Dry Needling for Tennis Elbow with Electrical Stimulation
I use dry needling for tennis elbow several times per week. Its a very effective treatment that gives immediate results in most cases. As the muscles and tendons associated with tennis elbow become so dense and ropey, I like to add electrical stimulation to the mix to get a better, faster, relief from elbow pain. Using Electrical stimulation, or eStim, or Estim, is helps to condition the fascia that courses through and around our muscle fibers.
Two Reasons I Add Electrical Stim to Dry Needling for Tennis Elbow
Electrical Stim Helps To Reduce Pain
Adding electrical stim to dry needling for tennis elbow or any other kind of myofascial trigger point pain, increases the stimulation to the sensory nervous system, increasing the effect on endorphins, natural opiates in the brain. This has a drug like effect on the brain, which relieves pain. This then makes it easier for you to now do the stretching and stregnthenging you need to do at home to make a full recovery. Part of the work of the dry needling here is to break the pain cycle.
Dry Needling with Estim added Increases the Effect on Muscle and Fascia rehabilitation
Tennis Elbow, or lateral epicondylitis is associated with tight shortended muscles and fascia. This is most often an overuse injury. It can be caused by playing tennis, but also by suddenly doing a lot of gardening on the weekend, especially hand clippers, or from doing acupunture, massage, or lots of typing or playing a musical instrument.
Muscle and fascia rehab involves using electrical impulses delivered by tiny electrodes attached to your needles that help to unlock tight muscles and fascia. We do this by stimulating motor points, and by deactivating painful trigger points. This is why when I do dry needling for tennis elbow you will feel and see a strong muscle twitch response. When the muscle twitch occurs, you will often feel your entire muscle on the back of your forearm litteraly jump, from the outside of the elbow down to the wrist. Cool!
The other wonderful effect of combining the eSim with the dry needles is that the eStim speeds the repair of collagen fibers that have been damaged by chronic inflammation.
How the Electrical Stimulation Machine Works
The machine I use is a high quality one made by hand in California. The brand name Pantheon Research, out of Marina Del Ray.
Its powered by 12v battery, and there are four electrical leads with alligator clips at the end. I attach one clip exactly to the belly of the intended muscle, and/or to the trigger point that is painful. Then the other clip follows the legnth of that muscle and may get inserted, for example, in the case of tennis elbow, right into the tendon as it attaches to the lateral epicondyle of the elbow. That is often where you perceive the pain, right at the bone. That is technically called Periostitis, which is inflamation of the surface of the bone, the Periosteum.
Electrical Pulse Waves
Now the target tissues of your body are receiving beneficial electrical pulse waves. These pulse waves send pleasurable sensations to the very part of the brain that has been registering pain sensations. It competes for bandwith, as it were..
The other thing is that the way our muscles work is via our own biochemically created electrical waves. That is why to test muscles and nerves neurologists use EMG machines, electromyograph machines. But those machinese are diagnostic, and painful, whereas the Estim machinese are therapeutic, and not painfuf.
Adjusting the Electrical Stimulation to the Individual
There is no one size fits all in natural medicine. Even when using electrical stim with dry needling for tennis elbow or any kind of myofascial pain, you have to adjust the treatment to the relative stregnth and pain tolerance level of the individual. Some folk are delicate and sensitive, others are stoic, or even obtuse.
Three Ways to Adjust the Estim–
- You can adjust the strength or amplitude of the electrical pulse.
- Adjust the speed of the pulse, from very slow to fast. Most people prefer slow, but at times I do try faster, especially in very strong athletes with very locked tight muscles. I especially do this with larger muscles like hamstrings, quads, and calf muscles.
- Vary the amount of time the eStim is applied.
Adjust Your Estim To Suit Your Goal
To Reduce Pain
Patients with chronic pain, pain of a longer duration, need to have their pain eliminated before we can try to change the muscle and fascial fibers. Whe my goal is to reduce pain, especially chronic pain, I keep the eStim at a low speed and low stregnth and leave it on for a longer period of time. Depending on the comfort level of the patient we may leave the eStim on for anywhere from 5 to 15 minutes.
The strength of the eStim (how strong the pulse is) is always going to be relative to the specific person and case. This is because some areas of the body may have greater impedence. But the key point is that low stregnth means that the patient only feels a gentle level of pulsation. Its very important that in all cases the eStim is adjusted to the tolerance and comfort level of the individual patient. Strong enough to feel, but never so much that the person can not relax.
The eStim needs to be comfortable so that the patient can relax during the process.
To Release Locked Tight Muscles and Fascia
Athletic types with relatively acute (of short duration) pain, associate with locket tight fascia and muscle with painful acute trigger point pain, require, and tolerate stronger and faster stimulation. But in this case we only use the estim for a shorter time. Anotherwords, we use a relatively intense burst of stimulation for a short period.
The purpose here is to cause an alternating muscle contraction/relaxation over a short time frame. When the fascia and muscle contracts and relaxes repeatedly, this can dramatically release trigger points and stimulate motor points, helping your muscle and fascia to release and legnthen. New blood enters the interstices and muscle cells, flushing out lactic acid and other toxic by-products of anerobic respiration that tight poorly vasculated cells resort to….
Now that the muscles have relaxed, we then see reduced inflammation at the tendon attachments and insertions. This process also can help stimulate laying down of new collagen fibers in cases of tendonosis, speeding healing of tendons, muscles, and fascial sheaths. This is how dry needling for tennis elbow with eStim works.
Dry Needling for Tennis Elbow Video, Above.
In the above video, I am treating an acute case of periostititis and tendonosis of the right elbow that developed after an intense burst of activity that involved cranking and uncranking the hitch to a trailer.
Also, as tendonosis involves both inflammation and damage to the collagen fibers, I want to stimulate healing of the tissues with a stronger stimulation that may speed up collagen repair. This patient is a strong, stoic type with super tight muscles and fascia that have led to his inflamation. After consulting with him, and assessing his typology, we together decided to. try an intense burst of strong stimulation, in part because he already enjoyed very strong deactivation of trigger points with 30 and 32 guage sterile dry needles.