Understanding Elbow Pain

Physiotherapist: Derek Martin.

Tennis Elbow and Golfer’s Elbow

Elbow pain is a common reason people seek the assistance of a physiotherapist. There are a few different causes of elbow pain. Two of the most prevalent causes include “Tennis Elbow” (Lateral Epicondylalgia) and “Golfer’s Elbow” (Medial Epicondylalgia). Both of these elbow injuries typically affect people between 35-60 years old.

Common Causes

As the name would suggest, Tennis Elbow is more prevalent in tennis players, affecting roughly 9%.  Likewise, with Golfer’s Elbow, this condition is common in Golf players. Interestingly enough, Golfer’s Elbow is also seen in people who play Tennis. No, the moral of the story is not “don’t play tennis”!

Confusingly, sometimes there is no straightforward reason for elbow pain, however here are a few common risk factors for BOTH Tennis and Golfer’s Elbow. The elbow pain is more common in the dominant arm. Over-usage of the arm through participation in sports or work-related tasks requiring repetitive elbow movements, heavy lifting and use of vibrating tools are the most common risk factors. Interestingly, under-usage of the arm/elbow is another risk factor for causing either Tennis or Golfer’s Elbow. Changing your racquet, throwing technique, computer mouse, desk, golf club, swing technique or work tools can also influence your likelihood of developing one of these conditions.

Signs and Symptoms

Tennis Elbow:

Pain and/or sensitivity to pressure occurs over the muscles at the OUTSIDE of your forearm close to the elbow (or more precisely, the Extensor Carpi Radialis Brevis Muscle of the Common Extensor Origin). It is not unusual for pain to refer to the back of the wrist and hand as well. Pain can be brought on when straightening the wrist back (especially repeated wrist extension such as with tennis or brick-laying). Pain often occurs around the elbow with gripping activities. You may also notice your ability to grip feels weaker.

Golfer’s Elbow:

Pain and/or sensitivity to the pressure occurs over the muscles at the INSIDE of your forearm close to the elbow (or more precisely, the Common Flexor Origin). Again, it is not unusual for pain to refer to the wrist and hand, although more on the palm side this time. As with Tennis Elbow, you may notice pain and weakness when gripping objects.

Anatomy

So, what is actually going on? Why does this happen? There are actual structural changes that occur to the forearm’s muscle tendons. In particular for Tennis Elbow, the tendon for the Extensor Carpi Radialis Brevis muscle is placed under considerable load during manual tasks that require wrist stabilization such as gripping or during wrist extension/straightening movements. The same can be said for the Common Flexor muscles of the forearm in Golfer’s Elbow. Changes seen in these tendons are similar to those seen in Achilles tendon issues. There are increased cells, pain fibres, inflammatory chemicals, and collagen among other substances which all lead to increased risk of partial tearing of the tendons. 

Treatment

Now the all-important question, how do we fix this? Non-surgical management remains the gold-standard treatment for both Tennis and Golfer’s Elbow.

• Manual Therapy: use of elbow glides to increase movement while unloading the tendon.
• Exercise Therapy: correct shoulder, elbow and forearm exercise dosage, direction, frequency and resistance are the optimal way to create greater and faster pain regression and increased work ability
• Range of Movement and Stretches: important to not only keep the elbow moving well, but also the wrist and fingers
• Motor Control Exercises: to improve movement between the fingers, hand, wrist and elbow
• Avoid pain provoking activities
• Load Management Strategies: change positions frequently, takes breaks every 30 minutes
• Ergonomic set-up: wrist and elbow positions at the keyboard
• Sporting Advice: swing technique, timing of ball connection
• Splints/Strapping/Orthoses: to assist elbow and wrist positions during sports and work
• Taping: promote elbow and wrist positions while also stimulating blood flow to the area
• Ice massage: to manage inflammation

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