Elbow pain

The most common elbow complaint is probably tennis elbow otherwise known as lateral epicondylitis because it is inflammation around the outside of the elbow. Medial epicondylitis, inflammation around the inner part of the elbow is more commonly known as golfer’s elbow. Both conditions are caused by the overuse (RSI) of the muscles of the forearm. Depending on which muscles are being overused will determine which side of the elbow becomes inflamed. The other main area to look for as a cause of elbow pain is the neck. Nerve irritation in the neck can cause pain anywhere along the arms, see the neck pain page (nerve pain section) for more details.

The standard advice for tennis or golfer’s elbow is to rest it, ice it and take anti-inflammatories. However more recent research suggests that resting inflamed tendons is not actually the best way to recover. Without treatment it can take 12-18 months to recover. The pain will subside if you rest them but it will likely quickly start up again if you go back to the previous activities that caused the overuse as you will not have repaired the damage done.

As far as rest goes you do however need to reduce or temporarily avoid the aggravating activities if you want a quick recovery but you should not stop using the elbow all together. Ice for 10 minutes at a time will help reduce inflammation and therefore pain but it must be combined with appropriate stretching exercises/manual therapy to gain complete recovery. If you need to use anti-inflammatories for pain relief try using the creams/gels instead of taking tablets as there will be less severe side effects.

What can we do for you? As mentioned above manual therapy can help speed up recovery time by reducing the muscle tightness that has accrued over time causing the tendon to become inflamed. Soft tissue therapies like trigger point therapy and stripping massage to the tight forearm (& sometimes upper arm) muscles will reduce the load on the tendon. Reducing the fascial tension on the arm/neck will also help so IASTM and manipulation or mobilisation of the thoracic spine has been shown to be helpful. The most important exercises are eccentric stretches, these are described below but they are complicated and if done wrong can exacerbate the problem so performing them under supervision from a qualified therapist will likely lead to a better outcome. Kinesiotaping like rock tape can help to maintain the benefits of massage post treatment.

What can you do for yourself? Avoid/reduce aggravating activities, often tendonitis like this occurs because of a significant increase in usage of muscles compared to your normal amount. Ice for 10 minutes at a time a few times per day. Do at least one session per day of eccentric stretching exercises as described below.

What does the evidence say? Injections, surgery and extracorporeal shockwave therapy do not appear to be very effective especially when compared to manual therapy and eccentric stretching. NICE has not published a full report on tennis or golfer’s elbow treatment although they do discuss the lack of evidence for effectiveness of extracorporeal shockwave therapy. The evidence for manual therapy & exercise is included in the “what can we do for you” section above.

Eccentric stretching exercises: When a muscle shortens as it contracts it is termed a concentric contraction. Muscles can also lengthen as they contract leading to a controlled descent/stretching of the joint in question, this is termed eccentric muscle contraction. Eccentric muscle contractions not only stretch the muscle but also the tendon helping to restore normal resting muscle and tendon length with fewer “knots”. If performed correctly they can help you recover from tendonitis within 4-6 weeks.

A greater stretch will be achieved with greater resistance although the weight used must not be too heavy. Begin by resting your forearm on a table or similar flat surface with the wrist hanging over the edge. With a weight held in the hand of the affected arm it is vital that you use the other hand to shorten the muscle by lifting the hand with the weight in it, only using the tight muscles to control the lengthening phase of the movement.

If the pain is on the outside of the elbow (tennis elbow) then have the palm face down and use the other hand to lift your wrist up into an extended position.

tennis elbow stretch

Slowly lower the weight with your affected forearm muscles and repeat the process by using your other hand to lift the weight/hand back to the start position again. Do NOT use your affected forearm muscles to lift the weight back to the start position. For pain on the inside of the elbow (Golfer’s elbow) just do the same thing but starting with the palm face up instead of face down so the movement is eccentric wrist flexion instead.