Intended for healthcare professionals

Rapid response to:

Research

Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38961.584653.AE (Published 02 November 2006) Cite this as: BMJ 2006;333:939

Rapid Response:

Re: tennis elbow: What is it?

Surely we should carefully define what the problem is before we
treat/research anything. The references attached to Bisset et al
demonstrates a very confused concept with respect to Tennis Elbow
aetiology and pathophysiology.

1. Is it a purely local phenomenon and no other part of the body
is involved as per reductionist medicine; OR

2. Is it a whole body response to damage via mechanoreceptive/
nociceptive activations passing via dorsal horn amplification to mid-brain
and then either/and higher centres for conscious recognition and via
autonomic and modulated motor mid-brain efferents back for attempted self
repair, resulting in swelling, chemical changes and increased afferent
responses again... causing nocioceptive wind-up?

This whole body response was originally identifed by Pavlov 1904-1916
in his Lectures, then defined neurophysiologically by de Bono in his
Mechanism of Mind 1969 and seemingly forgotten by modern reductionists!

Once the 'Tennis Elbow' definition problem is clarified then and only
then can we make logically and useful EBM findings and not merely add to
the current confused literature.

Competing interests:
None declared

Competing interests: No competing interests

03 October 2006
A. Breck McKay
Family/Musculoskeletal Physician
Brisbane