Tennis elbow – lateral epicondylitis – is one of those conditions that sounds sport-specific but shows up constantly in people who’ve never touched a racket. In Durango, we see it in mountain bikers gripping handlebars for hours on technical trails, in construction workers doing repetitive tool use, in office workers with poor ergonomics, and yes, in actual tennis players. The common thread isn’t the sport – it’s overloaded forearm tendons that have shifted from acute inflammation into chronic degeneration. And chronic tendon degeneration doesn’t respond to rest the way acute injuries do.
What’s Actually Going On With Tennis Elbow
Lateral epicondylitis involves the extensor tendons of the forearm – specifically where the extensor carpi radialis brevis attaches to the lateral epicondyle, the bony bump on the outside of the elbow. These tendons control wrist extension and are involved in almost every gripping activity. When they’re overloaded repeatedly without adequate recovery, the collagen fibers break down and the tissue shifts into a degenerative state called tendinopathy.
The term “epicondylitis” is actually a bit of a misnomer because the predominant finding in chronic cases isn’t inflammation – it’s tendon degeneration with disorganized collagen and, in some cases, calcification. This distinction matters a lot for treatment. Anti-inflammatories address inflammation. They don’t address tendon degeneration. It’s one of the main reasons cortisone injections provide temporary relief but rarely solve the underlying problem.
Who Gets It in Durango
Mountain bikers are among the most common presentations we see. The combination of sustained grip tension on the handlebars, repetitive braking on technical descents, and vibration transmission through the hands and wrists creates exactly the overload pattern that drives lateral epicondylitis. Hermosa Creek, Horse Gulch, and the trails above town are beautiful – and they’re genuinely hard on elbows.
Climbers deal with it too, both from sustained grip and from the specific loading patterns of crack climbing and crimping. Fly fishing, with its repetitive casting motion, is another common contributor in the Durango and Animas Valley community. And a significant portion of cases come from office workers and tradespeople – repetitive mouse use, tool handling, and keyboard work are just as capable of producing lateral epicondylitis as any sport.
Why Rest and Stretching Often Don’t Work
Rest reduces the load on the tendon and can bring the pain down temporarily. But in a chronically degenerated tendon, rest doesn’t stimulate the repair process – it just reduces the irritation. When you return to the activity that caused the problem, the pain returns because nothing about the tendon’s structural state has changed.
Stretching the wrist extensors helps on the margins and is part of a complete care plan, but it’s not enough by itself for established tendinopathy. The tissue needs a more direct stimulus to rebuild properly.
How We Treat Tennis Elbow at Our Durango Clinic
The most effective approach for lateral epicondylitis combines therapies that address different components of the problem simultaneously. Here’s what we use and why each piece matters.
Shockwave Therapy – The Primary Tool
Shockwave therapy is the most evidence-supported non-surgical treatment for lateral epicondylitis, and it’s the centerpiece of our approach for chronic cases. The acoustic pressure waves break down calcifications and disorganized scar tissue at the tendon attachment, stimulate the production of new collagen, and increase local blood flow to tissue that has very limited natural circulation.
Radial shockwave is the primary device for tennis elbow – it’s highly effective for tendons and soft tissue conditions close to the surface, which is exactly where the lateral epicondyle attachment sits. For cases with calcification at the attachment point, focused shockwave can be added to target the deeper calcified material with precision.
Most patients with lateral epicondylitis see meaningful improvement within 3-6 sessions. There’s no downtime – most patients return to normal activity the same day. Learn more about how we use both devices on our shockwave therapy page.
K-Laser Therapy for Inflammation and Healing
Our 30-watt Class IV K-Laser is commonly applied after shockwave sessions to accelerate the cellular repair process. For acute flare-ups of lateral epicondylitis – where inflammation is still a primary component – laser therapy can also be used between shockwave sessions to reduce pain and swelling. The laser works at the cellular level to stimulate mitochondrial activity and support tissue repair without any injections or medications.
Dry Needling for Forearm Trigger Points
Tight trigger points in the extensor muscles of the forearm – the muscles that feed into the affected tendons – are almost always present in lateral epicondylitis patients. These trigger points maintain constant tension on the tendon attachment and contribute to the load that drove the problem. They also refer pain in patterns that can mimic elbow pain even when the tendon itself is healing.
Dry needling with microvolt e-stim releases those trigger points directly. The combination of needling the forearm extensors followed by shockwave at the lateral epicondyle is a sequence Dr. Ridgway uses regularly for stubborn elbow cases – the needling loosens the muscle tissue first, and the shockwave addresses the tendon attachment where the structural damage is concentrated.
Chiropractic Assessment of the Elbow, Wrist, and Cervical Spine
Lateral epicondylitis doesn’t always exist in isolation. Restricted mobility at the elbow joint or wrist changes how load is distributed through the forearm tendons. Cervical spine involvement – specifically nerve root compression at C6 or C7 – can mimic or contribute to elbow pain in ways that get missed if the neck isn’t evaluated. Chiropractic assessment of the full kinetic chain from the neck through the wrist makes sure the treatment is actually addressing the right problem.
What About Cortisone Injections?
Cortisone injections reduce inflammation effectively and can provide significant short-term pain relief. For some patients, that temporary relief is enough to allow the tendon to recover on its own. But research shows that cortisone injections for lateral epicondylitis tend to have worse long-term outcomes than conservative care – the short-term relief can mask symptoms while the tendon continues to degenerate underneath.
Repeated cortisone injections into a tendon can also weaken the tendon tissue over time. If you’ve had one or two injections that helped temporarily but the problem keeps coming back, that’s a signal that the underlying tendon degeneration isn’t being addressed – and shockwave therapy is a better fit for that stage of the problem.
Activity Modification During Treatment
You don’t need to stop riding, climbing, or working during treatment in most cases. What matters is avoiding the specific loading pattern that provokes symptoms immediately after a shockwave session – typically 24-48 hours of reduced grip-intensive activity following each treatment. Outside of that window, activity modification is discussed based on what you’re doing and how your symptoms are responding.
For mountain bikers, ergonomic adjustments – handlebar width, grip type, brake lever position – sometimes make a meaningful difference in how much load the lateral epicondyle takes per ride. Dr. Ridgway will discuss practical modifications as part of your care plan.
Lateral epicondylitis is also one of the conditions we address under extremity pain treatment at our clinic, alongside Achilles tendinopathy, plantar fasciitis, and rotator cuff conditions.
Frequently Asked Questions
How do I know if it’s tennis elbow and not something else?
The hallmark is pain on the outside of the elbow that’s worse with gripping, wrist extension against resistance, and often with specific activities like lifting a coffee cup with the arm extended. Dr. Ridgway will confirm the diagnosis in the exam – there are reliable orthopedic tests for lateral epicondylitis that differentiate it from elbow joint problems, radial nerve entrapment, and referred pain from the cervical spine.
How long will it take to resolve?
For cases that have been present less than 3 months, most patients respond well within 4-6 shockwave sessions. Chronic cases that have been going on for 6 months or more typically need 6-8 sessions plus the associated soft tissue work. The longer the problem has been present, the more structural change has accumulated – which is why earlier treatment gets faster results.
Can I prevent it from coming back?
Usually yes, with the right combination of load management, forearm strength work, and equipment adjustments where applicable. Once the tendon has healed, Dr. Ridgway will discuss what ongoing maintenance looks like for your specific activity demands.
If elbow pain has been affecting your grip, your riding, or your work, schedule an evaluation at our Durango clinic or call 970-247-5519.
