Elbow exercises for pain

General advice for elbow pain exercises

For the majority of causes of elbow pain physiotherapy exercises form an important part of improving an individual’s symptoms. The majority of elbow pain is caused by trauma or tendon disorders but there are many other less common problems. Each problem will affect the elbow and surrounding soft tissue in different ways. As such it is important that any exercises to address elbow pain are advised by a qualified CircleHealth clinician and, thereafter, performed with the correct technique.

How much should I push my elbow when exercising it?

This depends entirely on the nature of the elbow pain and the stage of injury. If symptoms are acute, especially if there is significant inflammation involved, then this will be need to be respected and exercises may be best avoided or performed with no pain. In other cases, there may be persistent, low grade pain arising from the elbow joint or surrounding tendons. In these cases, it is normally recommended to push in to mild to moderate discomfort in line with the best available evidence.

Strengthening exercises for elbow pain

Strengthening exercises play a vital role in the rehabilitation of elbow pain. After acute injury including a fracture or soft tissue injury the prime movers and supporting muscles of the elbow will rapidly become very weak. This is due to disuse but also due to the effects that pain has on our ability to contract our muscles. In these cases a graded strengthening program to the muscles in the upper arm (biceps and triceps muscles) but also to the muscles of the forearm which rotate the forearm and provide force for gripping is needed.

If the forearm is placed in a supportive brace or sling for prolonged periods of time then the posture and strength around the neck and shoulder may change. In these situations a comprehensive program of strengthening to the supporting muscles of the neck as well as stability muscles around the shoulder blade and shoulder will be needed.

Common exercises may include reaching exercises with the shoulder blade as well as exercises designed to pull the shoulder girdle backwards or retract the shoulder blade. This may be done with resistance tubing in standing or by lying face down or over a swiss ball. A common protocol to retract the shoulder blades is known as blackburn exercises or TWY exercises.

After very prolonged use of a sling, especially if this is associated with neck pain, a program of exercises to strengthen the deep neck flexor muscles may also be of benefit. These exercises involve gentle nodding movements which isolate the deep muscles of the neck involved in postural support.

The muscle group on the top side of the forearm works to straighten (extend) the wrist and fingers. The muscle group on the lower side of the forearm bend (flex) the wrist and fingers. Both muscle groups work in synergy with gripping, opposition and twisting tasks. For tendon disorders such as tennis elbow and golfers elbow, strengthening exercises will be graded according to the intensity of pain.

Early stage exercises may involve lifting the wrist and/ or fingers in to manual resistance provided by the other hand. Further progressions will often involve lifting the wrist and/ or fingers dynamically throughout the entire range of motion against resistance provided by elastic tubing or a small handweight. These exercises are often started with the other hand assisting part of the movement and this may be progressed to performing with a heavier weight or without assistance.

Helpful stretches for elbow pain

Stretches and mobilising techniques which target improving elbow joint range of motion may be useful in certain cases where the elbow joint is suffering with stiffness. Examples may include degenerative arthritis to the elbow or after an elbow fracture or soft tissue injury that resulted in swelling around the elbow. Mobilisation techniques include using the bodyweight to lean in to the elbow to further push the joint in to a straight position (elbow extension) or a bent position (elbow flexion).

A common physiotherapy technique to free up the elbow joint is termed a mobilisation with movement and involves placing a rolled towel in to the corner of the elbow and levering the elbow joint into the towel to produce a gapping movement.

For elbow pain related to tendon related disorders such as tennis and golfers elbow physiotherapists will often prescribe stretches to the forearm flexor or forearm extensor muscle groups. The most common technique to stretch these muscles groups involves placing the arm in front of the body with the elbow straight. Using the other hand the wrist can be overpressed upwards or downwards and if more stretch is needed the fingers can also be overpressed upwards or downwards for a more intense stretch.

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