How to fix elbow pain

When thinking about how to treat elbow pain most individuals will consider the options of physiotherapy exercises, injections or seeking an orthopaedic surgical opinion. In some circumstances these options may be beneficial. However, the majority of cases of persistent elbow pain will have an underlying ergonomic factor which has led to the problem. To treat these cases of elbow pain, these ergonomic factors need to be analysed and modified which will be best done in conjunction with a therapist and patient working together to identify the exact aggravating postures and movements. Taking photos and videos to analyse these postures and movements may also be helpful for a more in depth analysis.

The most common ergonomic fault which may lead to elbow pain is repetitive desk work with poor neck, shoulder, elbow or wrist/ hand position. If one or several of these body areas is in a poor position while working, the muscles and tendons are placed in a weaker position. Furthermore, poor ergonomics when in static postures may reduce blood flow to the upper limb which has also been demonstrated to contribute to elbow pain.

If elbow pain is related to lifting, carrying and gripping tasks which is common with some trades other ergonomic solutions may be needed. Reducing the load or the manner in which the load is lifted and carried may be advised (a more neutral wrist and hand position will place less demand on the elbow tendons). Changing the material used for any handles, the thickness of any grips of using specialist gloves may reduce the effort needed to lift and carry heavy load.Technology solutions to lift or carry load may also be considered especially if the problem is ongoing and affecting several individuals.

For common tendon related elbow pain known as tennis elbow and golfers elbow, our physiotherapists may advise the use of an elbow clasp or strap which tightens in a loop around the top of the forearm. This may shield the tendon from stress and reduce pain levels.

In some cases of severe elbow pain or when the pain has been unresponsive to healthcare intervention previously, a period of full rest from the aggravating activity may be advised before returning to it with the modifications outlined here.

Disorders of the tendons of these muscle groups at the elbow, termed tennis elbow or golfer’s elbow are common and have traditionally been found difficult to treat. Fortunately, in recent years research has demonstrated a significant benefit to these tendon disorders when placing load through the muscle and tendon unit with strengthening exercises. When performing these strengthening programs, loading these structures in to mild-to-moderate discomfort may improve tendon disorders even more rapidly than performing them with no pain.

The exact mechanism of action is unclear but several well evidenced theories exist. Firstly, placing progressive, high load through the tendons may stimulate the cells known as tenocytes to increase their production of new tendon tissue. Secondly, these high load exercises may reduce blood vessel formation in painful areas of the tendon. Thirdly, with repeated loading of the painful tendons in to mild to moderate discomfort may in fact help to desensitise the nervous system in to feeling pain in the affected muscle and tendon.

For less common causes of elbow pain there may be a larger range of different exercises advised by you doctor or physiotherapist.

Shock wave therapy is a novel treatment which uses powerful pulses of energy delivered through a probe to the affected tendon. It aims to stimulate a new, more effective healing response in the tendon and early evidence has demonstrated that shock wave therapy may deliver similar benefits to a steroid injection with less risk to the tissue. Circle Health we are able to offer shock wave therapy as a consultant led course of treatment or under the direction of our expert musculoskeletal physiotherapists.

For more in depth information on shock wave therapy please visit our treatment page

In cases of unstable fractures, dislocations or ligament ruptures surgery may often be considered as the first option for elbow pain.

However, for the majority of persistent elbow pain cases related to tendon pain and sometimes degenerative joint disease surgery is considered only as a final option for severely disabling symptoms and once all appropriate non surgical options have failed.

When surgery is conducted for persistent elbow pain our orthopaedic doctors and physiotherapists will stress the need to adhere to a structured program of physiotherapy and ongoing ergonomic solutions after surgery.

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