Elbow Pain: Treat or Wait?
The common term is tennis elbow. It refers to pain on the outside of the elbow and results from all sorts of repetitive activities, not just tennis and not just sports.
The common term is tennis elbow. It refers to pain on the outside of the elbow and results from all sorts of repetitive activities, not just tennis and not just sports. Medical terminology for this includes lateral epicondylitis, epicondylalgia, and epicondylosis – all describing the same condition. We know that physiotherapy creates short-term pain relief and long-term improvements, with one-year recurrence rates as low as 5%. These results are much preferred over the results achieved by corticosteroid injections. But what about just waiting for tennis elbow to get better on its own, or just enduring it? Is that a good idea? New research gives us the best picture yet of how wait-and-see works with tennis elbow.
How Fast Does Tennis Elbow Get Better on Its Own?
In April, the peer-review journal Clinical Orthopaedics and Related Research® published the work of Joona Ikonen, MD and research colleagues. They performed a meta-analysis of randomized controlled-trials, just focusing on the people who did not receive active treatment. Thereby, they created the largest database ever of what happens with people who have tennis elbow, but do not receive any sort of treatment. Because different studies used different measures, they created a scale where 100 was no improvement and zero was complete improvement, and translated all previous results into that scale. In general, they found that disability scores improve 50% every three to four months, on average, but that included some placebo treatments that may not have been really placebos. For people in the wait-and-see groups, after one year, the average disability rating was 31 on that 100 point scale. That means some people got better, some did not, and on average 31% of the disability remained even after one year. Unfortunately, the long-term disability from tennis elbow may be more enduring than that.
How Reliable is that Data?
Another possible limitation of this data was that the researchers chose to throw out 13% of the studies, because they did not match the other studies. Three of the 24 trials originally included in the meta-analysis were disregarded because the tennis elbow did not go away. It’s hard to say if that makes the data more or less reliable. Nevertheless, we can say that, with wait-and-see, at the group level, at least 31% of disability remains after a year, maybe more.
Should I Get Physiotherapy or Wait for Tennis Elbow to Get Better on Its Own?
This data suggests that many cases of tennis elbow will get better on their own at some point, but you may wait eight months to two years. If you can tolerate it for eight months to two years, and it’s not getting worse, waiting may be the right strategy for you. Importantly, this study did not directly address recurrence. Without rehab to recondition the area, there may be increased risk of recurrence.
On the other hand, if the tennis elbow is interfering with work or sport, is more painful than you want to tolerate, or you want a faster more sure approach than a year or two of waiting, physiotherapy is the best answer. It offers short-term pain relief along with the lowest recurrence rates of any conservative therapy.