Osteopathy and Elbow Pain: Between Science and Beliefs

Epicondylalgia (Tennis Elbow, Golfer's Elbow) affects 10 to 15% of the general population. While structural osteopathy offers encouraging results for these mechanical pathologies, it is often surrounded by theories that are appealing but scientifically fragile. For lasting recovery, it is crucial to distinguish effective manual techniques from therapeutic myths.

Understanding the Elbow: A Transmission Joint

The elbow acts as a pivot between the shoulder and the hand. Pain often results from the overuse of the extensor or flexor tendons.

• Lateral Epicondylitis (Tennis Elbow): Inflammation or micro-tears of the wrist extensor tendons.

• Medial Epicondylitis (Golfer's Elbow): Affects the wrist flexor tendons.

• Nerve Entrapment Syndromes: Compression of nerves (such as the ulnar nerve) causing tingling or numbness.

The Myths of Osteopathy

Certain traditional explanations lack evidence and can mislead patients regarding the true cause of their pain.

A. The Visceral Osteopathy Myth

• The Belief: A "congested liver" or stomach issues disturb the blood circulation of the right or left arm, thereby causing tendonitis in the elbow.

• The Critical Reality: There is no scientific evidence that abdominal manipulation can treat epicondylitis. The invoked links (phrenic nerve, fascia) are anatomically real, but their mechanical influence on an elbow tendon is non-existent. Tendonitis is related to excessive mechanical load, not digestive issues.

B. The Global Posturology Myth: "The Twisted Pelvis"

• The Myth: Your elbow pain comes from an imbalance in your pelvis or a jaw problem creating upward tension.

• The Reality: While the posture of the shoulder and neck is determining for the elbow, the link to the pelvis is extremely tenuous. Focusing on the lower body to treat an elbow without evidence of a direct link is a biomechanical oversimplification without a solid clinical basis.

C. The Joint "Realignment" Myth

• The Belief: The elbow is "dislocated" or the radial head is "subluxed," and the osteopath must "put it back in place."

• The Reality: Except in cases of major trauma, bones do not "move out of place." HVLA manipulation (the "pop") does not put anything back; it stimulates nerve receptors to inhibit pain and relax protective muscles, thereby restoring physiological gliding.

Scientific Reality: What Actually Works

Osteopathy is effective when integrated into a modern manual therapy approach.

• Mobilization with Movement: Restoring the kinematics of the radial head can instantly decrease pain during gripping tasks.

• Trigger Point Therapy: Releasing the extensor muscles of the forearm reduces the mechanical pull on the bone (the epicondyle).

• Nerve Desensitization: Gentle mobilizations (neurodynamics) help reduce nerve excitability if the pain radiates, acting on perception rather than a physical "pinch."

Toward Lasting Recovery

Osteopathy is a powerful tool to "open the window" of recovery by suppressing acute pain. However, for a lasting result:

1. Movement is vital: Eccentric strengthening exercises are the only ones capable of regenerating the tendon.

2. Ergonomics is key: Adapt your workstation or your sporting technique.

3. The osteopath is a partner: They treat cervical and local blockages, but success depends on your consistency with exercises.

Alain Guierre