Answers to Questions about Chiropractic:
Are Chiropractic Adjustments
Appropriate for Elbow Tendinitis?

Samuel Homola, D.C.

Question

I have had elbow tendonitis for 7 months now. It is related to my many years of avid rock climbing—an overuse injury. I have had 2 months of physical therapy, including ultrasound, massage, cortisone shots, and strengthening procedures. The condition is still bothering me, so my brother recommended that I see his chiropractor.

I went last week. The chiropractor performed a series of strength and flexibility tests in all directions on my arms and legs. He tested to see whether my legs were the same length with my head in different positions, thumped my wrists with an Activator device, and adjusted my upper back, lower back, and neck on both sides. This treatment seemed odd. He seemed most satisfied by the biggest pops, as if the more noise it makes the more good it does. My lower back has been aching ever since he cracked it. He said this type of soreness is common and will not persist in the future. Before I left, he administered 7 minutes of ultrasound to the affected tendon. He said I needed to start coming in twice a week for this treatment in order to get my problem under control.

The problem is that he never even checked to determine which tendon was affected. I'm not sure if he even knows the difference between tennis elbow and golfer's elbow (the latter was my diagnosis, since I have a pronating tendon injury). When I had ultrasound a second time, the chiropractor couldn't remember which tendon in my elbow was affected.

Since my condition has not improved much in 7 months with conventional treatment, I am desperate to see some kind of improvement. Does what I describe above sound pretty standard for most chiropractic "doctors"? Do you believe he even knows how to treat my tendinitis?

Answer

The wrist flexor muscles are attached to the medial epicondyle (little-finger side) of the elbow. Tenderness over this knob is called medial epicondylitis (golfer's elbow or tennis elbow).

The wrist extensor muscles originate from the lateral epicondyle (thumb side of the elbow). When the tendon attachments of these muscles are strained or inflamed, it is called lateral epicondylitis (lateral or backhand tennis elbow, forehand tennis elbow, baseball elbow, or suitcase elbow).

You are apparently suffering from a medial epicondylitis, which involves the tendon attachments of muscles responsible for pronating and flexing your wrist, which you commonly do in rock climbing. Treatment should be supervised by both a physical therapist and an orthopedist. Even with proper treatment, however, recovery from epicondylitis may be slow, requiring many months, especially if there is spur formation or a periosteal tear.

Except for the ultrasound, none of the chiropractic treatment measures you described were appropriate for elbow epicondylitis. It was not necessary to measure your leg length, adjust your spine, or thump your wrist with an Activator instrument. Unnecessary manipulation of your neck and back subjected you to unnecessary risk and should not be repeated as a treatment for elbow tendinitis. The pops you heard during the manipulation are meaningless and totally unrelated to your elbow problem.

Since the chiropractor seems unable to focus on your elbow or to offer appropriate treatment, I would suggest that you see a good orthopedist to find out whether there has been a tear of some sort. Whatever the diagnosis, be patient—and try to avoid overexertion in your rock climbing.

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This article was posted on December 8, 2002.