Among tennis players there are often complaints of pain in the elbow, someone comes to workouts with dressings, someone takes a timeout and goes to the procedure, and from someone it all ends and the operation does.
The disease, called “tennis elbow” (epicondylitis) and accompanied by pain in the elbow and other parts of the arm, is found not only among tennis players – it can occur in anyone who often has to repeat the stereotypical movements of arm flexion, carrying heavy bags or briefcases. But whoever the sick were, for the last 10 years they have been offered basically the same cure – cortisone shots (steroid).
Recent studies in the United States and the United Kingdom have shown that administering a steroid that quickly reduces pain and fights inflammation is the most preferred treatment for many orthopedic surgeons. Nevertheless, an increasing amount of data suggests that these injections, being effective over a short period of time, can often worsen the patient’s condition in the coming months. This raises an interesting question about the risks of a quick pain treatment.
Edward Bezuglov, who is the chief doctor of the Russian national football team and at the same time heading his own clinic of sports medicine Smart Recovery, commented on the method of treating this tennis ailment.
I would treat tennis elbow by injection of platelet-rich plasma in parallel with long-term magnetic therapy (3 hours or more) and roentgenotherapy for 6-7 sessions.
For decades, it was believed that the cause of “tennis elbow” – inflammation of the tissues around the elbow joint. However, new studies of the disease, including biopsy of damaged tissues, show that a serious inflammatory process exists only in the early stages of the disease. Instead, it is worth talking about tissue degeneration: if the joint has a constant increased load, then the body does not have time to recover from all the microtraumas received during it, and the tendons holding the elbow begin to “wear out” and deform. The pain from this can be severe and last for months.
The attractiveness of cortisone injections is also in the fact that it is a fairly simple treatment to be performed – any medical practitioner can provide it. But according to the results of the most serious study of the therapy methods of “tennis elbow”, cortisone can even be counterproductive.
As part of this study, the results of which were published last summer in the journal BMC Musculoskeletal Disorders, 177 people with the newly diagnosed tennis elbow disease received either two cortisone shots for three weeks, or placebo injections according to the same pattern.
In each of these two groups, patients were randomly selected. All participants in these groups received an elbow massage, and also began to engage in a six-week home course of special exercises for the hands.
There was a third, control, group, to the members of which no type of treatment was applied.
Pain symptoms and functionality of the elbow of the study participants were regularly evaluated within a year after the end of treatment. At the first examination after six weeks, the men and women who had been given cortisone injections talked about much less severe pain than participants in the other two groups, who, on average, had only slightly less pain than at the beginning of the study. But after the next six weeks, the strength of the pain in people who received cortisone injections became equal to all the others, and in six months even became much greater.
Why cortisone can cause a worsening of the disease is unclear, says Dr. Morten Olaussen, a family doctor, a scientist at the University of Oslo in Norway, and co-author of the study described above. But there is a possibility that the steroid may interfere with the structural restoration of the joint.
The good news is that after a year, all study participants recovered – regardless of the availability, absence or type of treatment. The cure rate in the control group was the same as in the others – about 80%. These results show that despite our instinctive desire to do at least something, when we are in pain, the cheapest and most effective cure for tennis elbow is time.
“Eliminate traumatic activities, just wait and watch,” says Dr. Olaussen.
Source and authors: based on the materials of the New York Times, Ksenia Denisova, translation by Evgenia Pyatakova