What Is Epicondylitis?
Epicondylitis is a painful overuse condition affecting the tendons that attach to the epicondyles — the bony prominences on the inside and outside of the elbow. When these tendons are repeatedly overloaded, they develop micro-tears and a degenerative response that causes chronic pain, tenderness, and weakness. There are two forms, named for the epicondyle affected:
- Lateral epicondylitis (tennis elbow) — affects the outer elbow, involving the common extensor tendon
- Medial epicondylitis (golfer's elbow) — affects the inner elbow, involving the common flexor-pronator tendon
Current research has established that epicondylitis is not primarily an inflammatory condition (despite the "-itis" suffix), but rather a degenerative tendinopathy — the tendon develops disorganized collagen, ingrown blood vessels, and fibrotic tissue rather than acute inflammation. This distinction is critical because it explains why anti-inflammatory medications and cortisone injections provide only temporary relief without addressing the underlying tendon pathology.
Tennis Elbow (Lateral Epicondylitis)
Tennis elbow is the most common elbow condition in adults over 40, affecting approximately 1–3% of the general population. Despite the name, fewer than 5% of tennis elbow cases are actually related to tennis. It is far more commonly caused by:
- Computer mouse use and keyboard work
- Manual trades — plumbing, carpentry, painting
- Lifting and carrying with the palm facing down
- Gardening and repetitive gripping
Key symptom: Pain on the outer elbow, worsening with gripping, wrist extension, and lifting objects with the palm facing the floor.
Golfer's Elbow (Medial Epicondylitis)
Golfer's elbow is less common than tennis elbow but frequently more painful. Common causes include:
- Golf (particularly improper swing mechanics)
- Baseball pitching and throwing sports
- Rock climbing
- Forearm-intensive trades and manual work
Key symptom: Pain on the inner elbow, worsening with wrist flexion, forearm pronation, and gripping. May also involve ulnar nerve symptoms (tingling in the ring and little finger).
Critical note: Cortisone injections for epicondylitis have been shown in research to provide short-term pain relief but worse long-term outcomes compared to conservative care — including higher rates of recurrence. We consistently achieve better results with Graston technique and shockwave therapy than injection alone.
Why Conservative Treatment Works
Graston Technique for Epicondylitis
Because epicondylitis is a tendinopathy — a degenerative process rather than inflammation — it requires mechanical disruption of the disorganized tendon tissue to stimulate proper healing. Graston IASTM does exactly this: the instruments break down collagen cross-links, remove fibrotic adhesions, and stimulate a controlled healing response that remodels the tendon back to healthy tissue.
Shockwave Therapy
ESWT delivers acoustic pressure waves directly to the tendon, stimulating neovascularization, collagen synthesis, and growth factor release. Multiple high-quality trials show 70–85% success rates for chronic epicondylitis with shockwave therapy — making it one of the most evidence-supported non-surgical treatments available.
Eccentric Exercise Protocol
Properly dosed eccentric (lengthening under load) exercises are one of the most powerful tools for tendon remodeling. Dr. Crockatt designs progressive loading programs that systematically stress the tendon to drive adaptation without re-injury.
Suffering from Tennis Elbow vs. Golfer's Elbow?
Our team at Pittsburgh Physical Medicine treats this condition with chiropractic care, physical therapy, and soft tissue techniques — under one roof in East Liberty, Pittsburgh.
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