Dry Needling for Tennis Elbow
Trigger point dry needling is an effective treatment option for tennis elbow, also known as lateral epicondylitis. This technique involves inserting fine needles into specific trigger points within the muscles to alleviate pain and improve function. While dry needling uses acupuncture needles, its sole focus is on releasing muscle tightness and addressing neuromuscular dysfunctions. When combined with traditional acupuncture, which helps to relieve pain, reduce inflammation, and promote circulation, the two techniques can provide enhanced relief and promote overall healing.
Key Points
Dry needling effectively manages pain in patients with tennis elbow.
Enhances functional recovery and overall mobility.
Increases grip strength, aiding in daily activities and rehabilitation.
Targets specific trigger points for precise treatment and relief.
Offers a safe and low-complication alternative to other invasive treatments.
Tennis elbow or lateral epicondylitis
Tennis elbow, or lateral epicondylitis, is characterized by pain and tenderness on the outside of the elbow, often caused by overuse of the forearm muscles. Common symptoms include difficulty gripping objects, weakened grip strength, and discomfort during wrist and arm movements. For a more detailed explanation of tennis elbow, including its causes and symptoms, please refer to our comprehensive blog post on What is Tennis Elbow?.
Trigger Points Related to Lateral Elbow Pain
Dry needling works to release myofascial trigger points that may cause pain or reduce function of a muscle. When working with tennis elbow it is important to think of all the muscles that can be related to lateral elbow pain - since muscles elsewhere may also be causing problems that reinforce the local issue.
Here’s how dry needling each muscle implicated in lateral epicondylitis can help:
Anconeus: Dry needling the anconeus can assist in extending the elbow and stabilizing the joint, reducing pain and improving the range of motion during arm movements.
Brachioradialis: By targeting the brachioradialis, dry needling can help flex the elbow and aid in pronating the forearm, addressing discomfort and improving forearm functionality.
Extensor Carpi Radialis Longus (ECRL): Dry needling the ECRL can alleviate pain and improve the ability to extend and abduct the wrist, which is crucial for lifting and grasping activities.
Extensor Carpi Radialis Brevis (ECRB): As a key muscle in extending and abducting the wrist, dry needling the ECRB can significantly reduce pain and enhance wrist and forearm movements.
Extensor Digitorum: Targeting the extensor digitorum with dry needling helps in extending the fingers and wrist, which is essential for activities involving grip strength and manipulation.
Extensor Carpi Ulnaris: Dry needling the extensor carpi ulnaris can assist in wrist extension and adduction, alleviating pain and improving overall wrist functionality.
Supinator: By focusing on the supinator muscle, dry needling can aid in supinating the forearm, easing the rotation of the hand from a palm-down to a palm-up position and reducing associated pain.
Supraspinatus: Although not directly involved in elbow movements, dry needling the supraspinatus can address compensatory shoulder movements that contribute to tennis elbow, providing indirect relief.
Triceps Brachii: Dry needling the triceps brachii can help in extending the elbow and stabilizing the joint, reducing pain during various arm movements and enhancing joint stability.
Dry needling these specific muscles helps address the underlying muscle tightness and restricted range of motion that may contribute to tennis elbow, providing targeted relief and improving overall function.
Trigger Point Dry Needling Technique
Dry needling is a targeted technique used to address myofascial trigger points, which are hyperirritable taut bands within a muscle that cause pain and dysfunction. The process involves the following steps:
Assessment: The practitioner evaluates the patient's symptoms and identifies the specific trigger points via palpation (touch) causing discomfort.
Sterile Needles: Fine, sterile needles are inserted into the trigger points. The insertion may cause a brief twitch response in the muscle, which is a sign that the trigger point is being effectively targeted.
Manipulation: The needles may be gently manipulated to maximize the therapeutic effect, promoting a muscle fasciculation or spasm, which leads to muscle relaxation and pain relief.
Removal: The needles are generally not retained, but they may be left in if combining traditional acupuncture techniques.
This technique is highly effective in releasing muscle tightness, reducing pain, and improving overall function in patients with tennis elbow.
Treatment Approach
Dry needling specifically targets muscle tightness and pain associated with tennis elbow. By addressing the underlying trigger points, this therapy can:
Relieve Pain: By deactivating the trigger points, dry needling helps reduce localized and referred pain.
Improve Mobility: As the muscles relax, the range of motion in the elbow and wrist improves, aiding in the recovery process.
Enhance Function: Restoring normal muscle function allows patients to return to their daily activities and sports with less discomfort.
Reference to Travell and Simons
Janet Travell and David Simons were pioneers in the field of myofascial pain and trigger points. Their extensive research and publications have provided a foundation for understanding how trigger points contribute to various musculoskeletal conditions, including tennis elbow. Their work is highly relevant to dry needling, as it offers a scientific basis for identifying and treating trigger points effectively.
Dry needling for tennis elbow
Dry Needling for Tennis Elbow Research
Research has consistently shown that dry needling is an effective treatment for managing tennis elbow, also known as lateral epicondylitis. The following studies highlight its significant benefits in pain relief, functional improvement, and increased grip strength.
Dry needling is an effective treatment for managing pain.
Enhances function in patients with lateral epicondylitis.
Increases grip strength, aiding in overall recovery and daily activities.
Dry needling may be more effective than corticosteroid and PRP injections for treating tennis elbow.
A comprehensive 2024 review found that dry needling offers significant therapeutic benefits for patients with lateral epicondylitis. The review included data from 17 randomized controlled trials, encompassing 979 subjects, and evaluated the effectiveness of dry needling compared to other treatments. The primary outcome measures were pain intensity and elbow disability, with secondary measures including grip strength and upper limb function. The findings revealed that dry needling significantly improved pain intensity within one week of treatment (MD=-0.95, 95% CI, -1.88 to -0.02). Additionally, it showed better improvements in elbow disability and grip strength both within one week and in follow-up periods exceeding one week. Specifically, trigger point dry needling that elicited a local twitch response was more effective in reducing pain intensity (MD=-1.09, 95% CI, -1.75 to -0.44). Overall, the review concluded that dry needling is an effective treatment for managing pain, enhancing function, and increasing grip strength in patients with lateral epicondylitis.
A 2017 study published in International Orthopaedics evaluated the effectiveness of dry needling compared to first-line treatments for lateral epicondylitis (tennis elbow). The research involved 110 patients randomized into two groups: one receiving dry needling and the other receiving standard first-line treatments, including ibuprofen and a forearm brace. Assessments using the Patient-rated Tennis Elbow Evaluation (PRTEE) were conducted at three weeks and six months. The findings revealed that while both treatments were effective in the short term, dry needling demonstrated significantly greater effectiveness at the six-month follow-up. The study concluded that dry needling is a safe and potentially superior treatment for tennis elbow due to its low complication rate and sustained efficacy.
Another 2021 study, published in The Journal of Shoulder and Elbow Surgery, compared the effectiveness of dry needling (DN) to corticosteroid (CS) injections for treating lateral epicondylitis. This prospective, randomized, controlled study included 108 patients whose pain was not relieved by first-line treatments. Patients were randomized into two groups: one received dry needling, and the other received corticosteroid injections. The Patient-Rated Tennis Elbow Evaluation (PRTEE) scores were recorded before treatment and at three weeks and six months post-treatment. The results showed that while both treatments were effective, DN-treated patients exhibited significantly better improvement in PRTEE scores compared to CS-treated patients. Furthermore, fewer adverse effects were reported in the DN group, with only one patient withdrawing due to pain, whereas the CS group had cases of skin atrophy and whitening. This study suggests that DN not only offers superior pain relief and functional improvement but also has a lower risk of side effects compared to CS injections.
In 2022, a study showed that dry needling is an effective and safe short-term treatment for lateral epicondylitis, comparing its efficacy to corticosteroids and platelet-rich plasma (PRP) application. The study included 72 patients divided into three groups: dry needling, corticosteroids, and PRP treatment. Patients were assessed using the visual analog scale (VAS), Disabilities of the Shoulder, Arm, and Hand (DASH) score, and Jamar grip strength before treatment, at the third week, and at the third month. The results indicated that while all treatments improved symptoms, dry needling and corticosteroids significantly reduced pain and improved grip strength over time. The DASH scores showed significant improvement in the dry needling and corticosteroids groups, whereas the PRP group had a slight, statistically insignificant improvement. Overall, the study concluded that dry needling is a viable option for managing lateral epicondylitis in the short term.
Conclusion
Dry needling offers a promising solution back by research for those suffering from tennis elbow, providing targeted relief from pain and muscle tightness. By addressing the specific trigger points involved in lateral epicondylitis, this therapy can significantly improve function and quality of life. If you are struggling with tennis elbow, consider seeking professional guidance to explore dry needling as part of your comprehensive treatment plan.
For a more in-depth understanding of tennis elbow and its treatments, refer to our previous posts on What is Tennis Elbow? and Acupuncture for Tennis Elbow. Together, these resources provide a holistic view of managing this common condition.
Over to you
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Sources:
Buchanan BK, Varacallo M. Lateral Epicondylitis (Tennis Elbow) [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431092/
Ma, X., Qiao, Y. Q., Wang, J. Y., Xu, A. L., & Rong, J. F. (2024). Therapeutic effects of dry needling on lateral epicondylitis: An updated systematic review and meta-analysis. Archives of physical medicine and rehabilitation, S0003-9993(24)00823-2. Advance online publication. https://doi.org/10.1016/j.apmr.2024.02.713
Uygur, E., Aktaş, B., Özkut, A., Erinç, S., & Yilmazoglu, E. G. (2017). Dry needling in lateral epicondylitis: a prospective controlled study. International orthopaedics, 41(11), 2321–2325. https://doi.org/10.1007/s00264-017-3604-1
Uygur, E., Aktaş, B., & Yilmazoglu, E. G. (2021). The use of dry needling vs. corticosteroid injection to treat lateral epicondylitis: a prospective, randomized, controlled study. Journal of shoulder and elbow surgery, 30(1), 134–139. https://doi.org/10.1016/j.jse.2020.08.044
Güngör, E., & Karakuzu Güngör, Z. (2022). Comparison of the efficacy of corticosteroid, dry needling, and PRP application in lateral epicondylitis. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 32(8), 1569–1575. https://doi.org/10.1007/s00590-021-03138-2
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