Elbow Pain

The elbow is commonly injured from overuse by repeating the same movement.

Typical Elbow Injuries

The elbow is a complex hinge joint. The structure allows for the flexion and extension of the forearm relative to the upper arm, as well as rotation of the forearm and wrist.  

Because so many muscles originate or insert near the elbow, it is a common site for injury. One common injury is lateral epicondylitis, also known as tennis elbow, which is an inflammation surrounding the lateral epicondyle of the humerus. Six muscles that control backward movement (extension) of the hand and fingers originate on the lateral epicondyle. Repeated strenuous striking while the muscles are contracted and against force — such as that occurring with the backhand stroke in tennis — causes strain on the tendinous muscle attachments and can produce pain around the epicondyle. Rest for these muscles will usually bring about recovery.

Medial epicondylitis affects the inner tendons in the elbow, and is commonly called golfer’s elbow and little leaguer’s elbow. The repetitive throwing motion used in baseball and the downward swing of a golf club are common causes.

Medial epicondylitis can also be the result of a repetitive hand motion, such as swinging a hammer every day at work. This disorder can cause pain along the inside of the elbow. Wrist movements in particular can trigger pain.

Physiotherapy

The initial goal towards rehabilitation of elbow injuries focuses on the reduction of pain. The numerical pain rating scale is used to measure the level of perceived pain. The scale runs from 1 to 10, with 10 being the most pain felt and 1 being the least. It is frequently noted that pain will also limit some level of strength and neuromuscular control. Grip strength measured with a hand-held dynamometer can be used as a measure of improvement of upper body strength and general function.

In cases of serious injuries like fractures around the bones of the arm, most likely the arm will be immobilised in a cast or sling. In such cases, the elbow will not be allowed to move for weeks or sometimes months leading to mobility issues after the cast is removed. Mobility improvements with rehabilitation will be measured with goniometry, a common tool used to measure the angle of a joint through its motion. 

For the general population, depending on the needs of each person, the rehabilitation program will determine when a person is discharged from physiotherapy depending on progressive reduction in pain levels, improvement in strength components or improvements in mobility and functional capacity. For athletes, more sports specific training is required in order to improve performance and reconditioning to withstand the demands of the sport, preventing future injuries.

Elbow Sports Therapy 

Once the pain subsides, the therapist will begin with exercises. The exercises prescribed must be pain free. If it hurts the exercise must be stopped because pushing through will make the injury worse.  The therapist will begin with eccentric exercises that help to stretch the injured tendon. The eccentric exercises will begin with lesser load and progress to heavier load. These are followed by isometric exercises to strengthen the tendons surrounding the  elbow joint and progression exercises for the forearm muscle. All the exercises introduced must start with a lesser weight or use light resistance band with elbow flex 90 degree. As the patient progresses, the exercise load can be increased and the strengthening exercises can be done with elbow straighten supported and elbow straighten unsupported. The key is that these exercises are continued even after the rehabilitation sessions because the ideal goal is to prevent the injury from recurring and to maintain the strength and flexibility of the muscle.

Prevention & Reconditioning

The elbow is commonly injured from overuse by repeating the same movement. This can be due to playing a throwing sport, working a job, or pursuing a hobby. Less commonly, the elbow also can be injured by a sudden blow or in a fall or other accident.

Elbow injuries in throwing sports are usually the result of overuse and repetitive high stresses. In many cases, pain will resolve when the athlete limits or stops throwing. Be sure to check if your equipment is fit to your hand and you practise correct throwing technique.

To prevent work-related elbow injuries, modifying activities and adjusting the workstation to fit you will reduce the strain on the elbow. This can be done by using more ergonomic equipment, taking breaks, muscle training, and changing the way tasks are performed.

Rest or self-limiting from the activities that cause elbow pain is an important step for the management of elbow injuries. Be sure to take plenty of breaks between repetitive forearm movements. If pain sets in, apply ice at least twice a day to help reduce inflammation and ease the pain. Elbow braces and support pads may also be worn for short term pain relief. There are specific exercises you can do to prevent and recondition the injured elbow structure that caused pain.

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