Blog post title with image showing muscle tears in the elbow.

How To Prevent Elbow Tendinitis

Tendinopathy is a type of condition that affects the tendons of muscles where they insert into the bone.  It can happen in many muscles and joints.  At the elbow, tendinopathy is often referred to as tennis elbow and golfer’s elbow.  In this article, we will break down how to prevent elbow tendinitis as well as how to manage it.  For more on elbow pain, Click Here.

What Is Tendinopathy?

Tendinopathy involves the inflammation, and subsequent degeneration, of a muscle’s tendon where it inserts into the bone.  It is commonly seen in the elbows, knees, wrists, and other body parts.  The misconception in society is that most cases of tendinopathy are associated with tendinITIS.  However, this is not entirely accurate.  Tendinitis refers to an acutely inflamed and swollen tendon that doesn’t have microscopic damage.  The underlying culprit is inflammation.  We find that by the time a patient is seeing us for something like tennis elbow, they are way past the inflammatory phase.

An Image showing a muscle and tendon attaching to bone.

Muscle (7) --> Tendon (8) --> Bone (1)

Most cases actually involve tendinOSIS. Tendinosis involves a chronically damaged tendon with disorganized fibers that appear hardened and thickened.  The underlying cause of tendinosis is degeneration. The biggest difference between the two is time.  The -ITIS stage is very early on in the process while the -OSIS is a chronic issue. So when referring to elbow tendinitis, most of the time it is a case of tendinosis.  However, for simplicity, we will refer to it as the commonly known -ITIS version.

What is Elbow Tendinitis?

Elbow tendinitis is typically labeled as tennis elbow and golfer’s elbow.  Tennis elbow, medically known as lateral epicondylitis, involves tendinopathy of the extensor muscles of the forearm at the common insertion (lateral epicondyle/outer elbow).  Golfer’s elbow, medically known as medial epicondylitis, involves tendinopathy of the flexor muscles of the forearm at the common insertion (medial epicondyle/inner elbow).  As stated above, these cases typically are chronic in nature and are more of the -OSIS variety.

AN image showing the muscles of tennis elbow.

Lateral Epicondylitis (tennis elbow)

An image highlighting golfer's elbow

Medial Epicondylitis (golfer's elbow)

What Causes Elbow Tendinitis?

Elbow tendinitis is most commonly caused by a combination of poor repetitive movements and dysfunctional lifting mechanics.  However, the elbow pain may be caused by a direct injury but this is typically rare.

Elbow Tendinitis and Repetitive Movements

The first step to preventing and managing tendinitis of the elbow is to identify the problematic movement.  This movement is one that is done on a consistent basis and is leading to the degeneration of the tendon itself.  Initially, this movement is not painful.  However, over time, the movement will be unbearable.  Common repetitive movements can be purely work related.  Mechanics and painters are a few professions that come to mind that utilize repetitive movements and often have elbow pain.  However, athletes often have repetitive motions leading to the same issue (golf and tennis).

Once the movement is identified, proper rest is needed.  It is crucial to "put out the fire" so to speak before moving forward.  Otherwise, there is a constant cycle of re-injury which makes it nearly impossible to fully heal.

Elbow Tendinitis and Lifting Mechanics

Once the offending repetitive movement is identified, and proper rest has been utilized, it is crucial to improving HOW we lift things with our arms.  I find that the most common cause of elbow tendinitis is the over gripping of objects.  In other words, we “arm” all of our exercises or daily tasks.  I believe this is due to the inability to anchor their arm through the scapula (shoulder blade).  When the upper back and scapula are not actively engaged in upper body movement, we will overly rely on the muscles of the forearms and arm to accomplish the movement.  Check out this video that demonstrates proper technique with common pulling exercises.

Below is a simple checklist for improving lifting mechanics to prevent elbow tendinitis.  At the end of the day, simply decrease the weight you are lifting and try to influence the movement through your upper back rather than through the arm.

  • Decrease weight (sometimes by half at least)
  • Lighten grip
  • Anchor/engage the scapula
  • Limit shoulder, shrugging, forward tilting, and decreasing elbow angle

Best Exercises for Elbow Tendinitis

Once the repetitive movement is identified, rest has been implemented, and lifting mechanics are addressed, the next step is to strengthen the area.  The best exercises for elbow tendinitis (tennis elbow and golfer’s elbow) are eccentric exercises.  Eccentric exercises involve the reversing of the movement with control.  For example, the concentric portion of a biceps curl is when the weight is lifted (from the side) up until it is fully flexed.  The eccentric portion is the lowering down of the weight to its starting position.  When doing eccentric exercises for tendinopathies, it is OK to have a little bit of discomfort.  However, we don’t want you pushing above a 5/10 on the pain scale.

Best Exercises for Tennis Elbow

Best Exercises for Golfer's Elbow

How To Treat Elbow Tendinitis

As your Chesterfield chiropractor, we use a array of treatment and rehab strategies to help improve elbow pain.  Our initial visit involves an extensive evaluation using the Functional Triage method.  This helps us not only identify what is injured in the elbow but also other things that may be involved.

Treatment of the elbow consists of joint mobilization, usually at the radial head, and soft tissue treatment.  Soft tissue techniques can involve myofascial release, neurological stretching, and instrument assisted soft tissue mobilization (IASTM).  We often incorporate the FAKTR approach by combining treatment simultaneously with exercise.  In addition to hands on treatment, we will send our patients home with self stretching and mobilization techniques.  Check out the video below on some self treatment strategies for the elbow.

Self Myofascial Release, Stretching, Mobilization for the Elbow

Once pain is under control, a shift to exercise is done as soon as possible.  We utilize exercises like those listed above but also tailor the rehab approach to the patient’s goals and activities of daily living.

If you or someone you know has been dealing with ongoing elbow pain, tell them to give us a call.  If we are not located near them, we can help find a provider close by.  It is our goal to not only get people to feel better, but to be better than before.  Only when the public takes ownership of their body will we truly see optimal health!

Dr. Signature

Originally posted 01/28/2019

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