Elbow pain – commonly referred to as medial or lateral epicondylitis or “golfers” or “tennis” elbow is pain on the inside or outside of the elbow. Its common in many people, but to be honest, it’s actually not that common in professional golfers or tennis players. It’s much more common in the general population that are active or people who don’t play any sports at all.
Most doctors and therapists will look only at the painful spot – the pain is typically blamed on local overuse to tissues – trigger points, adhesions, degenerated tendons, etc that develop around the elbow and cause pain. This isn’t entirely wrong, but it’s over-simplifying the issue. Often treatment only at the site of pain provides limited short term relief.
“He who treats at the site of pain is lost.” -Karel Lewit
We learn from some pretty smart people – so we understand that where the pain is isn’t always the cause of that pain. We need to look at the body as a functional unit, rather than as an isolated system.
We need to be able to evaluate the elbow for local soft tissue adhesions. We also need to look at the nerves that supply the region, as we can have nerve entrapment issues locally in the arm/elbow, but also further up the chain, in the neck or shoulder, that can refer pain down to the elbow and be a silent trigger for elbow pain.
We also need to look at the neck, upper-back and shoulder position and mechanics. Remember the site that hurts isn’t usually the only issue. Bad neck posture and forward “desk posture” of the upper back and shoulder blades stress the joints – these can be primary referral sites for elbow pain, or they can cause disturbances down the shoulder kinetic chain.
Remember the song – “the hip bones connected to the – knee bone!” – there’s a lot of truth to this.
Our muscles form fascial slings that connect different regions of the body, tension in our shoulders may travel down the kinetic chain to cause pain and irritation at the elbow. Don’t just look at the site of pain – that’s why elbow treatment fails for so many people.
What do the studies show?
-71% of subjects with lateral elbow pain had pain with cervicothoracic junction (where the neck meets the upper back) on exam.
-Cervical manipulation increases pain free grip in subjects with lateral epicondylitis.
-Reduced grip strength with lateral epicondylitis, which was improved with scapular (shoulder blade) positioning.
If you’re constantly stuck in your “desk posture” your upper back becomes rounded; this changes the position of your shoulder blade and has a cascade effect on your neck (think constant headaches, pain in the neck or across the tops of the shoulders) as well as your shoulder/elbow/wrist.
There is a clear cervical and upper back/shoulder blade component to most cases of elbow pain – do the posture in the above pictures look familiar? It’s basically all of us, every day, sitting at our desks.
This posture puts a lot of extra stress on the discs and joints in the neck, which can refer pain down to the elbow. So don’t think of it as an isolated issue at the elbow – we need a more comprehensive approach.
To get you out of pain – we need to understand the mechanism of injury, and look at the entire body, how it moves and functions together as a unit. If we only treat adhesions, we’re lost. If were only adjusting your neck/upper back, were lost. If we’re only trying to “strengthen” your weak muscles, we’re lost.
We need a functional approach to treating pain – one that encompasses soft tissue work, mobilizations, and rehab, which only come when we get a proper functional evaluation first to determine the cause of the pain, rather than only focusing on what hurts.
Fortunately, at Back In Line – we are trained to identify the cause and treat with soft tissue work, adjustments, and exercise to get you out of pain fast. Give us a call today at 319.892.3363 to schedule an appointment.
Back in Line BLOG
Drs. Nate, CJ, and Hannah will take turns sharing information they stumble across from certain research, publications, or may just post a quick healthy tidbit to keep you motivated to leading a happier, healthier lifestyle!