I was asked by a client this week about how to avoid elbow pain. They are a squash player and suffer elbow pain for a number of days after playing, in their serving arm. They asked me what they could do about it.
Overuse or repeated pressure on the tendons near the elbow joint can overload these tissues, particularly where the tendon anchors to the bone. If overload occurs, it can cause pain around the elbow, particularly when using the wrist and hand. Depending on the location and severity of the injury, full recovery can take months.
The most common type of elbow pain is known as ‘tennis elbow’. ‘Golfer’s elbow’ is a less common, but similar overuse injury. Despite their names, these injuries can occur as a result of a range of physical activities – racquet sports, rowing, canoeing, weightlifting, hockey, wrestling, swimming – as well as repetitive work tasks undertaken in a variety of occupations.
The elbow joint
If you bend your arm, you can feel three bumps at your elbow joint. Injury to the tendons that anchor muscles to the two bumps on either side of the elbow are a common cause of elbow pain. These bumps are:
lateral epicondyle (‘tennis elbow’) – the bump on the outer side of the elbow. The muscles on the back of your forearm, responsible for curling your wrist backwards, are anchored to this bony point. Pain in this bump is called lateral epicondylitis. This area is particularly susceptible to tennis elbow because it has a poor blood supply.
medial epicondyle (‘golfer’s elbow’) – the bump on the inner side of the elbow. The muscles on the front of your forearm, responsible for curling your wrist up, are anchored to this bony point. Pain in this bump is called medial epicondylitis.
Symptoms of elbow pain
Some of the symptoms of elbow pain include:
Causes of elbow pain
Some of the many conditions and events that may contribute to elbow injuries include:
Prevention of elbow pain
Ways to reduce the risk of elbow injury include:
Causes of elbow pain in more detail
While overuse injuries such as tennis and golfer’s elbow are common causes of elbow pain, other conditions can include:
Radiohumeral bursitis – bursitis is inflammation of a bursa. Bursae are small sacs that contain fluid to lubricate moving parts such as joints, muscles and tendons. Bursitis may be caused by repetitive use or frequent pressure or by injury to the elbow.
Osteoarthritis – the joint cartilage becomes brittle and splits. Some pieces of cartilage may even break away and float around inside the synovial fluid (a liquid found in the joints). This can lead to inflammation.
Referred pain – injuries to the bones of the spine (vertebrae) can irritate the nerves servicing the arm and cause referred pain around the elbow joint.
Nerve entrapment – the radial nerve is the main nerve of the arm. If this nerve can’t move freely, it can cause pain when the arm is stretched out. The radial nerve can be pinched by vertebrae or the elbow joint. There is evidence to suggest that nerve entrapment contributes to the pain of tennis elbow in some cases.
Ligament sprain – joints are held together and supported by tough bands of connective tissue called ligaments. A sprain is a type of joint injury characterised by tearing of the ligaments.
Bone fracture – a heavy fall or blow to the elbow may cause one of the bones to break or crack.
Avulsion fracture – a powerful muscle contraction can wrench the tendon free and pull out pieces of bone.
Osteochondritis dissecans – in younger people, a piece of cartilage and bone can become loose in the joint.
Strengthening exercises to try