Elbow Pain? Think Twice Before Blaming Your Elbow

Author:  Dr. Artem Imnadze, DPT

 

There is much more to elbow pain than blaming the sport you play or the equipment you use. If you have experienced elbow pain, you have likely heard terms like tennis elbow or golfer’s elbow. Despite being named after sports, neither condition has much to do with the sport itself.

Yes, golfers and tennis players commonly experience elbow pain, but there is another major common factor these sports share that is far more relevant to elbow pain. That factor is often the key to finally resolving it.

When searching for solutions, you will find no shortage of advice. Stretch your forearm. Perform isometrics. Strengthen your grip.

Unfortunately, many of these recommendations miss the real issue and often fail to resolve the pain long term.

Anatomy Overview

Golfer’s elbow, also known as medial epicondylitis, refers to stress and pain in the wrist flexor tendons that attach to the inner portion of the elbow. Tennis elbow, or lateral epicondylitis, involves stress and pain in the wrist extensor tendons that attach to the outer elbow.

While symptoms vary depending on which side of the elbow is affected, common aggravating activities include gripping, pushing or pulling, and throwing motions.

A commonly referenced concept in physical therapy is the joint by joint theory. This theory suggests that joints throughout the body alternate between primarily requiring mobility and primarily requiring stability. For example, the wrist and hand need a high degree of mobility to perform daily tasks. The next joint up the chain, the elbow, is designed more for stability.

The elbow is primarily a hinge joint, meaning it mainly moves through flexion and extension and has limited rotational capacity. When excessive motion occurs outside of this hinge function, problems tend to arise. This contrasts with the shoulder, which sits above the elbow and requires a large amount of mobility to function properly.

This creates a challenging situation. The elbow, which is not built for large amounts of movement, sits between two highly mobile joints. When mobility is lost where it is needed most, the body compensates by finding motion somewhere else. Often, that compensation shows up in the joints closest to the restriction.

A Shoulder Issue Masked as Elbow Pain 

One of the most commonly missed components in resolving stubborn tennis or golfer’s elbow is shifting the focus away from the elbow itself and asking why the elbow is being overloaded in the first place.

Frequently, limited shoulder motion in specific directions forces the elbow to make up for that lost movement. This results in increased stress and strain at the elbow joint and its surrounding tissues.

A helpful example of this can be seen in baseball pitching mechanics. A pitcher who lacks adequate shoulder external rotation to reach the proper arm position during the throwing motion often compensates by creating excessive motion at the inner elbow. This results in a gapping force that places high stress on the wrist flexor tendons.

Over time, this excessive load can lead to tendon irritation, tendonitis, or even damage to the ulnar collateral ligament that may require surgical intervention such as Tommy John surgery. In this scenario, the elbow is not the true problem. The lack of shoulder motion forces the body to find movement in the next available place, which happens to be the elbow.

Addressing factors like forearm flexibility and tendon strength may provide temporary relief. However, those components are usually far more effective once the underlying shoulder mobility limitations have been identified and addressed.

The next question then becomes how and why shoulder mobility was lost in the first place. To learn more, refer to our article on the missing piece in resolving shoulder pain.