Tennis Elbow Treatment In Toronto: Yorkville Corrective Chiropractic

The most important part of providing the best tennis elbow treatment in Toronto is not to treat the elbow at all. At Yorkville Corrective Chiropractic, our approach is to correct the underlying problem with the body that leads to symptoms and complaints. Ultimately, symptoms are like your body’s “check engine light” and the elbow pain is usually the consequence of problems far beyond the elbow – the neck and nerves leaving that part of the spine MUST be assessed as a potential root problem. If you are looking for tennis elbow treatment in Toronto that looks to address the root cause and not just the symptoms then read on and learn by a comprehensive approach should be taken!

Cause Of Tennis Elbow and Do I Know If I Have Tennis Elbow 

Best tennis elbow treatment in Toronto. Dr Alex Ritza Yorkville Chiropractic
The coloured muscles of the forearm originate as the common extensor tendon, which inserts into the humerus

“Tennis elbow” (TE) is known clinically as lateral epicondylalgia.  Previously it was called lateral epicondylitis, or extensor tendonitis. It is diagnosed in the presence of pain located over the lateral (outside) epicondyle of the elbow, with gripping and/or manipulation of the hand. The extensor muscles of the wrist originate at the elbow in the form a common extensor tendon. This tendon attaches into the lateral epicondyle, and is generally implicated as the source of the problem. This common and painful condition is a complicated one to correct and understand. Scientific studies have shown that changes occur throughout the nervous system, shoulder and neck that could act as potential underlying causes, which reinforces the need for global and holistic treatment.

We think we are amongst the top clinics to visit for the best tennis elbow treatment in Toronto because we always look to address any underlying causes in the shoulder, neck, spine or nervous system.

Best Tennis Elbow treatment Toronto. Elbow Anatomy
Another view of the elbow highlights the intimate location of the radial nerve to the area of pain

Why Did I Get Tennis Elbow ….. not just tennis players get it

What is happening to my elbow? –  It’s degeneration, not inflammation!

There are two major reasons there is pain at the elbow – a change in the tendons / muscle, and changes in the nervous system.

Best Tennis Elbow treatment Toronto. Tendon Anatomy
A somewhat complete photo of the tangle of collagen fibres that occur in the tendon as it attaches to the lateral epicondyle

There is a general consensus that although there is pain, there is no actual extensor tendon inflammation occurring at the site of injury1. Typically tennis elbow is a case of repetitive strain and degeneration of the tendons of the forearm extensor muscles. The forearm extensor muscles are on the back of the forearm. These muscles pull the wrist back, such as when giving a high five.

The most important role of this muscle group is to eccentrically resist wrist flexion (a difficult job) while gripping, manipulating or holding objects in the hand, which puts a great deal of load on these muscles and their tendons.

The tendons of these forearm extensor muscles, namely the extensor carpi radialis brevis, begin to degenerate from repetitive strain. The cause of the degeneration is not entirely understood but a lack of strength seems to be a key factor. This degeneration causes the following changes to the tendon:

Is it normal to feel weakness with tennis elbow?

Strength is almost always affected by this condition at the wrist, elbow and shoulder. It is likely that some of the weakness experienced at these sites is both a consequence and cause of the condition. Besides the changes in the nervous system mentioned below, which can lead to weakness, local muscle changes have also been observed including muscle fibre death, and wasting, amongst others.

Grip strength and more importantly, pain-free grip force (PFGF) is reduced. PFGF is the maximum amount of force a patient can produce before pain is felt and is one of the best outcome measures for this condition we have. TE sufferers often demonstrate reduced strength of the shoulder, biceps, triceps and forearm flexors. More importantly, studies have shown that strength deficits exist beyond the resolution of symptoms and highlight the need for proper rehabilitation. Even when pain is alleviated, exercises that are part of a good rehabilitation program should be continued to restore strength to, and beyond its initial levels. 1

Nervous System Changes in Tennis Elbow1  

Neck and shoulder nerve anatomy.
The nerves of the upper limb move through very small spaces in the neck and through the shoulder where they form the brachial plexus. Tightness or tension of structures in the shoulder and neck may be causing undue stress to the radial nerve and perpetuating your symptoms

There are changes in the peripheral nervous system (the nerves of the arms and hand) and the central nervous system too (the brain and spinal cord) that may be creating your tennis elbow pain. Knowing this is the key to getting the best tennis elbow treatment in Toronto.

Peripheral Nervous System Changes

Central Nervous System Changes

 Do I need an x-ray or MRI?

As long as your doctor does not think that a major medical condition is ongoing, an x-ray, ultrasound or MRI is not considered necessary to make a diagnosis of TE. The diagnosis can be made by listening to the patient history and touching the elbow, shoulder and neck to ensure that the pain is coming from the elbow. Your healthcare practitioner should determine the extent to which the shoulder and neck are involved. Research has shown that diagnostic ultrasound might be most efficient and effective in confirming the diagnosis of TE but it is rarely necessary.1

Prognosis and Natural History: How Long Is This Going to Last

Without treatment, the natural history of TE can see symptoms last months to years based on the lifestyle factors that one is exposed to. The condition may spontaneously resolve with rest though it is more likely to recur and go unresolved.

The prognosis for the treatment of Tennis Elbow varies depending on the mode of therapy used. Typically, studies evaluating manual therapy and chiropractic-like treatments demonstrate the successful resolution of symptoms by 1 year in 70%-100%, with the resolution of symptoms common by 8-12 weeks with treatment.

Treatment For Tennis Elbow

By and large, Tennis Elbow responds well to manual, multimodal care provided by a good Corrective Chiropractor. Studies examining what treatment is best are limited. However, studies where manual therapy and rehab exercises are combined, show better results than doing-nothing or corticosteroid injections13. No particular treatment is guaranteed to be effective for all patients, and it is likely a combination of treatment modalities will be most effective.

Some important notes before treatment

How I Treat and Fix Tennis Elbow If I Live In Toronto

The following is a general approach to how I treat, and try to provide the best tennis elbow treatment in Toronto. I will also share the scientific rationale behind it. It is by no means a complete summary but is meant to give a general overview. The following treatment options are supported in the literature as being helpful in its treatment.


Active Release Technique

Mobilizing and manipulating the neck



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