June 5, 2022
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 implement you use. If you’ve had any experience with elbow pain then you’ve likely heard about “tennis elbow” or “golfer’s elbow.” Now, despite being named after a sport, neither of those conditions have very much to do with the sport itself. Yes, it is true that golfers and tennis players commonly experience elbow pain. There is another major commonalty that both sports share that is more related to elbow pain and is usually the key to breaking through elbow pain. 

When searching for solutions for these elbow issues there are a myriad of takes; “stretch your forearm!”, “perform isometrics!”, “strengthen your grip!” 

Unfortunately, all of these “solutions” miss the boat on what the actual issue is, and many times don’t resolve the issue at all. 

Anatomy Overview

Golfer’s elbow, or medial epicondylitis, refers to stress and pain in the wrist flexor tendons that attach to the inner elbow. While Tennis elbow, or lateral epicondylitis, refers to the stress and pain in the wrist extensor tendons that attach to the outer elbow. While symptoms vary depending on which side of the elbow hurts, commonly, gripping, pulling/pushing, and throwing motions tend to be painful. 

A popular theory in Physical Therapy is the Joint- By- Joint theory. This theory states that all joints in your body will alternate between predominantly requiring mobility while the joint above and below requires stability. For instance, the wrist/ hand requires a great deal of mobility to perform daily tasks. The next joint up the chain, the elbow, predominantly requires stability. This is because the elbow is a “hinge” joint, meaning that it mostly moves in one plane of motion (flexion/extension) and lacks a great deal of rotational capability. If the elbow induces a lot of motion outside of it’s “hinge” like movement bad things happen.  This is in contrast to the next joint up the chain, the shoulder, which has and requires a great deal of mobility to maintain its normal mechanics. 

As you can see, we have a predicament in which the elbow, which is not a highly mobile joint is stuck between two highly mobile joints. What happens when we veer off from what’s normal and lose mobility in places where we require it most? We will make up or compensate for that lack of mobility somewhere else. Commonly, it will be the joints closest to where the loss of motion occurs. 


A Shoulder Issue Masked as Elbow Pain 

A common missing piece in resolving pesky “golfers” or “tennis” elbow is taking the focus away from the elbow itself and identifying WHY the elbow might be under such a great deal of stress. Often, it is a lack of shoulder motion in specific directions that will force you to make up for that motion with excessive elbow motion and stress. 

An easy way to visualize how the lack of shoulder mobility will influence the elbow is in a baseball pitch. A baseball pitcher who lacks enough shoulder External Rotation (ER) to get into the proper arm position to initiate the throw will commonly create a gapping mechanism in the inner elbow. This will allow him to make up for the lack of shoulder motion to get into the proper arm position behind him. This gapping in the inner elbow will cause excessive tension on the wrist flexor tendons and over time can result in tendon irritation (tendonitis) or damage to the inner elbow ligament (UCL) that can require surgery (Tommy John). The problem in this instance isn’t the elbow, it’s the lack of shoulder motion that causes the pitcher to find motion in the next best place which happens to be the inner elbow.  

Addressing factors such as forearm flexibility and tendon strength may provide short term relief of pain. More than likely, those factors will be much more relevant once the root cause of limited shoulder motion is addressed. 

The next question becomes…how and why did you lose shoulder mobility in the first place? Please refer to our article on the missing piece in resolving shoulder pain to find out more!