Hey, My Elbow Hurts, Now What?

By: Heather Rozen PT

I cringe when people ask me questions about the elbow.  Especially, “Hey, my elbow hurts, do you have any stretches that I can do?”  If it were only that easy!!!  There are 16 muscles that cross the elbow, and a lot of them share common tendon attachments (tendons attach muscle to bone).  We have the medial side of the elbow which has the wrist flexor tendons and the pronators, the lateral side of the elbow that has the extensor tendons and supinator, the anterior part of the elbow with the biceps, and the posterior part of the elbow which has the three heads of the triceps. In this little tiny area of the body, you also have the blood supply, ligaments, and nerves.  That’s a lot of body parts in a tiny area!!  When things go wrong in this small area, it can cause ligamentous injury, tendon tears, a tendinopathy, nerve irritation, stress fractures, etc.  So, no, I can’t give you a little stretch to fix things.  Fortunately, most of the elbow complaints that you’ll find at a place like a Fitness Strength and Conditioning center will be soft tissue injuries, but even with a soft tissue injury, the pain can increase to the point that you can’t pick up a gallon of milk.  So depending on the symptoms, you should be assessed by either an orthopedist, chiropractor, physical therapist, occupational therapist or athletic trainer not only to treat the injury but also to clean up any of the mechanics that got you in that mess, to begin with.  

With all the elbows that I have treated over the years, the pain at the elbow was usually caused by problems from further up the chain at the shoulder and the shoulder blade.  Poor posture, poor alignment, muscle imbalances, misbehaving shoulder blade muscles, poor mechanics at work, and poor technique during sports (just watch me play tennis or golf, and this will all make sense) all played a part in the pain.  Add all of this to someone who will perform repetitive movements with a grip during work or sports, and it’s no small surprise that they have pain at the elbow. I’ve also found that a person’s poor movement to the lower body can change their sports techniques enough to ultimately change their grip and cause pain.  This is why it’s important to have good movement overall (I use the functional movement system to screen or assess clients).

I will talk a little bit about the most common pain at the elbow which depending on the side of the elbow goes by medial epicondylitis or “golfers elbow” and lateral epicondylitis or “tennis elbow.”  They are called “tendonitis” injuries.  However, tendonitis is a misleading term because it implies inflammation, but this is not an inflammation injury.  Tendinosis is a better word to use to describe the tendon injury.  There is an area of soft tissue that gets bound down and causes stiff spots in the area.  As you start grabbing the weights, picking up a gallon of milk, or even turning a door knob, you can feel the pain up in the elbow.  We now have a lot more information in the field of physical therapy about chronic pain, but that is another whole article (you can see some interesting articles on www.bodyinmind.org).  

Suffice it to say the brain does indeed play a part in your elbow pain and many practitioners now take that into account.  This is not to say that there isn’t a real injury to the tissue that hurts, but that the brain when it perceives a threat, not only creates pain to get our attention but can exaggerate the threat. As I stated, this goes beyond the scope of this article, but it is worth checking out the above website if you want information on pain.  In any case, as far as tennis elbow goes, the standard treatments for this type of injury vary depending on the practitioner.  For physical therapists alone we have many different kinds of hands-on techniques (McKenzie, Mulligan, ART, etc.) and in the hands of a skilled practitioner, most of these treatments work well.  Along with these techniques, most physical therapists also utilize the following:

Relative rest: This depends on the severity of the symptoms.  In mild cases it will include avoiding the activities that cause the pain, changing the mechanics of your work activities or sports specific activities but can also mean, if the symptoms are severe enough, splinting the area.  I’ve found the Spidertech or RockTapekinesiology tape to be pretty helpful for my patients and it’s something that they can manage themselves at home.

Soft tissue work: This will help those bound down areas.  Practitioners will use different techniques to do this including cross friction massage, myofascial release, massage, ART, etc.  However, I’ve used a much lighter touch over the past few years with the same outcome.  I just don’t think it’s necessary to perform painful massage anywhere including the elbow area. The foam rollers can be tough to use at the forearm so the massage sticks or even the theraband stick can be pretty useful.  You can use these preventatively too.  

Eccentric Exercise (lengthening under contraction): This has shown good results to the affected tendons and getting people back to their activities.  Using this method, the muscle is strengthened while it’s lengthening only and then assisted back into position.  The theraband stick got pretty popular as a tool for tennis elbow.  The “Tyler Twist” exercise using this stick is found online.  

These treatments can all work well but not without cleaning up the issues that got you there to begin with.  I spend most of my time cleaning up poor movement patterns further up the chain.  Utilizing your coach to clean up poor mechanics would be helpful as well.  Good alignment and proper form pretty much minimize your risk for injuries across the board.