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 or chiropractor. 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:

  1. Ulnohumeral Joint: upper arm bone to larger forearm bone
  2. Humeroradial Joint: upper arm bone to smaller forearm bone
  3. Superior Radioulnar 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 or chiropractor.

Elbow Pain from a Muscle Strain or Tendinopathy

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 certain 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, and Massage Therapy 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.

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 family 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.

Bicep Curl

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.

Wrist Curls

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

Forearm Rotations

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.

Triceps Stretch

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.

Wrist stretches

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 Massage Therapist is highly recommended!  Please give us a call today to book an assessment.

Tennis Elbow

When you hear the name Tennis Elbow injury, it would not be uncommon to think to associate it with a tennis or racquet sport injury. However, typically patients with this injury are rarely tennis players or racquet sport players. Instead, many of our clients with this condition are office workers who spend countless hours in front of a computer at work.

What is Tennis Elbow?

Tennis Elbow (aka Lateral Epicondylitis or Tendinosis of the elbow) is a painful condition of the elbow that is caused by overuse of the forearm muscles through repetitive actions. The pain and symptoms of tennis elbow are a result of inflammation at the tendon that attaches the forearm muscles to the outer part of the elbow bone. The tendon is a tough, ropey structure that connects muscle to bone. Physiotherapy, chiropractic treatment, or massage therapy can all be effective for treating tennis elbow.

What are the Symptoms of Tennis Elbow?

Common symptoms of tennis elbow include tenderness on the outside of your elbow bone and pain with gripping, pushing, pulling or carrying objects with your hand/wrist. It is common with office workers to get this condition as a result of using their computer mouse excessively while positioned in poor wrist postures. Elbow pain can also be caused by dysfunctions of the neck or the nerves that travel down your arm. This is why it is best to have a professional such as a trusted physiotherapist or chiropractor conduct a thorough assessment to determine if you actually have tennis elbow or if the pain is a referral from the neck or a combination of the two conditions.

How do Physiotherapists, Chiropractors or Massage Therapists Treat Tennis Elbow?

The specific management for tennis elbow will depend on a few factors such as what caused it, how long it has been going on for, how much pain you are experiencing and what your treatment goals are.

Typically, Physiotherapy and Chiropractic treatment will involve soft tissue release such as ART® to release the muscles and decrease the pull on the tendon, stretching exercises, strengthening exercises and possibly acupuncture or dry needling. Your therapist might also suggest extracorpeal shockwave therapy. Shockwave therapy uses a form of sound energy to break down scar tissue and help to stimulate an accelerated healing response. Research demonstrates great results for shockwave therapy especially when it is used in combination with exercise, activity modification and education. For best results from treatment, it is advisable to be regular with your home exercise program.

Massage therapy is another treatment approach that can be used in conjunction with Physiotherapy and Chiropractic treatments to help release the soft tissues in the forearm and possibly the upper arm, neck and upper back as well.

How Can I Treat Tennis Elbow at Home?

Sometimes it is difficult to rest your arms from the aggravating activities that contributed to the injury in the first place. Each time you use your arm to the point that pain is produced, a cycle of re-aggravation and further tissue damage occurs. Wearing a brace can help with this issue. A tennis elbow brace, if used properly, can limit the amount of tension transmitted through the tendon with everyday activities. This allows the tendon to get the rest it needs for appropriate healing.

At home, you can also work on your exercises that were prescribed by a trusted physiotherapist or chiropractor. You may also try to gently massage your forearm at home to see if you are able to gradually decrease the tightness that caused this injury in the first place.

What are the Best Exercises to Help with Tennis Elbow?

  1. Forearm muscle stretching to perform these exercises you will do this with your wrist and hand in two positions. In both, straighten your elbow with your arm out in front. To stretch the back of your forearm, palm faces the ground, make a closed fist and bend your wrist downwards. For the front of the forearm, palm faces the ceiling, splay your hand open and bend your wrist and hand down to the ground. In both positions use your other hand to apply overpressure. Make sure the stretch does not feel painful or shaky, just like a gentle pulling sensation.
  2. Tyler Twist exercise for eccentric strength in the forearm.
  3. Eccentric forearm strengthening exercises using a dumbbell. The focus of this exercise is to perform the muscle shortening portion of the exercise with assistance from the other hand (ie lift the weight up and extend the wrist) and then perform the lowering of the wrist in a slow and controlled fashion, taking the wrist all the way down past neutral. This exercise should be done in a pain free manner by using light weights or doing few repetitions and gradually building your tolerance.
  4. Forearm muscle endurance strengthening “Wrist curls”. To perform this exercise take a light weight and do repetitive slow controlled curls in both the flexion and extension. When training for endurance you want less weight and high number of reps. Try 20-30 repetitions 3xday. The amount of weight depends on what you can tolerate without pain, we suggest using a soup can or a slightly heavier 2-5 lb dumbbell.

How Long Does it Take to Recover from Tennis Elbow?

Tendon injuries can be stubborn to manage without active treatment plans such as those offered by qualified physiotherapists and chiropractors. If you wait too long you can also end up with permanent cell damage in parts of the tendon. It is best you have this issue looked at if it is not resolving on its own in 2-4 weeks with rest. A straight forward tennis elbow should take 6-8 weeks to fully recover but can take months when there are a combination of factors that need to be addressed.

If you are suffering from this condition, avoid waiting too long before you seek treatment. Contact us today to book an appointment with one of our trusted physiotherapists, chiropractors or registered massage therapists.

Elbow Dislocation

The elbow joint consists of three bones: humerus (arm bone), radius and ulna (forearm bones). A dislocated elbow occurs when these bones are forced out of their normal position. It is the most commonly dislocated joint in children, and the second most common in adults after the shoulder.

The signs and symptoms are difficult to miss:

  • Sudden onset of extreme pain following a trauma
  • Visibly deformed elbow
  • Unable to bend or straighten arm
  • Swelling and possible bruising around the elbow

Elbow dislocations are quite often reducible without surgery, but do not attempt it on your own. In addition to the dislocation, broken bones, muscle, vascular or nerve damage may happen. If you think you have dislocated your elbow, seek medical attention promptly.

A partial dislocation on the other hand can be easily missed as the bones can slip back into place. Book an appointment with a physiotherapist if you have lasting elbow pain following a trauma.

What Causes an Elbow Dislocation?

Commons causes of an elbow dislocation include:

  • Landing on an outstretched hand as a result of a fall (i.e. football, skiing, volleyball, cycling, slipping on ice)
  • Hard direct blow to the joint (i.e. Motor Vehicle Accident)

How can Physiotherapy or Chiropractic Help with Elbow Dislocations?

Following the assessment in the hospital, the doctor will decide if the joint is reducible or additional surgery is needed (broken bones, damaged nerve/blood vessels may need repair).

If the dislocation is stable, surgery will not be required. The joint will be reduced (put back into place), and splinted for 7-10 days to allow the ligaments and muscles to heal and to prevent re-dislocation. Early mobilization is important, so make sure you book an appointment with a physiotherapist or chiropractor within that time frame. Most elbow joints become stiff as a result of prolonged immobilization, which will require longer recovery and more therapy.

During the assessment, the therapist will assess your current range of motion, and provide you with exercises to help you regain range and function. Performing home exercises 3-4x a day is the cornerstone of a successful outcome. During this session, they will also provide you with exercises to the surrounding joints to avoid disuse injuries. They can also help you find safe alternatives to continue exercise and stay active.

In the subsequent therapy sessions, manual therapy techniques may be applied to the joint and surrounding connective tissues. Joint stability and ligament healing will be monitored over time, and range of motion, stretching and strengthening exercises are progressed based on guidelines and tolerance. If needed, your therapist can use taping or bracing. If pain is an issue, they can use modalities such as acupuncture and interferential current to help control pain.

What Should be Avoided with an Elbow Dislocation?

Avoid excessively moving and using your arm while in a sling. Pushing it too hard early on may result in a re-dislocation, but keeping it from moving at all afterwards could result in range of motion and functional loss. Follow the guidance of your healthcare professional closely. You will have a gradual return to sport, gym etc.

How Long Does it Take to Recover from an Elbow Dislocation?

Every case is different, but following a non-surgical elbow dislocation, most people able to return to activities within 4-8 weeks. It may take longer if the dominant hand is involved, or there are high sport specific demands (i.e.: gymnast or volleyball player). Ligamentous healing will continue long after the initial healing time of 4-6 weeks. If surgery was required following the dislocation, recovery may take longer, up to 3-5 months.

During the initial few weeks, the goal is regaining functional range of motion, followed by strengthening and work hardening/return to sport training. The length of each stage will depend on the type of dislocation and whether it required surgical treatment. The key to recovery is performing the prescribed exercises post dislocation at home as prescribed.

Patients following simple dislocations typically do well with recovery, and report high levels of satisfaction and high functional level. However, some residual stiffness and pain is possible in the long term. Unlike the shoulder, where the chance of re-dislocation is high, the elbow tends to stiffen up and become tighter after the dislocation has healed.

What are Safe Home Exercises for an Elbow Dislocation?

Following a dislocation, exercises are vital in order to restore range of motion, function and strength. It is always important to be assessed and prescribed individualized exercises by your Physiotherapist and/or Chiropractor.

Unless the surgeon directed otherwise, the following range of motion exercises are safe to start with. Perform them 10x each, 3-4x a day:

Elbow flexion and extension active range of motion (AROM) in neutral forearm

  • Turn your wrist so your thumb is facing up
  • Bend and straighten your elbow in the available range
  • Some pain is expected at the end of range
  • Don’t shy away from a little pain but also don’t push into sharp pain

Elbow AROM in supination

  • Turn your wrist and forearm so the palm is facing up to the ceiling
  • Bend and straighten your elbow in the available range
  • Some pain is expected at the end of range
  • Don’t shy away from a little pain but also don’t push into sharp pain

Elbow AROM in pronation

  • Turn your wrist and forearm so the palm is facing down to the floor
  • Bend and straighten your elbow in the available range
  • Some pain is expected at the end of range
  • Don’t shy away from a little pain but also don’t push into sharp pain

Key Points:

  • If you think you dislocated your elbow, go to a hospital
  • Following the initial splinting, EARLY mobilization is key, because the elbow joint tends to stiffen up
  • Patients do well long term, but special focus needs to be on regaining functional range of motion to avoid chronic stiffness and pain

If you need to rehab your elbow dislocation, book an appointment with one of our experienced physiotherapists or chiropractors today.