Elbow Pain
Ever had pain around your elbows?
If you have, you know how annoying it is.
Let us show you how we treat it.
This week we’re talking all things elbow! Ever get pain near those bones on the inside or outside of your elbow? Maybe the pain even goes down the muscles in the forearm on either side. You are more than likely looking at either tennis or golfer’s elbow. The fancier name for those are lateral and medial epicondylitis. Lateral epicondylitis is the most common overuse syndrome in the elbow.
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So how did you get this type of pain? Well, epicondylitis simply means Inflammation around the epicondyle - aka, the bones that stick out on either side of your actual elbow bone (or olecranon). It is a tendinopathy injury involving the muscles that go up and attach to these bony areas. Though the name of the condition ends with ‘itis’ which is Greek for inflammation, inflammation is there in only the earliest stages of the disease (1). Microscopic tearing occurs and eventually leading to a degeneration process (1).
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A common way to get one of these conditions is overloading the tendons in the forearm repetitively. Common people who walk in with it? Not only tennis players or golfers! Believe it or not, only 5% of those with tennis elbow actually play tennis! Additionally, though golfer’s elbow is common in you guessed it, golfers, it is also very common among other athletes like baseball pitchers, bowlers, and football players. However, the majority of those who get it do not play sports.
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The most common people walking in with these conditions are those who have jobs that have repetitive wrist movements like carpenters, painters, electricians, gardeners, plumbers, those who have heavy computer use, those who hold onto something with repetitive vibration, those who do heavy lifting, etc.
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So how do I know I may have one of these conditions? To start, the area where these muscles attach at the elbow is very painful! You may experience weakness with lifting or gripping. There may also be radiating pain up or down the arm.
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So what are you looking at for the prognosis of these conditions? It varies upon how quickly you act on the pain. However, to give you some numbers, for lateral epicondylitis “symptoms last, on average, from 2 weeks to 2 years. 89% of the patients recover within 1 year without any treatment except perhaps avoidance of the painful movements” (1). I don’t have statistics for medial epicondylitis, but typically these can both resolve within months the sooner you rest your arm and start treatment
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So what does treatment look like in our office? The latest research tells us that there needs to be a multitude of conservative treatments (1, 2). First is soft tissue. We can address the trigger points often found in the muscles of the forearm a couple different ways - with our hands using myofascial release, with tools to “scrape” the muscles, with cupping therapy, or with dry needling. We may use one or a couple of these options in one treatment.
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We also address the joint restrictions with manipulation to the joints. Finally, we do rehabilitation to the area to fix the function. We usually find trigger points along the muscles of the forearm, and we know that a tight muscle is a weak muscle, therefore it must be strengthened! Research also shows us that a lot of the time these muscles involved in lateral and medial epicondylitis are weak and lack flexibility (2). That’s where the rehab comes in in addition to the soft tissue. I love using eccentric exercises for the forearm, the FlexBar, and tennis ball squeeze holds until the pain subsides. The best part is, there have been studies to show the effectiveness on a multitude of these treatments. These are all shown in the video below.
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Now, there are of course more invasive procedures to address these conditions. A common one is steroid injections. I may be bias, but I would choose a trial of conservative care every day of the week before an injection, because at Chiro CLE we are fixing the root of the problem. An injection is simply masking the pain, like putting a piece of tape over the check engine light in your car. “If the symptoms of epicondylitis lateralis will prove to be resistant surgical treatment is indicated. Usually this is after a failed conservative treatment for more than 6 months” (1). However, there is a time and place for all treatments. Sometimes the issue in your elbow may be past the point of conservative fixing, and it may need an injection or surgery. In which case we would refer you out to a physiatrist or orthopedic surgeon. It’s all about getting you into the right hands at the right time.
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If you are experiencing elbow pain, don’t wait on it fixing it. The sooner you start treating it, the sooner you can go back to the activities you love, pain-free and functioning better than ever!
https://www.physio-pedia.com/Lateral_Epicondylitis
https://www.physio-pedia.com/Medial_Epicondyle_Tendinopathy
