Traditional Chinese Medicine (TCM) Treatment and Prevention of Tennis Elbow
By Physician Zhang Yufei
What is Tennis Elbow?
Tennis elbow, medically known as lateral epicondylitis, falls under the categories of "Elbow Strain" (肘劳) and "Tendon Injury" (伤筋) in Traditional Chinese Medicine (TCM).
According to TCM theory, the internal cause is insufficiency of Qi and Blood, leading to poor nourishment of the tendons, while the external causes include trauma, repetitive overuse of the elbow, or invasion of wind-cold pathogens.
The condition is commonly referred to as "tennis elbow" because it frequently affects tennis players. However, it can also occur in athletes of other sports and individuals whose occupations require repetitive use of the forearm and wrist. Excessive frequency or intensity of forearm and wrist activities may lead to this condition.
Modern medicine believes that repetitive contraction and excessive traction of the forearm extensor muscles cause acute or chronic cumulative injury at the tendon insertion sites. This results in micro-tears, bleeding, fibrosis, adhesions, and sterile inflammation.
TCM considers the disease to result from overstrain causing impairment of Qi and Blood circulation, leading to disharmony of the tendons and meridians.
TCM Syndrome Differentiation
According to TCM syndrome differentiation, tennis elbow can be classified into three patterns:
1. Wind-Cold-Damp Invasion Pattern 寒湿外侵型
Clinical manifestations
- Diffuse aching pain around the elbow
- Pain relieved by warmth
- Pain aggravated by activity
- Difficulty rotating the forearm
- Difficulty lifting objects
Tongue & Pulse
- Thin white tongue coating
- Floating and moderate pulse
2. Qi and Blood Stagnation Pattern 气血瘀阻型
Clinical manifestations
- History of sudden swinging movement or forceful twisting activities
- Sharp, stabbing pain
- Pain radiating to the forearm and wrist
- Weak grip strength
- Difficulty holding objects
Tongue & Pulse
- Thin white tongue coating
- Wiry and tight pulse
3. Liver and Kidney Deficiency Pattern 肝肾两亏型
Clinical manifestations
- Persistent elbow pain
- Mild pain during the day but worse at night
- Weak grip strength
- Dizziness
- Blurred vision
- Tinnitus
- Soreness of the lower back and knees
Tongue & Pulse
- Red tongue with little coating
- Thin and weak pulse
Acupuncture Treatment
The TCM treatment principle is to:
- Warm the meridians
- Dispel cold
- Relax tendons
- Promote circulation through the channels
Surrounding Needling Technique
The Surrounding Needling Technique (围针法) is commonly used.
- The primary point is the Ashi point (阿是穴), which corresponds to the area of maximum tenderness.
- Four additional needles are inserted approximately one inch anterior, posterior, medial, and lateral to the Ashi point.
- Needles are inserted obliquely toward the center.
- Twirling-reducing manipulation is performed after obtaining Deqi (得气).
- Electroacupuncture with alternating dense-disperse stimulation is applied for 20 minutes.
- Treatment is performed once daily.
Clinical experience has shown that after seven treatments, pain may disappear and elbow function may return to normal. Patients are advised to avoid lifting heavy objects and overusing the affected arm. In the reported case, no recurrence was observed during a six-month follow-up.
The surrounding needling technique originates from the Yang Needling Method (扬刺法) described in the Huangdi Neijing (Yellow Emperor's Inner Canon), which is especially suitable for superficial disorders caused by cold obstructing the meridians.
Common Acupuncture Points
Frequently selected acupuncture points include:
- Ashi Point (Tender Point)
- Qinglengyuan (SJ11)
- Quchi (LI11)
- Xiaohai (SI8)
- Cervical Jiaji (Paraspinal) Points
Treatment Recommendations
1. Rest
- Avoid activities that provoke pain.
- Do not resume sports until pain has completely resolved, especially tennis.
2. Ice Therapy
- Apply ice to the lateral elbow
- Four times daily
- 15-20 minutes each session
- Wrap the ice in a towel to avoid frostbite
3. Herbal Medicine
TCM herbal prescriptions are used to:
- Relax tendons
- Promote circulation
- Warm the meridians
- Dispel cold
4. Bracing
A counterforce elbow brace may reduce stress on the forearm extensor muscles.
5. Heat Therapy
Infrared heat (e.g., TDP lamp) is recommended before stretching exercises or rehabilitation training.
6. Stretching and Manual Therapy
After acute pain subsides:
- Perform gentle elbow and wrist stretching
- Hold each stretch for 10 seconds
- Repeat six times
- Stretching should not cause pain
7. Strengthening Exercises
Strengthen the wrist extensor muscles under professional guidance.
8. Gradual Return to Activity
Resume work or sports progressively according to medical advice.
9. Acupuncture
Regular acupuncture treatment may accelerate recovery and reduce recurrence.
Prevention
- Correct improper tennis strokes by maintaining an appropriate angle between the upper arm and forearm during both backswing and follow-through.
- Wear supportive wrist and elbow braces to reduce excessive extension and rotation.
- Wrap an elastic bandage around the forearm muscles during sports to reduce stress, ensuring it is snug but not overly tight.
- Once diagnosed with tennis elbow, discontinue aggravating activities until fully recovered and faulty movement patterns have been corrected.
Summary
Tennis elbow is primarily caused by chronic repetitive traction and contraction of the muscles and soft tissues surrounding the elbow, resulting in cumulative injury.
Early recognition of elbow pain and timely TCM intervention, including acupuncture, Tuina (therapeutic massage), herbal medicine, and rehabilitation, can significantly improve recovery and help prevent recurrence.
