Tennis elbow is a frustrating condition to live with. You may experience a mild elbow ache or even excruciating elbow pain with shaking hands or lifting your morning coffee mug. You have been advised to consider platelet-rich plasma (PRP) injection. But does it work?
What is tennis elbow (or lateral epicondylitis)?
Lateral epicondylitis affects up to 3% of adults worldwide.
It’s more commonly known as tennis elbow because it affects up to 50% of tennis players. However, the condition affects people from all walks of life. You can suffer from lateral epicondylitis even without playing tennis!
Artists too suffer from the condition. At least enough for The Journal Gallery in New York to name their weekly solo exhibition Tennis Elbow.
While commonly mistaken to be a muscle or joint problem, tennis elbow is a tendinous condition which typically involves the tendon of the extensor carpi radialis brevis muscle in the forearm.
If you have some pain in your elbow joint – racquet sports athlete or not – you may just be experiencing the early symptoms of tennis elbow.
What is tennis elbow caused by?
Many online articles consider tennis elbow to be an inflammatory condition. However, current research DO NOT support this narrative. If we were to look at a biopsy of an affected tendon under the microscope, we will find disorganised collagen fibrils. This histological finding is more consistent with a “degeneration” rather than inflammatory process.
While the exact mechanism behind the cause of tennis elbow is still unknown, experts agree that tendinopathy is the result of repetitive overuse (e.g. repetitive strain injury) or training error (e.g. too much, too fast, too soon).
What are the current treatments for tennis elbow?
Most treatment recommendations online are based on the assumption that tennis elbow is an inflammatory condition. As such it’s common to hear suggestions such as:
- Icing or other forms of physical therapy
- Nonsteroidal anti-inflammatory (NSAIDs – ibuprofen, naproxen, etc)
- Steroid injections
Using a elbow strap during the early stages can be a good strategy for load management for the injured tendon. Most people do feel a decrease in symptoms with this. However, it is important to note that elbow strap is only a pain alleviation strategy. The decrease, or even resolution, of symptoms do not indicate that your elbow has recovered.
What about platelet-rich plasma (PRP)?
Platelet rich plasma therapy is a treatment option for tennis elbow. Often used in the management of muscles and tendons injury, PRP available at Singapore General Hospital under their Sports Medicine Service program.
The interesting thing about PRP is that it uses your own blood as treatment. As part of the PRP therapy, a few tubes of blood will be drawn and processed to concentrate the platelets found in your blood. These platelets are then injected into the affected tissues.
It is theorised that the release of growth factors – a type of protein involved in wound healing – will enhance recovery. However, research doesn’t seem to support that.
A systematic review/meta-analysis of clinical studies comprising of 276 patients with tennis elbow found PRP treatments to be not superior to placebo.
In the study, no statistical difference was reported between the PRP vs. the placebo group for both pain and function! In other words, patients who received a saline injection experienced as much improvement in pain and function as those who received PRP.
A separate study published a few months ago also found PRP for patellar tendinopathy to be no better than saline solution.
It is not clear how much does PRP cost in Singapore.
p.s. some one of you may have heard of PRP being used in other conditions such as hair loss.
PRP was touted as a revolutionary breakthrough in sports medicine
Despite the lack of evidence supporting the use of PRP, the treatment is gaining popularity throughout the world.
The Fior Markets’s report expect the platelet-rich plasma market to grow to a whopping $USD540 million over the next five years.
American professional athletes are particularly receptive to the treatment:
- American professional baseball pitcher Chris Sale received PRP for his elbow injury last August and is looking to return to play pending the outcome of a third opinion.
- A few weeks ago, American professional basketball player Richaun Diante Holmes just received PRP treatment for a well-publicised labral tear in his shoulder. He reported good response to the treatment and is expected back to in court soon.
- Just last week another baseball pitcher Griffin Canning was reported to receive a “biological substance” for his elbow soreness.
“Patients, of course, prefer the quick fix. It’s much more satisfying to walk out of the doctor’s office with an appointment for an injection than with instructions to spend several months at home doing seemingly pointless exercises. And it’s much easier—and more lucrative—for doctors to promise an injection than to spend an hour explaining why an injection isn’t needed.”
According to Alex Hutchinson, the award-winning writer behind the Sweat Science column, athletes are giving PRP a shot because “it can’t hurt”.
In studies that compare exercise training alone vs. a combination of exercise + PRP, the exercise-only group OUTPERFORMED the exercise plus PRP group.
In short, PRP treatment may actually negatively interfere with your rehabilitation program.
Depsite having no true “side effects”, platelet-rich plasma can still lead to sub-optimal recovery results!
Exercise rehabilitation for lateral epicondylitis
When it comes to tendon injuries in conditions such as a tennis elbow, a well-designed exercise recovery program is what it takes to achieve a good recovery outcome.
A typical recovery program will utilise a combination of isometric and eccentric exercises for pain relief and improve in function. As recovery progresses, a well-prescribed program will start to include heavy slow resistance exercises.
While most patients may start to feel better from as early as 6 to 12 weeks, it is advisable to keep up with the exercises for at least six months.
Check out these papers for more information on tendinopathy recovery:
- Heavy eccentric exercises is superior to traditional physiotherapy for treating tendinopathy
- Exercise-based therapies are as effective as surgery for tendinopathy even after 12 months
- Eccentric exercise training and slow concentric contractions can reestablish normal tissue structure (i.e. fibril alignment and cell morphology) in a tendinopathic tendon
- Isometric exercise was effective in improving pain and disability in lateral elbow tendinopathy
How should recovery look for your tennis elbow?
Too often we get swept away by new “revolutionary” technology and assume that new = better.
Sometimes, we may also falsely assume more = better.
Yet research tells us that platelet-rich plasma injection does not work better than placebo. When we compare exercise alone vs. exercise + PRP, we see that PRP has a tangible, negative effect on recovery.
The good news is that most of us do understand that “quick fix” is not the solution.
Book in an appointment via the form below to discover the difference the right care can make for your tennis elbow.