are different grades of tears that occur in the muscle and tendon. The most common is a Type I tear or 'Repetitive Strain'. This basically consists of micro-tears. The other grades of tearing are Type II (partial tear), which can typically heal without surgery 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. A MRI can also be used. 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.