Functional Neurological Approach To Tennis Elbow


By: Dr. John Conde DC, DACNB Special to the Boca and Delray newspapers

Tennis elbow (lateral epicondylitis) is by far one of the most prevalent injuries in tennis. It is caused by the micro-tearing of the extensor group muscles of the elbow.  These muscles are located on the thumb side of the elbow and allow us to bring our wrist back and side to side. Scar tissue can form in the muscle belly which can compress important nerves and blood vessels. It typically occurs secondarily to the use of an aluminum racquet, incorrect grip measurement, improper backhand technique, excess weight of the racquet, and due to too much tension in the strings. A rare known fact is that tennis elbow is actually the most common form of tendinitis in golfer’s as well and usually due to poor swing mechanics.

The primary goal in treating this disorder in the acute phase is to reduce inflammation and create an optimum healing environment for the torn tendons. FDA approved class IV laser therapy or photobiomodulation is now used to attain these results and accelerate healing. Some of the benefits include increased oxygen deposition locally, increased energy production, increased protein production at the cell level by stimulating a cascade of enzymatic processes, and inhibition of bacterial growth. The use of class IV laser therapy has been demonstrated to accelerate healing by tenfold.

As the injury transitions into the sub-acute and repair phase of healing the focus shifts to breaking up fibrotic adhesions (scar tissue) within the damaged tendons, strengthening the surrounding musculature and neurological pathways, and restoring proper joint motion.  This entails some simple procedures including instrument assisted soft tissue mobilization technique (IASTMT), myofascial release, passive and active mobilization, isometric and isotonic strengthening, and joint manipulation (adjustment).

The more cutting-edge procedures involve the strengthening of the neurological pathways to the tendons to accelerate healing and are termed mirror imaging technique and motor imaging technique. In reference to the mirror imaging technique, the patient places the “good” arm in front of the mirror and the “bad” arm behind the mirror. The “bad” arm has electrical muscle stimulation applied to the elbow region, only to perception. The patient is then instructed to perform the aggravating movement with the “good” arm in front of the mirror and to observe the movement. The goal of this therapy as recited in medical literature is to stimulate “mirror” neurons in the frontal lobe region of the brain which then increases overall activation to the “bad” arm and thus accelerates healing.

In reference to motor imaging technique, the patient visualizes in sets and repetition format, a learned movement such as the provocative movements of the elbow and wrist in a traditional backhand. The visualization must be very detailed in nature and be done using the “bad” arm. Electrical muscle stimulation is used as well on the elbow. Scientifically, the neurological pathways involved in the particular movement are enhanced and other non-pertinent pathways inhibited.  This activity is gaining great notoriety as many of the top athletes in the world are incorporating this into their treatment regimen.

Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach, FL and can be reached at 561-330-6096,, and at