DEAR DR. GOTT: I find your column interesting and useful, but I am often frustrated by some of your answers when they concern muscle or joint pain. In your column about tennis elbow, you left out a very likely cause of the problem, but you seemed to disregard it or are unaware of it.

Trigger points may well cause this person’s tennis elbow and, while the pain could be coming from the forearm as you suggested, it could also be coming from the triceps. The trigger points can be caused by trauma or overuse of the muscle; but physical therapy, heat and massage treatments will not cure them, just provide short-term relief. Trigger points are small knots in the muscle that can cause constant pulling at the tendon, resulting in tendonitis. If you don’t release the trigger point, you won’t cure the problem. Physical therapy, heat and massage may relax the trigger point, but it will tighten up shortly after treatment and the pain will return.
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