Elbow Pain: Causes, Symptoms, Treatment and Exercises
Elbow pain is a common injury that can influence your ability reach, grip, lift and load your arms. Elbows can be injured by a trauma, repetitive strain, and poor postures. When you are having elbow pain it is important that you have it assessed by a medical professional, be it a physiotherapist, chiropractor or sports medicine physician. This is especially important if you are having pain that has not resolved on its own over a two to three-week period. Read on to learn about the elbow, some of the most common causes of pain and steps you can take to treat it.
Why is the Elbow Joint Unique?
The elbow is made up of three joints:
- Ulnohumeral Joint: upper arm bone to larger forearm bone
- Humeroradial Joint: upper arm bone to smaller forearm bone
- Superior Radialulnar Joint: just below the elbow between the two forearm bones
The elbow joint moves in four directions; to bend and straighten (flexion and extension) and to turn or twist the hand in space (palm up “supination” and palm down “pronation”). The main muscle groups that cross the elbow are the biceps (front of the upper arm) triceps (back of the upper arm) and the wrist flexor and extensor tendons (that cross from below the elbow and insert on the sides just above the elbow and move your wrist)
What are the Causes of Elbow Pain?
Elbow Pain from Ligament Sprains
Ligaments connect bone to bone and surround a joint to provide stability and support. There are several ligaments around the joints of the elbow. When your elbow absorbs extra forces quickly, like in a fall, or from repetitive straining movements one or more ligaments may become injured. This also means the elbow joint does not have its ideal support system which puts more pressure on the joint and or muscles. This can then lead to inflammation, irritation, and pain of multiple structures around the elbow. It is important in this scenario to stop activities that are strenuous on the elbow, and to have your elbow properly assessed by a physiotherapist, chiropractor or sports medicine doctor.
Elbow Pain from a Muscle Strain or Tendonopathy
This is the most common reason people seek treatment for elbow pain. The elbow has several muscle groups that cross the joint, all of which can become strained or develop unhealthy tissue (tendinopathy) due to overuse. The most common elbow tendinopathy occurs at the forearm extensors insertion on the outside of the elbow and is known as “Tennis elbow”. Click here to learn more about Tennis elbow. Other common areas of elbow tendinopathy occur at the insertion of the bicep, triceps and or forearm flexors. These tendinopathies and are sometimes referred to as golfer’s elbow.
Elbow Pain due to Bursitis
This can occur with abnormal repetitive strain and or direct force on the elbow. The most common area of bursitis is on the back of the elbow and is named Olecranon bursitis. If you have bursitis in this area you may have a large pocket of swelling at the back of your elbow. Click here to learn more about bursitis.
Elbow Pain due to Arthritis
Osteoarthritis of the elbow typically occurs due to a previous traumatic elbow injury such as a fracture or bilaterally with age >60 due to overuse. Rheumatoid arthritis can also be isolated to the elbow or in conjunction with other affected joints in the body.
Elbow Fracture or Dislocation
There are several different kinds of fractures that can occur at the elbow but they are all most likely a result of a fall on an outstretched hand. Some are associated with dislocations (loss of joint congruency) and ligament sprains. Depending on the severity of the fracture you may require a sling or even surgical intervention. In either case it is very important to get manual therapy from a Physiotherapist or Chiropractor to prevent long term loss of range of motion of the joint.
Elbow pain due to Radial Tunnel Syndrome
The radial nerve travels down the back of the upper arm and forearm and provides innervation to the triceps, and wrist extensors (two important muscles groups that cross the elbow). Along its path the nerve can become compressed in tight tissue over the outside of the elbow and result in radiating elbow and forearm pain. This pain can present like shooting, burning, tingling and even numbness down to the back side of the hand.
Elbow pain due to Cubital Tunnel Syndrome
Like the above injury, this occurs due to a nerve entrapment around the elbow but is located closer to the inside. The Ulnar nerve supplies some forearm and hand muscles and also sensation to the pinky and ring finger. If entrapped in tight tissue as it bends over to the elbow, pain that can be described as shooting, sharp, numb, and or tingling can occur. There can also be signs of weakness in the hands when this nerve is irritated.
Elbow pain caused by a Cervical Radiculopathy
The pain that is being felt in the elbow can actually be coming from compression on the nerves exiting at your neck or along their pathway down the arm. You may also experience pain and or stiffness at the neck and notice curtain neck positions or postures change the pain. The compression of the nerve at the neck also makes the nerve more sensitive to compression in other areas down the arm along its path, this can lead a “double crush” and appear as Radial Tunnel or Cubital Tunnel Syndrome. It is important that you have a thorough assessment from your trusted Physiotherapist or Chiropractor to have the proper diagnosis.
How can Physiotherapy, Chiropractic, Massage Therapy and or a Sports Medicine Doctor Help your Elbow Pain?
A team of healthcare professionals can personalize your treatments to address your specific injury and help you return to your personal lifestyle goals. Each member of the team has its role. Treatments with a Physiotherapist or a Chiropractor can include controlling pain with therapeutic modalities such as shockwave therapy, acupuncture or dry needling. They can also help improve range of motion of the joint with hands on manual therapy or manipulation which will increase or maintain range of motion. They will also develop an exercise program for you which will include strength, flexibility and motor control exercises. Soft tissue release is also important and may require adjunct massage therapy treatment. Education in regards to lifestyle modifications, posture re-education and possible bracing and or taping maybe recommended. At Rebalance Sports Medicine we also have the support of Sports Medicine Physicians for consultation who can refer for diagnostics if needed.
How Long Does it Take to Recover from Elbow Pain?
Depending on the cause, severity, duration of the pain and your ability to get the proper treatment, recovery can take a few weeks up to months. It is important to understand what is happening and to seek guidance and treatment from a qualified health practitioner as soon as possible. When pain has become chronic, which means greater than six weeks in duration, it can take longer to heal due to the changes in the tissue and compensation strategies. When you have committed to rehabilitation of an injury it is important to be patient and consistent with your exercise program. Keep in mind that your trusted physiotherapist or chiropractor sees these types of conditions regularly and will be the best person to advise you on the best course of treatment. They will inform you if your symptoms are not progressing as expected and if you should book a consultation with a Sports Medicine doctor for further investigations or treatment options.
What are the Best Exercises to Help with your Elbow Pain?
Depending on the cause of your pain, a well-rounded program should address neck, shoulder, elbow and wrist range of motion and a graduated strengthening program. It should also include a daily exercise and stretching regime. These exercises should be individualized to your particular needs and goals.
Some of the most common exercises for elbow pain are described below. These exercises should be performed in a pain free range of motion and modified or stopped if pain increases during or after the exercise. When performing motor coordination exercises pay close attention to your form, move in a slow and controlled fashion, and aim to do 3 sets of 10-15reps.
Hold weight in your hand with your thumb facing up towards the ceiling. Move only your bending elbow as you bring the weight up towards your shoulder
Repeat 10-15reps, 3xday.
Triceps Pull Down
Standing with a resistance band or light pulley anchored above shoulder height, start with your elbow bent gripping the resistance, then pull your elbow straight.
Repeat 10-15reps, 3xday.
Hold a light dumbbell 2-5lbs in your hand and support your forearm. Moving just at your wrist curl the weight up towards the ceiling. Preform this exercise with your palm up and down.
Repeat 15x in each direction 3xday
Holding a hammer at its handle base or a weighted object that is top heavy slowly twist your forearm so that your palm faces up and then down. Make sure no movement occurs at the shoulder and your wrist stays neutral as it is turned.
Repeat 20x 3xday.
Place your arm overhead and bend your elbow fully, as long as the movement in pain free. You should feel a stretching sensation on the back of your upper arm. Hold this position with your other hand.
Hold for 30 second, 2-3 reps 2-3xday.
This is done in two directions, only into a stretch sensation and not into pain. To stretch the front of your forearm, hold your elbow straight and keeping your fingers straight bend your wrist back so that your palm is facing forwards. You should feel a stretch along the inside of your forearm.
To stretch the other side of your forearm, repeat above with your hand now closed in a fist and bend your hand down so your palm would be facing towards you. This will be felt on the back side of your forearm.
Hold 30seconds, repeat 2-3 reps 2-3xday.
How to Treat Elbow Pain at Home?
- If you have a recent onset of pain in your elbow, you may first want to try ice, especially immediately after the injury event, or if there appears to be swelling. If the pain has more of a gradual onset or has been lingering for some time then heat might be the better choice. You may also choose to apply both heat and ice intermittently depending on how they make your symptoms feels. Apply for 10min with some compression 3x on and off.
- You should also try to figure out the activities and or positions that can aggravate your elbow pain. Pay close attention to the positions that make you feel worse such as using a computer, gripping, or lifting. Try to reduce the amount of time and duration you spend doing them or modify how you do them.
- Try out wearing an elbow brace especially during the aggravating activity. You can buy them at most drug stores or we have a selection available for sale at the clinic.
- In the early painful stage, try to maintain range of motion of the elbow with gentle pain free movements of the neck, shoulder, elbow and wrist. Bend and straighten your elbow, and flex and extend your wrist 20x every few hours in its pain free range so the elbow does not become stiff. Try activating your muscles using reduced weight by doing elbow and wrist curl in both directions.
If your elbow pain continues an assessment and treatment from a Physiotherapist, Chiropractor or Sports Medicine Physician and or treatment by a Massage Therapist is highly recommended.
Heather Imrie, FCAMPT Physiotherapist
Heather Imrie is a FCAMPT physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.