Dry Needling & Joint Manipulation for Golf & Tennis Elbow (Medial / Lateral Epicondylitis): Turn a Chronic Impairment into a Quick Fix

First off, golf and tennis elbow are deceiving, misleading, dumb dumb names. Medial and lateral epicondylitis are much more accurate. Either one can happen from either sport. Now that we have that out of the way, why are these two simple impairments such a chronic problem for so many people? As with many chronic impairments, a vital component of pathology is periostitis (bone lining inflammation). Periosteal pathology impossible to directly address without dry needling. With needles, it is super easy. Regardless of the initial cause of the problem, if medial / lateral epicondylitis have persisted for any significant duration, the underlying cause of recurrence is often residual inflammation of the periosteum.

Muscle tendons attach directly to joints via the periosteum. If those muscles / tendons have been shortened for a while, which they are on the majority of humans, they place undue stress on the periosteum, causing periostitis and joint deviation. Without direct periosteal treatment and full joint reduction, tissue healing and resolution of pain can be next to impossible. Lucky for us, once needling is introduced to treatment, direct periosteal treatment is easy and the results are nothing less than mind boggling. I can’t tell you how many patients with decades of chronic, recurring medial / lateral epicondylitis that have been treated with typical interventions without much success, experience full resolution of pain and functional limitation within a handful of needling treatments.

Periosteum is one of the most sensitive tissues in the body. It is also one of the deepest tissues in the body, often covered by layers and layers of other tissues, including ligaments, muscles and tendons. Anyone who has experienced a bone bruise knows how painful and stubbornly lasting they can be. The main reason for this is, without needles, zero direct treatment of anything but the skin is possible. At a certain threshold of sympathetic autonomic nervous system (SANS) hyperactivity, everyone is different, without direct treatment, the periosteum lives in a chronically inflamed state. This is no bueno. Periosteum gets grumpinitis (new medical term per my wife Angela) when it is inflamed, aggravating every other tissue in the vicinity. Without removing the inflamed grumpiness from the periosteum, full resolution of pain and functional deficit is simply not possible.

There are about 9 muscle muscles attaching to the lateral epicondyle and 6 muscles attaching to the medial epicondyle. The majority, if not all, of these 15 muscles are fast twitch and powerful, attaching on a small piece of periosteum about the size of a dime. Just one tight muscle on either epicondyle can cause epicondylitis. I do not think I have ever seen just one tight muscle in the forearm. Especially in chronic conditions, most of the muscles / tendons are typically tight. So, what happens when a bunch of muscles get tight and inflame the crap out of the periosteum they attach to? Bad stuff. Bad stuff is the answer.

When you hit healthy periosteum with a needle, it feels like a piece of steel. The softer and mushier the periosteum feels, the more inflamed it is. Healthy periosteum also does not hurt when it is contacted. The more pathologic it is, the more it hurts. Between these two methods, it is simple to search out and fix pathologic periosteum. If you encounter soft periosteum, poke it a handful of times, leave the needle point in the periosteum, and add low frequency (1-5 Hz) stim, I like 2 Hz.

Remember, low frequency microcurrent releases 4 times the amount of bioavailable endogenous opioids, beta endorphins, from the hypothalamic-pituitary-adrenal (HPA) axis.

Also remember, almost 100% of people with epicondylitis, or any type of pain / stress, for that matter, are going to present with SANS hyperactivity. Chronic SANS hyperactivity is destructive to human body and mind wellbeing.

Aside from dampening pain, which in and of itself depresses sympathetic hyperactivity, endogenous opioids are sympathetic depressors and ANS homeostasisizers (another new medical term) via numerous other mechanisms. Therefore, it is logical to induce endogenous opioid release via parasympathetic autonomic nervous system (PANS) stimulation. This brings the autonomic nervous system (ANS) toward homeostasis. A homeostatic ANS is the key to health, for any impairment.

Joint manipulation, especially if a cavitation, “pop,” is achieved, has synergistic effects with needling on the ANS. If muscles have been pathologic, especially in chronic conditions, all the joints those muscles attach to are also going to be deviated and pathologic. To achieve maximal ANS homeostasis and resolution of neuromusculoskeletal impairments, for any condition, including epicondylitis, joints and soft tissues both must be addressed. If soft tissues are treated but the joints are left alone, the deviation, along with periosteal inflammation, will result in pathologic recurrence. Same goes for if joints are treated without treating the soft tissues. To achieve maximal outcomes, soft tissues, joints, and ANS homeostasis must be intricately treated as a single, multifaceted impairment.

Check out some of my other blogs on how to regulate the ANS toward homeostasis:

Related: Click here to learn more about Dry Needling and Joint Manipulation for Athletic Trainers

Related: Click here to learn more about High Velocity Low Amplitude Manipulation Techniques: Mid-Cervical Biomechanical Goal

Related: Click here to learn more about Dry Needling Scar Tissue

Related: Click here to learn more about Dry Needling the Forgotten Nine

Related: Click here to learn more about Dry Needling and Manipulation for Psychotherapy

Related: Click here to learn more about Controlling Autonomic Sympathetic Hyperactivity with Dry Needling and Spinal Manipulation

To sum this all up:

Epicondylitis, both medial and lateral, are chronic, painful impairments that many people deal with for life, unnecessarily, even if they seek out treatment. Regardless of the underlying cause of the initial problem, what causes recurrence is often periostitis, inflammation of the bone lining the muscle tendons attach to. It is impossible to directly treat the periosteum, or anything else in the body aside from the skin, unless you employ the use of dry needling. At a certain threshold, the human body simply does not respond to indirect treatment. It never responds to indirect treatment as well as direct treatment. Hence, without direct treatment, certain impairments will never resolve, and even if they do resolve, the resolution is not as complete as it could be. Dry needling is the only direct treatment for the vast majority of tissue in the human body.

Intricate Art Spine & Body Solutions and its affiliates are not responsible for any injury or damage that may result from the use of techniques taught or information being provided. This content is provided for informational purposes only and by participating you are doing so at your own risk.

References

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Autonomic Nervous System

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•   Clark, N.G., Hill, C.J., Koppenhaver, S.L., Massie, T. and Cleland, J.A., 2021. The effects of dry needling to the thoracolumbar junction multifidi on measures of regional and remote flexibility and pain sensitivity: A randomized controlled trial. Musculoskeletal Science and Practice, 53, p.102366.
  

•   Sánchez-Infante, J., Navarro-Santana, M.J., Bravo-Sánchez, A., Jiménez-Diaz, F. and Abián-Vicén, J., 2021. Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis. Physical Therapy, 101(3), p.pzab070.
  

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