The elbow is a unique joint in the body. As a hinge joint, all the elbow can do is bend and straighten. The long arm bone, the humerus, and the long forearm bone, the ulna, fit together. The humerus has a little notch and then the ulna a little cupped hand-like structure. The cupped hand fits over this notch and that makes the elbow. On the inside of the elbow, there’s a bony prominence called the medial epicondyle. Medial means to the middle. In anatomy drawings, they always show the body with the palms facing forward. With the palms facing forward, your thumb is out to the side, the inside of your elbow is medial.
If people have pain in the medial epicondyle, we typically call that golfer’s elbow due to the effects of a golf swing, bringing that arm down at an angle and putting a lot of force on the inside part of the elbow. It’s also referred to as little leaguer’s elbow. Young individuals throwing baseballs may have their mechanics a little bit off, or they’re not as strong in their shoulders, so they start whipping through their elbow and stretching their arm and elbow improperly. That inside part of the elbow can be affected.
The outside part of the elbow can experience lateral epicondylitis, commonly referred to as tennis elbow. Holding the racket creates a grip-based discomfort. With lateral epicondylitis or tennis elbow, there’s typically one muscle, ECRB (extensor carpi radialis brevis) most commonly involved. When individuals grip things, they start to pull their wrist up and they hold their wrist in what’s called extension. Their knuckles are coming back to the top of their forearm. By pulling back their wrist or gripping in that way, it can cause increased stress and strain on that part of the elbow.
The elbow moves through the biceps on the front side and the triceps on the back side. But both medial and lateral epicondylitis issues tend to be problems that happen with what people are doing with their hand or their wrist, not so much with their elbow. The back bony part of the elbow that sticks out is called the olecranon. There’s a little fluid filled sac of bursa there. It’s possible for that bursa to get really inflamed, making the appearance of a fat elbow. Physical therapy can reduce that inflammation with ultrasound treatments, manual therapy and compression. But the elbow itself is pretty unique that the main joint is usually not the issue. It’s the elements on the side related to mechanics of how a person is gripping or doing things with their hand, or weakness up in the shoulder that end up causing more discomfort for people.
When a Patient Comes in with Elbow Pain
When a patient first arrives at a physical therapy clinic like ProHealth with tennis elbow, the first thing that the physical therapists do is check for the cause of the pain. They’ll look at biomechanics of grip strength, and what the wrist is doing when a patient grips. Next, the physical therapist will look to decrease muscle tension using manual therapy techniques or other modalities that may decrease inflammation and tenderness. Shoulder strengthening is a huge part of it. The PT will also work on retraining some grip mechanics, as well as flexibility of the muscles in the forearm both on the palm side, as well as the back of the hand side. Because those muscles can get pretty tight, and that in turn causes more pressure on that bony prominence. It may be very tender on the bony prominence, but the bone itself isn’t really the culprit. It’s the fact that the tendon is pulling on that part of the bone and causes that.
When a patient arrives with golfer’s elbow, it’s not so much the tendon pulling, it’s stress on a ligament. Similar to an ankle sprain, you can stretch this inside elbow ligament, and that can start to cause some other issues. The ulnar nerve runs through there, and that can create some other symptoms down in the little finger or the ring finger on that hand. It can create pins and needles, sharpness, or burning. That’s generally why baseball players will have what’s called Tommy John surgery to create a new place where that nerve sits because that nerve has gotten irritated. For the most part it’s because of so much pitching or throwing.
A qualified PT can teach and train people how to properly hold their racket and their golf club. At ProHealth, we will also work with golf or tennis pros at the patient’s preferred location who are experts in the equipment, once a patient is ready to get back into action. This produces better outcomes.
Treatment length can vary, depending on how long symptoms have been present. When a patient has been in pain for years, it won’t be a quick fix, because there have likely been a lot of compensations. Likely treatment may take several months. If a patient goes to the physical therapist within the first few weeks to a month of symptoms, they can expect treatment to work in two to four weeks. An athlete or avid enthusiast should think of physical therapy first as a partner, so they can maintain their activity. If you felt it while you were playing the sport, that’s when to call, not to wait until you’re experiencing pain all the time.
How Do I Recognize Elbow Pain
Many times elbow pain presents with gripping and grabbing tasks. Some people say, “When I try to grab the coffee pot in the morning and try to turn to pour my coffee or grab the coffee mug, I’ve got to grab with my other hand too.” Or they’ll mention it is hard to pull up pants, or other things that require that dexterity in your hands. There are some people for whom it does hurt all the time. Even touching that little bony prominence can be quite tender.
What Does Physical Therapy for the Elbow Look Like
PT for the elbow is a matter of stretching what needs to get stretched, and strengthening what needs to get strengthened. At ProHealth, all physical therapy is individualized. Using good researched-based protocols, we individualize just what the patient needs. We use to create a healing process.
For example, recently a patient came into ProHealth who had medial epicondylitis—but it wasn’t from golf or baseball. The patient worked out a lot, but had poor grip mechanics on dumbbells and kettlebells during her weight lifting. Her shoulder strength wasn’t in a good enough place, and the process was putting too much torque on their elbow. She’d had pain for a while, so it took several months to calm the inflammation, as it was easily aggravated by any sort of activity.
And then from there, once the elbow pain was calmed down, the PT worked with them to change their movement patterns. The physical therapist provided some stretches to do and strengthening exercises. It took about three and a half months of physical therapy to get her to a place where she was back doing her fitness routine without feeling her elbow discomfort. The day to day elbow pain went away much quicker than being able to fully return her fitness routine, because her pain had been there for over a year by the time she came in.
If you are experiencing elbow pain and you live within easy driving distance of Peachtree City, Georgia, consider calling ProHealth Physical Therapy and Pilates Studio for a PT appointment. Our PTs are experts, and appointments fill fast, so call today at 770-487-1931.