ELBOW PAIN

What is Elbow pain

Elbow pain is discomfort or pain experienced in or around the elbow joint, it can occur on the inside, outside, or deep within the elbow joint, and may result from injury, overuse, inflammation, or underlying medical conditions affecting the bones, muscles, tendons, ligaments or nerve.

According to a 2014 study done by Shawn E. Kane et al., elbow pain can be localized to one of four anatomical regions: anterior, medial, lateral, or posterior, and is often caused by lateral and medial epicondylitis, ulnar neuropathy, radial tunnel syndrome, ulnar collateral ligament injuries, and biceps tendinitis.

Prevalence:

The prevalence of elbow pain varies widely depending on the population, with rates ranging from 1-3% in the general population, 25.2% for primary elbow osteoarthritis in older adults,54.6% in youth baseball players, 71.4% in salon workers, and 15.2% among healthcare professionals.

Causes of Elbow pain:

Elbow pain can result from traumatic or non-traumatic causes.

Traumatic Causes

These involve injuries or damage caused by a specific event/injury:

Elbow pain causes
  1. Fractures: Breaks in the bones of the elbow (e.g., radial head fracture).
  2. Dislocations: When the bones of the elbow joint are forced out of alignment.
  3. Sprains: Ligament injuries due to overstretching or tearing.
  4. Tendon or Muscle Tears: Partial or complete tearing of tendons or muscles around the elbow.
  5. Bruises or Contusions: Direct impact injuries causing pain and swelling.
  6. Nerve Injuries: Trauma to nerves near the elbow, like the ulnar nerve.
  7. Bursitis from Impact: Swelling of the olecranon bursa due to a direct blow.

Atraumatic Causes:

These develop gradually or without a specific injury:

1. Tendinitis: Overuse of tendons, such as in:

  • Lateral epicondylitis (Tennis elbow).
  • Medial epicondylitis (Golfer’s elbow).

 

2. Arthritis: Inflammatory conditions, including:

  • Osteoarthritis
  • Rheumatoid arthritis

 

3. Nerve Compression:

  • Cubital tunnel syndrome (ulnar nerve compression).
  • Radial or median nerve issues.

 

4. Bursitis: Chronic irritation or infection of the olecranon bursa.

 

5. Overuse Syndromes: Repeated stress from free activities like typing, throwing, or lifting.

 

6. Referred Pain: Pain originating from the neck, shoulder, or wrist, radiating to the elbow.

 

7. Infections: Rare but possible, such as septic arthritis or infected bursitis.

 

8. Bone Conditions: Such as osteoporosis or Paget’s disease.

 

9. Other possible causes

  • Lack of strength or flexibility in the forearm muscles.
  • Lack of strength in the shoulder muscles.
  • Instability of the elbow joint.
  • Poor technique during sporting activities (especially tennis and golf) that puts too much strain on the elbow joint.
  • Inappropriate sporting equipment, such as using a heavy tennis racquet or having the wrong-sized grip on a tennis racquet or golf club.
  • Repetitive movements of the hands and arms, such as working on an assembly line in a factory.
  • Continuously making the muscles and joints take heavy loads.
  • Other factors such as neck symptoms or nerve irritation.

Prevention of Elbow pain:

It is not possible to prevent all instances of elbow pain, however, it’s possible to minimize the risk by addressing specific activities that cause discomfort. Some cases are simply due to natural aging and activity.

The ways to reduce the risk of elbow injury include:

 

  • Always prioritize a proper warm-up and cool-down routine before and after engaging in sports activities.
  • Ensure you use the correct techniques and appropriate equipment for your chosen sport to prevent strain or injury.
  •  If you are doing excessive work in an awkward posture, do strengthening exercises to the elbow according to the load with weights, bands, etc.
  • There is no need to avoid the activity but you have to build the strength to withstand the load (improving the load tolerance).

Treatment for Elbow Pain:

Management of elbow pain depends on the duration (acute, subacute, or chronic) and underlying cause. Most treatments are non-invasive, including physical therapy, activity modification, and pharmacological options such as NSAIDs. Surgical interventions are reserved for specific cases, such as persistent tendon damage, severe joint degeneration, or significant nerve compression, and those that are not responsive to conservative care.

Pharmacological Management:

Topical NSAIDs:

Proven effective for reducing pain in lateral epicondylitis with fewer systemic side effects compared to oral NSAIDs (Coombes et al., 2010).

Oral NSAIDs:

Recommended for short-term use to manage pain and inflammation, but prolonged use should be avoided due to gastrointestinal and cardiovascular risks.

Corticosteroid Injections:

Provide short-term relief in lateral epicondylitis but may lead to poorer long-term outcomes compared to physiotherapy (Bisset et al., 2006).

Analgesics:

Paracetamol may be used for mild pain, though less effective than NSAIDs in inflammatory conditions.

Opioids and Muscle Relaxants: Not routinely recommended; limited evidence supports their use, and they carry risks of side effects and dependency.

Surgical treatment

Surgery is rarely the first choice for elbow pain and is considered only for severe or refractory cases that fail to respond to conservative treatments.

Tendon debridement or repair

Surgical options like tendon release or repair may be considered for chronic tendinopathy unresponsive to non-surgical interventions.

Nerve Decompression

For conditions such as cubital tunnel syndrome, surgical decompression or transposition of the ulnar nerve may be performed to relieve symptoms.

Arthroscopic Surgery

In cases of arthritis or loose bodies within the joint, arthroscopic procedures may be used to address mechanical dysfunction or pain.

However, evidence for surgical interventions in common conditions like lateral epicondylitis (tennis elbow) is limited. Most studies, including Buchbinder et al. (2008), recommend conservative treatments such as exercise therapy as the primary intervention. Surgery is associated with higher risks, prolonged recovery times, and no guarantee of superior long-term outcomes.

Physiotherapy treatment

Exercise therapy

Exercise therapy is widely regarded as the most effective intervention for elbow pain, particularly for tendinopathies like lateral epicondylitis, with robust evidence supporting its superiority over other treatments.

Manual Therapy

Manual therapy, such as mobilization with movement, may provide short-term pain relief and functional improvement (Abbott et al., 2015). However, it is less effective than exercise therapy for achieving long-term outcomes, emphasizing that manual therapy should only be used as an adjunct to active treatments.

Pain Modulation Techniques

Passive modalities like TENS and ultrasound show limited benefits for elbow pain (Chung et al., 2016). Similarly, while radial shockwave therapy (Notarnicola et al., 2018) may improve outcomes in chronic tendinopathy, it does not match the comprehensive benefits of a structured exercise program.

Kinesio taping and Dry Needling

Evidence for kinesiology taping (Mostafavifar et al., 2012) and dry needling (Gerwin et al., 2016) is limited, with studies showing no significant advantage over exercise therapy or placebo.

How to strengthen Elbow Joint?

1. Eccentric Exercises

A systematic review by Coombes et al. (2015) highlights the strong efficacy of eccentric exercises in reducing pain and improving function in elbow tendinopathies. These exercises facilitate tendon remodeling, making them a cornerstone in the rehabilitation process.

2. Isometric Exercises

Rio et al. (2015) demonstrated that isometric exercises not only reduce pain but also maintain tendon load capacity, making them highly effective in the early stages of rehabilitation.

3. Plyometric and Functional Training

Advanced strengthening and functional exercises, as supported by Docking et al. (2019), are crucial for restoring normal activity levels and preventing recurrence, particularly in later rehabilitation stages.

What are the exercises for Elbow pain?

Given below are a few exercise recommendations for elbow pain:

Elbow flexor strengthening:

  •       Biceps curls 
  •       Hammer curls
  •       Zottman curls
  •       Preacher curls 
  •       Chin-ups
  •       Spider curls 
  •       Concentration curls

Elbow extensor strengthening exercises:

  •       French Press  
  •       Skull crushers 
  •       Triceps pushdown
  •       Triceps dips  
  •       Diamond Push up 
  •       Triceps kickback  

Click here to learn more about Physiotherapy exercises for elbow pain

Our Approah:

Step 1: Comprehensive Assessment

Begin with a thorough evaluation of the patient, not just the condition:

  •       Collect detailed history, including onset, activities, and aggravating/relieving factors.
  •       Assess fear of movement and psychosocial factors contributing to pain or dysfunction.
  •       Identify root causes (e.g., overuse, poor mechanics, underlying conditions) and risk factors for elbow pain.
  •       Diagnose accurately with clinical correlation, considering both local and referred pain sources.

Step 2: Patient Education

Effective communication fosters better understanding and recovery:

  •       Explain the condition simply as “elbow pain”; avoid using overly technical diagnostic terms.
  •       Maintain positivity and reassure the patient about the likelihood of recovery.
  •       Clearly outline the rehabilitation process and provide education about pain mechanisms.
  •       Emphasize the importance of lifestyle modifications, such as ergonomic adjustments and activity pacing.

Step 3: Tailored Treatment Plan

Design a plan that addresses both physical and psychological aspects:

  •       Focus on the root cause (e.g., tendon overload, joint stiffness) and psychosocial factors.
  •       Reduce session frequency, allowing time for gradual improvement.
  •       Use active approaches to enhance range of motion, tendon health, and strength of the forearm and surrounding musculature.
  •       Provide home exercises to improve overall physical and mental health, while addressing specific elbow issues.

A thorough assessment, clear communication, and individualized treatment ensure lasting relief and better outcomes for elbow pain.

Conclusion:

Elbow pain is always not a serious problem. With proper treatment and care, most of the individual recover fully. However, it is important to identify the root cause and treat it accordingly. So, it is essential to consult a qualified physiotherapist before beginning any new exercise routine.

At Exercise Prescriptor Clinic, we provide a professional assessment that will help to determine the root cause of your pain and ensure that the given exercises are appropriate and tailored to your specific needs, reducing the risk of further injury or complications.

Schedule a consultation today to take the first step toward a healthy and pain-free life.