Do you suffer from elbow pain?
If you have ever suffered from elbow pain, you will know that it can really feel debilitating as often the smallest tasks such as putting on a belt or opening a jar can prove near impossible.
On assessment, it’s important for the therapist to rule out referred pain from the neck as this can radiate down the arm into the elbow. However, the most common pain around the elbow joint is known as ‘tennis elbow”. This name comes from the action in tennis whereby the player flicks the wrist backwards (into extension) whilst executing a backhand. But you don’t have to be Roger Federer to be at risk for this one as there are many different activities that can predispose one to tennis elbow. Manual jobs such as brick laying and painting also involve repetitive wrist extension and therefore higher loads being transferred through the tendon of the muscle which does wrist extension. (Extensor Carpi Radialis Brevis or ECRB). This causes an acute pain at the outside upper tip of the elbow that is exacerbated by any gripping and twisting action of the forearm.
Other sportspeople at risk are cyclists especially mountain bikers who grip the handlebars very tightly e.g going down steep downhills. The vibratory forces going through the forearms in this instance may also aggravate the tendon.
Weightlifting even light weights with poor form is another mechanism of injury. Woman are especially at risk here as they tend to have inherently weaker upper body strength and when using toning weights, tend to extend at the wrist instead of keeping the wrist flat when executing curls or fly’s etc.
Physiotherapy treatment for tennis elbow, if caught early can be very effective. The therapist will address training and predisposing factors, release tight muscles, mobilise neural structures such as the radial nerve in this case as well as mobilise one of the small elbow joints called the proximal radio-ulnar joint to retrain better palm-up/palm-down movements at the elbow (also called pronation and supination movements). The therapist may also make use of taping or a brace at the wrist to try to rest the tendon and better disperse the forces in the forearm.
It should be mentioned that pain on the opposite side (I.e the lower underside bony tip) is referred to as Golfer’s elbow and is an overuse of the flexor muscles of the wrist as opposed to the extensors. Treatment follows similar principles.
In a case where the condition has become chronic (i.e longstanding) and conservative management has failed, what may be effective is a cortisone injection from a trained medical practitioner. A physiotherapist would be able to refer you to an appropriate doctor.