Pain on the outside of your elbow?

Lateral Elbow pain

Lateral elbow pain: the pain on the outside aspect of your elbow, commonly known as ‘tennis elbow’. Elbows are an area which is often not forgotten about but almost seen to be less severe especially when the injuries are given names like ‘tennis elbow’ when 9 out of 10 the people who get lateral elbow pain aren’t even tennis players. So yes, if you aren’t a tennis player you can still get lateral elbow pain. This discomfort is seen in a variety of people from your weight lifter to your sit-at-home knitter.

What is lateral elbow pain?

Lateral elbow pain could be linked to a variety of injuries but what we will focus on in this blog is extensor tendinopathy commonly seen in the extensor carpi radialis brevis (ECRB) known to many as ‘tennis elbow’. The area where the ECRB attaches to the lateral epicondyle (that little bony bit on the outer aspect of your elbow) has a poor blood supply, with that and overuse could lead to degenerative changes to the tendon. Carrying on loading this tendon excessively could lead to microscopic tears and scarring of the tendon (Brukner and Khan) therefore, leading to lateral elbow pain.

Pain is normally felt post-exercise (24-72hours) after performing a lot of repeated wrist extension. The pain felt is usually a pain or burning sensation on the lateral aspect of your arm present with a weak grip. This isn’t a certain injury which is normally present due to age, although it is seen in more 30-50-year-olds, it is dependent on what sport/job you participate in so just because you hit 30 doesn’t mean you’re going to suddenly get elbow pain (AAOS–American academy of orthopaedic surgeons).

Why do we get lateral elbow pain?

There are many reasons why we might get lateral elbow pain but here are a few which are more commonly linked to this issue are:

• Poor technique
• Overuse- repetitive flexion to extension movement or pronation and supination movement (rotating wrist inwards and outwards)
• Altered environment that you are used to playing your sport in, for example- playing tennis in the rain the ball becomes heavy which means more forearm muscle recruitment is needed

Aggravating factors:

• Wrist extension- causes a shearing force on ECRB
• Gripping
• Repeated wrist extension against resistance e.g. in sports such as tennis and manual labour such as bricklaying
• Improper equipment
• Poor technique

So, how on earth do we manage this?

Approximately 80-95% of people with lateral elbow pain have success with non-surgical treatments (AAOS), which is great news. But only great news if you actually manage it properly. So how are we going to do this? The points below highlight some areas that need to be addressed to ensure this lateral elbow pain is decreased and prevented from re-occurring.

Pain needs to be addressed

we need to decrease the lateral elbow pain and manage this by:

• Avoiding painful movements
• Avoiding excessive repetitive movements
• Activity modification (Calfee et al., 2008)

Please, please, please don’t work through the pain. Us sports people kind of think we are invincible. But realistically we all get injured… yes it sucks but like I said there are plenty of ways to manage it. One easy thing is don’t work through the pain. Coaches are happy to adapt things for you or even speak to one of us therapists, as we are happy to help out, activity modification plays a key part in management. For example, pull-ups are hurting you, right? Well, let’s adapt this, let’s try it with a band, and take some stress away from the arms. Or a certain lift is hurting, well let’s lower that weight or even just change the movement entirely until that movement becomes pain-free, then we look at reintroducing this previously painful movement which should now hopefully feel pretty fabulous. Wahoo easy peasy!

Technique

• Address the cause… was it poor technique?
• Work on technique- if this was the cause, it’s always best to go back over technique after an injury anyway to prevent it from re-occurring.

Do you think it’s linked to poor technique? It is always best to get your technique checked out whether you lift weights, or play racquet sports? You name it. Get a professional to check out your technique and ensure you are performing all movements correctly. For example, for you people who like to lift when you perform a strict press do you ‘accidentally’ let your elbows flare outwards and have a party by themselves? This isn’t accidental this is due to poor technique… you are tired so don’t repeat this technique in cases like this you are more likely to develop an elbow injury.

Follow a treatment/rehab programme

• It’s always a good idea in this situation to have the elbow fully assessed by a professional to work out what is the best treatment method/rehab protocol for you
• Treatment by a professional such as massage, frictions (a deeper form of massage focused on a certain area of pain/discomfort) rehab, and joint mobilisations (Bisset et al., 2006)
• Rehab- look at restoring flexibility and strength which may have been lost

Strengthening of wrist extensors using isometric (joint angle and muscle length do not change during contraction), concentric (shortening of a muscle) and/or eccentric contractions (lengthening of a muscle) with gradual progressions and also bring in some gripping.

Click the link below for an example of a strengthening exercise for lateral elbow pain

Stretching of the forearm extensors like shown below

Keep an eye on those elbows and enjoy training with great technique and pain-free.

Any questions feel free to get in touch.

Jessica Woodhouse

BSc Hons Sports Therapy MSST