CONDITIONS • WESTMINSTER, ARVADA, BROOMFIELD, THORTON & DENVER METRO
Elbow Pain Treatment in Westminster, CO
Tennis elbow and golfer's elbow are not tendon problems. They are loading problems — and the load is almost always coming from the neck and shoulder, not from how you grip a racket.
The lateral and medial epicondyles of the elbow are the attachment points for forearm muscles that are among the hardest-working in the body. When those muscles are asked to compensate for dysfunction above them in the cervical spine or shoulder, or are deprived of the nerve signal quality they need to coordinate properly, the tendons at the elbow pay the price. Understanding this changes everything about how elbow pain should be treated.
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WE UNDERSTAND WHAT YOU'RE GOING THROUGH
Elbow pain is relentlessly present because the arm is involved in nearly every movement you make, and there is no such thing as truly resting it.
The outer or inner elbow pain that starts with a specific activity quickly becomes the thing you feel every time you open a door, carry a bag of groceries, shake hands, or pick up a coffee mug. The grip weakness is particularly unsettling. Tasks that should feel effortless suddenly require conscious effort and produce a deep, gnawing ache that lingers for hours afterward. And then there is the frustration of being told to rest, stretch, and do some exercises — month after month — while the pain keeps coming back the moment you return to normal activity. We hear this from elbow pain patients constantly, and we want you to know that the cycle is almost always breakable once the real drivers are identified and treated.
WHAT YOU MAY BE EXPERIENCING
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Pain on the outside of the elbow (lateral epicondyle) with gripping, lifting, or extending the wrist
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Pain on the inside of the elbow (medial epicondyle) with gripping, flexing the wrist, or throwing
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A weakened grip that makes everyday objects feel heavier than they should
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Aching that travels up the forearm or into the wrist and hand
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Stiffness in the morning or after periods of inactivity
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Tenderness to the touch directly over the bony prominence on the inside or outside of the elbow
IF THIS SOUNDS FAMILIAR
You have likely been told you have tennis elbow or golfer's elbow, been given a compression strap, told to rest and stretch, and possibly offered a cortisone injection. The injection probably helped for a few weeks or months. The pain came back when you returned to normal activity.
What you almost certainly have not been told is that the tendons at your elbow are failing because of forces arriving from the cervical spine and shoulder that have never been assessed or addressed. The tendon is the victim. The neck and shoulder are the perpetrators.
WHAT YOU PROBABLY HAVEN'T BEEN TOLD
Tennis elbow and golfer's elbow are tendinopathies, not tendinitis. The distinction is not semantic — it completely changes what treatment actually works.
For decades, lateral epicondylitis was understood as an inflammatory condition, hence the "-itis" suffix and the widespread use of cortisone injections. Research over the past twenty years has established conclusively that the dominant pathology in persistent elbow pain is tendinopathy — a degenerative change in the tendon structure involving failed healing, collagen disorganization, and abnormal vascularity, with little to no active inflammation present in the tissue. This distinction is clinically critical, because cortisone injections reduce inflammation. They do not reverse degeneration. This is why injections provide short-term relief but the tendon has not changed, and the pain returns.
THE CERVICAL SPINE CONNECTION — THE MOST OVERLOOKED DRIVER IN PERSISTENT ELBOW TENDINOPATHY
The C6 and C7 nerve roots supply the motor and sensory function to the wrist extensors and the extensor carpi radialis — the exact muscles that attach at the lateral epicondyle in tennis elbow. When these nerve roots are irritated by cervical joint restriction or disc changes, the quality of the nerve signal reaching the forearm muscles is compromised. Compromised nerve input leads to subtly altered muscle activation patterns, impaired motor coordination, and increased mechanical demand on the tendon attachment point. The tendon begins to degenerate not because it has been traumatized, but because it has been asked to compensate for a poorly-functioning muscle supplied by an irritated nerve for months or years.
Research has demonstrated that lateral elbow tendinopathy is significantly associated with cervical spine dysfunction, and that treating the cervical spine alongside the elbow produces substantially better outcomes than treating the elbow alone. This is why many patients with tennis elbow improve dramatically with chiropractic care to the neck even before any local elbow treatment has been applied.
Tennis elbow (lateral epicondylalgia)
Degenerative tendinopathy of the extensor carpi radialis brevis and the common extensor tendon at the lateral epicondyle. Driven by repetitive wrist extension loading in the context of compromised cervical nerve supply and poor shoulder mechanics. The tendon is not acutely inflamed. It is structurally degenerated and failing to self-repair in a biomechanical and neural environment that does not allow it to do so.
The C6 nerve root supplies wrist extensor motor function. C6 restriction is found in the majority of lateral elbow tendinopathy cases when the cervical spine is properly assessed.
Golfer's elbow (medial epicondylalgia)
Degenerative tendinopathy of the common flexor tendon at the medial epicondyle. The flexor-pronator group attaching here includes the muscles responsible for gripping, wrist flexion, and forearm rotation. The medial epicondyle is also immediately adjacent to the ulnar nerve, and ulnar nerve irritation at the cubital tunnel is a frequent coexisting condition. The same principle applies: the cervical spine's contribution, through the C7 and C8 nerve roots supplying the flexor group, is almost always present and almost always unaddressed.
Golfer's elbow frequently coexists with cubital tunnel syndrome. Both must be assessed independently and treated simultaneously.
Why cortisone injections work and then stop working
Cortisone reduces the minor inflammatory component that is present early in tendinopathy, providing meaningful short-term relief. However, cortisone also inhibits the fibroblast activity responsible for collagen repair and has been shown in research to accelerate tendon degeneration with repeated use. The structural problem that was present before the injection remains. The cervical and shoulder contributors that were loading the tendon remain. And the tendon is now somewhat more degenerated than it was before.
Multiple cortisone injections into the same tendon are associated with significantly increased long-term tendon degeneration and rupture risk.
What actually heals tendinopathy
Tendinopathy responds to two things above all others: appropriately dosed mechanical loading that stimulates collagen remodeling, and correction of the neural and mechanical environment that caused the degeneration in the first place. Dry needling directly stimulates the tendon's healing response. Correcting the cervical spine restores proper nerve input to the muscles overloading it. Addressing the systemic biochemistry ensures the body has the nutritional and hormonal resources to complete the repair. These three components, applied together, are what produces lasting resolution — not an injection that temporarily masks the symptom while the underlying problem progresses.
UNDERSTANDING YOUR PAIN
Why elbow pain presents so differently from person to person
Which side of the elbow is affected, whether the pain travels into the forearm or hand, how long it has been present, and whether it started with a specific activity or came on gradually all point to different drivers and require different approaches. Two people with the same diagnosis can need completely different treatment.
Tennis elbow (lateral)
WHAT HAPPENING
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Extensor carpi radialis brevis tendinopathy at the lateral epicondyle
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C6 cervical nerve root irritation compromising wrist extensor motor quality
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Often compounded by shoulder dysfunction altering forearm muscle loading patterns
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Radial nerve entrapment in the radial tunnel is frequently mistaken for or coexists with lateral epicondylalgia
WHAT IT FEELS LIKE
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Pain on the outer elbow reproduced by resisted wrist extension or gripping
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Weakness with lifting and carrying — even a coffee mug can feel heavy
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A deep aching that lingers for hours after provocative activity
Tendinopathy and repetitive strain
WHAT'S HAPPENING
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Flexor-pronator common tendon degeneration at the medial epicondyle
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C7 and C8 nerve root contribution compromising flexor and grip muscle quality
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Frequent concurrent ulnar nerve irritation at the cubital tunnel
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Often driven by gripping-intensive activities: golf, racket sports, construction, typing
WHAT IT FEELS LIKE
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Pain on the inner elbow reproduced by resisted wrist flexion or gripping
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Sometimes accompanied by ring and little finger numbness from ulnar nerve involvement
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Worse with shaking hands, throwing, or any sustained gripping activity
Chronic and recurrent elbow pain
WHAT'S HAPPENING
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Advanced tendon degeneration from years of insufficient recovery between loading cycles
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Central sensitization maintaining pain and hypersensitivity beyond the structural findings
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Multiple cortisone injections that have progressively worsened the underlying tendon quality
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Systemic inflammation impairing collagen repair capacity
WHAT IT FEELS LIKE
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Pain present even at rest or with very minimal provocation
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Loading exercises that briefly improve then worsen the pain
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History of multiple treatments that each provided temporary relief
Why identifying the type and stage matters
Early-stage tendinopathy responds well to load management, cervical spine treatment, and dry needling. Established mid-stage tendinopathy requires progressive tendon loading alongside neural and systemic treatment. Chronic and advanced cases need all of those components plus systemic inflammation management and nervous system regulation. The loading program that is helpful in mid-stage tendinopathy can significantly worsen pain in irritable chronic-stage tendinopathy. Staging the condition correctly before selecting the treatment approach is essential — and it is rarely done in standard care.
THE BIGGER PICTURE
What you've probably already tried
Most elbow pain patients have followed a predictable path: a diagnosis, a compression strap, rest, an injection that helped, a return to activity, and a return of pain. Each treatment addressed the tendon at the elbow while the cervical spine, shoulder mechanics, and biochemical environment that were actually driving the degeneration continued uncorrected.
TREATMENTS PEOPLE TYPICALLY TRY
✓ Rest and activity modification
✓ Counterforce compression strap
✓ Anti-inflammatory medication
✓ Cortisone injection into the epicondyle
✓ Eccentric wrist extension or flexion exercises
✓ Surgery for refractory cases — debridement or release
Every one of these is directed at the elbow. None of them assess or address the cervical nerve root contribution, shoulder mechanics, radial or ulnar nerve entrapment, or systemic biochemistry that together determine whether the tendon can actually repair itself.
THE GAP NO ONE HAS FILLED
You have done the exercises. You have had the injection, possibly more than once. Each time the relief lasted a few months and then the pain returned when you resumed normal activity. You are wondering whether surgery is the next step, or whether you are simply going to have to manage this indefinitely.
"I've done the eccentric exercises for months. I've had two injections. Every time I go back to playing tennis or working at my desk the pain returns. Why is this not getting better?"
Because the cervical joint restriction that is compromising the nerve supply to your forearm extensors has never been treated. Because the shoulder mechanics that are distributing excess load onto the forearm have never been assessed. Because the systemic inflammatory environment that is impairing collagen repair has never been addressed. The tendon is being asked to repair itself in an environment that will not allow it. That environment is what needs to change.
OUR FRAMEWORK
What's actually driving your elbow pain
Persistent elbow tendinopathy is not simply an overuse injury that needs more rest and different exercises. It is the result of a tendon that is degenerating in a neural and mechanical environment that prevents it from repairing, in a body whose biochemistry may not be supporting the healing response. All three systems must be addressed together for lasting recovery to occur.
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The Physical System
The cervical spine, shoulder, and the elbow's own mechanics — the full chain that determines how load arrives at the tendon
What goes wrong
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C6 and C7 cervical joints become restricted, degrading the nerve signal quality to the forearm extensors and flexors
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Rotator cuff weakness or shoulder dysfunction alters the position of the arm during activity, concentrating load on the forearm tendons
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Radial nerve entrapment in the radial tunnel reproduces lateral elbow pain independently of the tendon
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Ulnar nerve compression at the cubital tunnel contributes to medial elbow pain and hand symptoms
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Stiff or restricted wrist and elbow joint mechanics alter forearm muscle leverage and increase tendon strain
Why that causes pain
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A muscle supplied by a compromised nerve cannot coordinate its contraction timing correctly, placing disproportionate strain on its tendon attachment with every repetition
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Shoulder dysfunction that alters arm position during gripping activities is invisible without careful assessment but significantly increases the mechanical demand on elbow tendons
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Treating the tendon while these upstream contributors persist ensures that the tendon remains under the same injurious load that caused the degeneration
Correcting cervical spine mechanics often produces immediate reduction in elbow pain — before any local elbow treatment has been applied. This diagnostic response confirms the cervical contribution.
What this means
Assessment must extend from the cervical spine through the shoulder and elbow to the wrist. The cervical nerve root contribution and shoulder mechanics must be identified and corrected alongside local elbow treatment. In many patients the cervical correction alone produces significant elbow improvement. In all patients, failing to correct the upstream contributors means the tendon degeneration will continue regardless of what is done locally at the elbow.
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The Nervous System
How compromised nerve input prevents proper tendon recovery — and why pain can persist after the tendon has structurally improved
What goes wrong
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Compromised cervical nerve root input produces subtle but clinically significant motor coordination deficits in the forearm muscles
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The radial nerve, which passes through the radial tunnel just below the lateral epicondyle, can become entrapped independently and produce pain that is indistinguishable from lateral epicondylalgia on clinical examination alone
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Central sensitization develops after prolonged tendon pain, causing the elbow region to become hyperreactive and produce pain with loading levels that a healthy nervous system would not register
Radial tunnel syndrome is one of the most commonly missed diagnoses in lateral elbow pain. The pain location is nearly identical to tennis elbow but requires completely different treatment.
What this feels like
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Elbow pain accompanied by forearm aching or fatigue that seems disproportionate to the activity performed
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Pain that extends further down the forearm or into the wrist alongside the elbow symptoms
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Symptoms that have become progressively more sensitive over time — provoked by less and less activity
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Neck stiffness or mild shoulder aching that accompanies the elbow pain, particularly after desk work or driving
What this means
The elbow tendon cannot receive an adequate healing stimulus from loading exercises when the nerve supplying its muscle is being irritated at the cervical spine. And when pain has persisted long enough for central sensitization to develop, the pain response has become partially independent of the tendon's structural state. Both of these require direct treatment. Cervical spine mobilization normalizes the nerve input. Dry needling directly stimulates the tendon's repair response while simultaneously reducing the sensitized pain cycle. Neither can be substituted for the other.
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The Biochemical System
The internal environment that either allows tendon collagen to repair and remodel — or keeps the degeneration progressing
What Goes Wrong
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Systemic inflammation impairs the fibroblast activity responsible for tendon collagen repair
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Nutritional deficiencies in collagen co-factors — vitamin C, zinc, glycine, and proline — directly reduce the body's capacity to synthesize new tendon collagen
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Hormonal changes, particularly declining estrogen and growth hormone, reduce connective tissue repair capacity and increase tendon vulnerability in middle-aged patients
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Poor sleep and high cortisol impair the protein synthesis and cellular repair cycles that tendon healing depends on
What this feels like
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Tendon pain that improves with loading programs for a while and then plateaus despite continued effort
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Multiple tendon problems occurring simultaneously or in close sequence — elbow and Achilles, for example
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Poor recovery after setbacks — longer and longer to return to baseline after flare-ups
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Onset or worsening of elbow tendinopathy around hormonal transitions including perimenopause
What this means
Tendon collagen repair is a biological process that requires specific nutritional and hormonal inputs. When those inputs are deficient — and they frequently are in the age group most affected by elbow tendinopathy — the loading program that should stimulate repair produces incomplete healing regardless of how well it is dosed. Addressing nutritional status, hormonal function, and systemic inflammation is not supplementary to elbow tendinopathy treatment. For chronic and recurrent cases, it is often the determining factor in whether the condition finally resolves.
OUR APPROACH
How we treat elbow pain differently
We treat the tendon as one part of a larger system, not the entire problem. That means restoring cervical and shoulder mechanics to correct the neural and mechanical environment the tendon is working in, directly stimulating tendon repair through dry needling and appropriately dosed loading, and optimizing the internal biochemistry for collagen repair. All three, at the same time.
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Restore the neural and mechanical environment the tendon depends on
The cervical spine and shoulder must be corrected alongside the elbow — the tendon cannot repair in an environment that is continuously overloading it.
Restore C6 and C7 cervical joint mobility to normalize the nerve root input to the forearm extensors and flexors, and correct the thoracic mechanics contributing to shoulder dysfunction
Direct needling of the degenerated tendon to stimulate the fibroblast activity required for collagen remodeling, alongside release of the forearm and brachialis trigger points perpetuating elbow loading
Reduce chronic forearm extensor or flexor tension that is maintaining continuous low-level strain on the epicondyle attachments
Eccentric and isometric tendon loading programs dosed and staged appropriately for the current condition severity, alongside rotator cuff and scapular stabilization to correct shoulder mechanics
WHAT THIS CORRECTS
Cervical nerve root contribution · Shoulder mechanics · Radial and ulnar nerve entrapment · Tendon collagen stimulation
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Accelerate tendon tissue repair and reduce the sensitized pain response
The tendon requires both a biological repair stimulus and normalization of the pain response that has become sensitized through months of chronic irritation.
Consistent cervical correction normalizes the afferent input from the forearm to the spinal cord, directly reducing the central sensitization maintaining pain hypersensitivity at the elbow
Serial needling sessions to progressively stimulate the tendon's biological repair response while releasing the protective forearm guarding that perpetuates mechanical loading
Photobiomodulation to stimulate fibroblast activity and mitochondrial energy production in tendon cells, accelerating collagen synthesis and reducing local inflammatory mediators
Progressive return-to-sport or return-to-work loading protocols designed around the tendon's improving structural capacity rather than symptom levels alone
WHAT THIS CORRECTS
Tendon collagen remodeling · Central sensitization · Protective guarding cycle · Functional loading capacity
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Optimize the internal biochemical environment for tendon collagen repair
Particularly important for chronic tendinopathy, bilateral involvement, or onset around hormonal transitions.
Identify and treat systemic inflammation, hormonal status, gut health, and nutritional factors preventing adequate tendon collagen synthesis and repair
Identify deficiencies in collagen co-factors, hormonal contributors, inflammatory markers, and gut function that explain why the tendon has failed to repair despite appropriate loading
Reduce systemic inflammation, support detoxification, and improve the circulation to the forearm and elbow region that tendon repair depends on
Targeted collagen synthesis protocols including vitamin C, glycine, zinc, and anti-inflammatory support timed to enhance the biological response to tendon loading
WHAT THIS CORRECTS
Systemic inflammation · Collagen synthesis deficits · Hormonal contributors · Biochemical repair capacity
WHY THIS APPROACH WORKS
We treat the tendon's environment, not just the tendon
The tendon at your elbow is failing to heal because the neural, mechanical, and biochemical environment it exists in will not allow it. The cervical nerve root is sending a compromised signal. The shoulder is distributing excess load down the arm. The body's biochemistry does not have what it needs to complete collagen repair. Treating only the tendon while these conditions persist is why elbow tendinopathy is so notorious for months-to-years of persistent or recurrent pain.
✓ The cervical spine and its nerve root contribution to the forearm muscles
✓ The tendon's own repair stimulus through appropriately dosed loading and dry needling
✓ The internal biochemical conditions that collagen synthesis and tendon remodeling require
The tendon is the victim of what is happening above it. That is where treatment has to begin.
WHO THIS IS FOR
This approach is for people whose elbow pain...
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Started recently and they want to resolve it fully rather than manage it through repeated injections
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Has improved with injections or exercises but returns every time they resume normal activity
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Is accompanied by neck pain or shoulder tightness alongside the elbow symptoms
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Involves forearm pain or hand symptoms alongside the elbow complaint, suggesting nerve involvement
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Has been told the only option left is surgery and wants a comprehensive, non-surgical evaluation before committing to a procedure