Your condition (Epicondylitis) responds reasonably well to "break thru" exercises with minimal risk of rupture in those less than 35-40 years.
Again the reason is multiple (3-4) tendons coapting at a broad axis.
Actually I've evaluated many patients with lateral epicondylitis and I've never witnessed a "rupture".
Jim
What made me decide to try "break thru" exercises or at least helped reassure me that it wouldn't cause more harm were some studies that suggested the traditional inflammatory model is wrong, i.e., the belief that lateral epichondylitis is the result of macroscopic or microscopic tears at the common tendon of the wrist extensor muscles due to chronic overuse. It's my understanding the traditional view has never been substantiated and the literature seems to show it's not an inflammatory process.
Nirschl et al published on his histopathological examination of lateral epicondylitis in the 70's, showing the affected tendon (extensor carpi radialis brevis) was characterized by disorganized and immature collagen, a dense population of fibroblasts, and an ABSCENCE of inflammatory cells which he believed were characteristic a degenerative process rather than an inflammatory one. Newer studies have similar histological findings including at least one that found normal levels of E2 prostaglandin - not what you would expect in an inflammatory condition.
The only consensus seems to be that tendonitis is very complex. Any thoughts on this or the idea that changing the name to epichondylosis/epichondylalgia would better reflect the etiology?
J Bone Joint Surg Am. 1979 Sep;61(6A):832-9.
Tennis elbow. The surgical treatment of lateral epicondylitis. Tennis elbow. The surgical treatment of... [J Bone Joint Surg Am. 1979] - PubMed - NCBI
Nirschl RP, Pettrone FA.
Abstract
Of the 1,213 clinical cases of lateral tennis elbow seen during the time period from December 19, 1971, to October 31, 1977, eighty-eight elbows in eighty-two patients had operative treatment.
The lesion that was consistently identified at surgery was immature fibroblastic and vascular infiltration of the origin of the extensor carpi radialis brevis. A specific surgical technique was employed, including exposure of the extensor carpi radialis brevis, excision of the identified lesion, and repair. The results at follow-up were rated as excellent in sixty-six elbows, good in nine, fair in eleven, and failed in two. There was an over-all improvement rate of 97.7 per cent, and 85.2 per cent of the patients returned to full activity including rigorous sports
Acta Orthop Scand. 2000 Oct;71(5):475-9.
In vivo investigation of ECRB tendons with microdialysis technique--no signs of inflammation but high amounts of glutamate in tennis elbow. In vivo investigation of ECRB tendons with... [Acta Orthop Scand. 2000] - PubMed - NCBI
Alfredson H, Ljung BO, Thorsen K, Lorentzon R.
Abstract
We used the microdialysis technique to study concentrations of substances in the extensor carpi radialis brevis (ECRB) tendon in patients with tennis elbow. In 4 patients (mean age 41 years, 3 men) with a long duration of localized pain at the ECRB muscle origin, and in 4 controls (mean age 36 years, 2 men) with no history of elbow pain, a standard microdialysis catheter was inserted into the ECRB tendon under local anesthesia. The local concentrations of the neurotransmitter glutamate and prostaglandin E2 (PGE2) were recorded under resting conditions. Samplings were done every 15 minutes during a 2-hour period. We found higher mean concentrations of glutamate in ECRB tendons from patients with tennis elbow than in tendons from controls (215 vs. 69 micromoL/L, p < 0.001). There were no significant differences in the mean concentrations of PGE2 (74 vs. 86 pg/mL). In conclusion, in situ microdialysis can be used to study certain metabolic events in the ECRB tendon of the elbow.
Our findings indicate involvement of the excitatory neurotransmitter glutamate, but no biochemical signs of inflammation (normal PGE2 levels) in ECRB tendons from patients with tennis elbow.