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

Dear Editor,
I have a major issue with the published article, which appears to ignore
whole body function and addresses Tennis Elbow as a single localised
condition.

While researching Pain and Low Back Pain (1, 2) our group started at
the basic questions of 1) Why does a muscle not rip out of its
attachments? 2) How Ivan Pavlov’s 1910 Lecture identified the orienting
response activating whole body functions to internal and external
environmental changes, results in coordinated body activity and not
isolated muscle actions.

Adding the simple concept that a new born baby is a complete
neuromuscular system, responding by orienting to environmental changes;
which learns each and every movement by repetition of combined actions,
until they pass to unconscious complex conditioned reflexes, (eg, standing
to walking to driving and writing, musicianship, craftsmanship, etc). Pain
management is similarly learnt, but as a subservient, parallel neural
system. (2)

Obviously the functional adult body operates as one single unit in
Pavlov’s learnt coordinated manner, responding to both internal and
external environmental changes. 'Tennis elbow' is a classical example of
this as a whole body function.

Injury/pain produces internal environment change to the
mechanoreceptor and nociceptor inputs from the muscle attachments at the
periosteum, which causes afferent dorsal horn stimulation, leading to
midbrain activation of the autonomic and sensory-motor systems; resulting
in efferent feedback modulation to prevent increased muscle
contraction/damage, often before conscious awareness of the injury occurs.
Tennis Elbow is an excellent example of this process.

We found that after injecting patients with chronic low back pain (2)
it often relieved their neck pain, carpal tunnel syndrome and tennis or
golfer's elbow.
We considered the issue from the above first principles and published(3)
our surprising findings with a proposed explanation, supported by over 300
clinical cases.

Tennis Elbow must be considered as a whole body response to strain or
injury at the lateral epicondyle attachments resulting in secondary
activation of the autonomic and other nervous system areas with the
efferent result being the clinically perceived syndrome. The published
article appears to have considered Tennis Elbow as a localised condition
without appreciating the whole body mechanisms and as such must be
challenged.

References:
1. McKay AB, Wall D, The orienting response and the functional whole human
body. Australasian Musculoskeletal Med. November 2003,8(2):86-99.
2. McKay AB, Pain and chronic low back pain: a new model? Part 1 and Part
2 Australasian Musculoskeletal Med. May 2004, 9(1):14-25
3. McKay AB. Tennis Elbow Everywhere, Australasian Musculoskeletal
Med. November 2005, 10(2:127-130

These references are available in .pdf if required for assessment.

Competing interests:
None declared