Elbow pain is relatively common, and when you have it – can be quite debilitating, especially if it’s the arm you use the most (your dominant arm).
Most of the time, elbow pain is caused by overuse of either the “flexors” or the “extensors” of the hand.
Not all elbow pain is “tennis elbow”.
Not all elbow pain is “golfers elbow”.
There are a number of reasons that elbow pain can be present.
1. Elbow Pain Causes
Elbow pain causes – are relatively simple to diagnose, as the joint itself is relatively simple.
Very often people will come in and say they’ve got “tennis elbow”.
We take this information on board for sure, then ask a lot of questions about HOW you got this pain.
Most of the time it’s not playing tennis! 🙂
Sometimes the actual problem is something like a tennis elbow (lateral epicondylitis).
The most common causes of elbow pain that we see are:
- Medial epicondylitis (Golfers elbow)
- Lateral epicondylitis (Tennis elbow)
- Olecranon Bursitis
- Biceps tendonitis
- Triceps tendonitis
- Ulnar nerve pain
There are many other causes of elbow pain – but these are the most common in what presents to us.
If your practitioner only looks at the site of your pain, they’re lost.
The most important thing an Osteopath does is take a global view of your problem.
An Osteopath NEVER just looks at the site of the problem, EVER.
Osteopaths take a more global view.
Your site of pain is where your brain FEELS the pain. But WHY is it there???
An Osteopath thinks along the lines of:
Is it a strain of the area?
Can we change pain there?
Do tests of the area make things worse?
What other things could predispose you to become painful there?
Golfers Elbow (medial epicondylitis)
This is caused by straining of the muscles/tendons that are involved with (mostly) gripping action of the hand.
The muscles insert into a common tendon which in turn inserts onto the inside of your elbow.
Inside edge elbow pain is commonly referred to as “Golfers Elbow”.
Tennis Elbow (lateral epicondylitis)
This is caused by straining of the muscles/tendons that are involved with (mostly) extending action of the hand and wrist.
The muscles insert into a common tendon that then inserts onto the outside of your elbow.
So, if you’ve got outside elbow pain – it’s commonly referred to as “Tennis Elbow”.
It’s a sore, often red swelling on the back of the elbow.
It’s very painful and has a number of causes – including gout, trauma and impact.
This is an example of where manual therapy is limited in it’s effectiveness of treatment.
The biceps (front of your upper arm) insert down close to the elbow.
Sometimes overuse of this muscle can give you elbow pain, usually more to the front than to the sides.
The triceps (rear of your upper arm) insert down close to the elbow.
Sometimes overuse of this muscle can give you elbow pain – usually more to the rear than to the sides.
Ulnar nerve pain
This is not that common but can be related to elbow pain as the ulnar nerve travels down behind the inside to the elbow joint.
Sometimes this can be related to nerve compression issues further up the arm, or neck.
2. Elbow Assessment
Osteopaths take a global view for all things that present to them.
Just because your pain is in the elbow, doesn’t mean that is where we have to focus to get you “results” in your treatment.
Assessment of the elbow usually follows this order:
- Active range of motion
- Passive range of motion
- Active resisted movements
- Special tests
- Diagnostic images
There is a lot we can gather from your history. It guides us as to reasons WHY your pain might be there, and where we should “look”.
We then use palpation to fee what is going on – to see if we can recreate the pain you experience.
Osteopaths look at you differently.
Generally, an Osteopath will look for movements and positions that increase your pain, followed by movements, tests positions that decrease your pain.
It’s very easy for an inexperienced practitioner to simply press hard, and proclaim that they’ve found the source of your problem…
If your elbow is painful on movement, there’s only a handful of things it can be.
Sometimes, we can take your “pain” away in literally seconds, for it to come back again.
Sometimes – you “feel” your pain in the elbow – but the actual cause is in the shoulder, or wrist – away from the elbow!
Osteopaths are like “pain detectives” and really have a thorough look as to WHY the problem is there, so we can help you faster.
3. Elbow Pain Diagnosis
Diagnosis of elbow pain is mostly straight forward.
We run through the list in the assessment above, and correlate these findings with your history and onset of pain.
Most of the time – the elbow is pretty easy to get a more “tissue specific” diagnosis – as there are less things that can go “wrong” with it.
We look at the site, the movement quality, and how we can reproduce or decrease pain.
With all of these things lined up we can provide a diagnosis, however, on occasion people need a diagnostic ultrasound to see which structure might be torn.
4. Elbow Exercises
There aren’t that many exercises specific to Elbow pain.
Other than to increase flexion/extension and rotation of the wrist, that’s it.
Remember the elbow is simply a joint in between two others (the shoulder and knee) so it’s directly affected by them.
You can’t do an “elbow” exercise without using muscles that cross either the shoulder or the wrist.
So – in prescribing exercises for the elbow, your Osteopath will consider the flow on effects of movements required to bring balance back to your elbow.
5. Elbow Pain Relief
To get relief from elbow pain, you must have a correct diagnosis.
Most elbow pain is relatively simple, and to get relief, you follow a step by step process to help reduce inflammation and encourage healing.
If the cause is muscular, we look to initially help take pressure off surrounding structures and limiting movement.
This is not always easy to do!
After all – most elbow pain involves tendons and muscles that control movement of the HAND – so sometimes it requires a wrist brace.
If there is a tear in a tendon/muscle – it takes time to heal, and the only way it’s going to do this is if it’s “allowed” to heal.
Things take time to heal!
If you keep using a structure that’s broken, it’s going to stay broken, or at the very least – not heal for a very long time.
This is why it’s often quite slow to help elbow pain. People often have this for a fair while, thinking that it’ll just go away on it’s own.
Many times, the actual reason WHY the elbow pain is there, isn’t actually at the elbow itself, and is away from the elbow, so to really fix it – you MUST look away from the site of pain.
We’re not a fan of taking painkillers and or anti-inflammatories so that you can keep using the affected area – it just doesn’t make sense, unless you don’t really care about getting the problem solved.
6. Elbow Pain Prevention
The ultimate elbow pain prevention protocol would go something along the lines of:
- Never use your arms ever
- Don’t use your hands ever
- Try not be too strong or
- Don’t be too weak.
As you can see – this is impossible.
Generally speaking – if your elbow pain is related to movement, you want to make sure that you are strong enough for the activities you’re trying to do.
There are no real “mobility” exercises for the elbow.
7. Osteopathic Treatment of Elbows
Osteopaths never only look at the site of pain.
Elbow pain treatment can definitely involve actual treatment of the soft tissue and skeletal structures of the elbow.
Usually – treatment would involve a combination of:
- Dry needling
- Mobility exercises
- Immobility advice
- Postural advice
It just depends on the actual presentation of your elbow pain.
Most of the time, Osteopaths can really help your pain very quickly.