Elbow pain tends to be one of those conditions that people tend to ignore for long periods of time until they physically CANNOT ignore it any longer. Though the elbow is a relatively small area of the body, pain and dysfunction here can have huge impacts on daily activity - typically with things such as gripping, lifting, or manipulating objects. Check out these simple tips for getting your elbow pain taken care of once and for all.
First, let's distinguish the difference between tennis elbow and golfer's elbow. Tennis elbow, or lateral epicondylitis, is pain on the outside of the elbow. Golfer's elbow, or medial epicondylitis, is pain on the inside of the elbow. These bony points where you feel pain are excellent tendon attachment points for multiple muscles, which is also typically why pain begins here as opposed to directly in the forearm muscles themselves.
The tendons that attach at these locations are from multiple smaller muscles within the forearm that act at the wrist, hand, and fingers to position your arm for tasks. However, as the tendons approach the epicondyle (bony point) they begin to blend together and form a single tendinous structure. This is why when you have a significantly inflamed elbow condition on either side of your elbow the use of any of these muscles can provoke pain.
In general, these conditions are a result of the overuse or excessive strain over time on this common tendon - which can lead to a degeneration of the tendons at the cellular and tissue levels. In my experience, this usually comes down to a repetitive gripping motion that the individual has to do either repetitively, forcefully, or both for their sport, hobby, or occupation.
All right, lets get into it. The 3 primary ways that we will discuss improving elbow pain are:
Temporarily offloading the elbow tendons
Strengthening and building up the muscles and tendons
Addressing the cause of the overuse in the first place
Temporary offloading of the tendons, I want to be clear, is only necessary if the painful condition is more acute in nature. Meaning, the condition or pain has been relatively short lived and spontaneous onset to the tune of 2-4 weeks. Any longer than this and the issue is likely considered more of a "tendinosis" than a "tendonitis" meaning that inflammation is not the pain generator. In this case, skip straight to the next step to gradually load the tendon and improve the tendon health directly.
Offloading, for treatment purposes, consists of limiting the activities that provoke pain. This is considered a sort of relative rest and I want to be clear this is NOT an excuse or reason to stop training or regular exercise. In fact, as we'll learn in the next step, this is exactly the opposite of what is needed to clear up the condition for good.
One final point in this step is the use of equipment and bracing. Elbow sleeves can often improve the perception of pain due to the compression they provide and therefore can be helpful in the short term for tennis and golfer's elbow. A device called a "chopat strap" can also be useful when applied appropriately because it assists with offloading the tendon in the short term as well. A quick Google or Amazon search of the term and you will find many options - many of which are very affordable.
This step is short and sweet in concept. Essentially, we want to progressively load the muscles (and more importantly, the tendons) in order to induce alignment of the collagen fibers within the tendon. Without getting too technical, a dysfunctional and painful tendon under a microscope looks something like spaghetti with fibers crossing and going in all directions. Healthy tendons have fibers that are aligned in a relatively parallel manner which allow them to hold up well to challenges.
Tendons respond directly to the loads presented to them. Therefore, the treatment and strengthening are aimed at progressively challenging the strength of the tendons enough to allow them to change to looking more parallel versus "spaghetti". Check out this video for some exercise ideas to start the process.
As I mentioned earlier, the true "cause" of elbow pain and dysfunction is awkward, repetitive, or forceful gripping that is often required for a hobby, job, or sport. Many times I'm able to have a discussion with individuals taking me through their day and together we can identify what the insulting activity is and then appropriately intervene.
On some occasions, all that may be necessary is to change the grip strategy for the identified activity so as to more evenly distribute strain throughout the elbow. Other times, relative rest combined with a lengthy rehab process is indicated. There is significant variability depending on the individual and the situation at hand.
One final point I wanted to mention is the role of the muscle latissimus dorsi, commonly called the "lats", in the context of elbow pain. The lat is a very large and powerful muscle that plays a large and stabilizing role in a variety of movement and activities. It spans from the lower back to the lower angle of the scapula and inserts onto the arm. The root cause of one's elbow condition can often be a result of weakness or dysfunction within the adjacent shoulder joint and muscles. In this case, the elbow is simply the "victim" of what is more a shoulder issue and this would be a good situation to see a rehab professional, like myself, to deal with appropriately.
When you bring up shoulder dysfunction, many are quick to blame the rotator cuff. While the rotator cuff is definitely undertrained and important to address, I find that often elbow pain is much more common on the arm with the weaker lat muscle. In this case, it is important to address the strength and flexibility of the lats to treat the elbow dysfunction. Check out this video for ways to incorporate lat and back muscle training into your program.
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