elbow injuries and rehab care

[Doc.Sust]

Although the elbow and knee share certain similar anatomical characteristics, elbows in general sustain far fewer injuries. One of the main reasons for this is that non-weightbearing joints such as the elbow are usually exposed to much lower levels of force than weightbearing joints (such as the knee). There are a few sports, however, in which the elbow joint does have to support the body's weight; gymnastics is an example of such an activity or increased loads as we use in powerlifting as well as body building.

An Integral Joint

The main duties of the elbow's joints, muscles and connective tissues are to precisely position the hand and transmit or resist a force (such as throwing a ball or spear, striking a punching bag, blocking a tackle, lifting a box, or twisting a screwdriver). The elbow joint is an integral part of the upper-extremity kinetic chain. Problems in the shoulder joint and cervicothoracic region can contribute to elbow joint dysfunction. Looking beyond the elbow itself for the source of its pain is critical, and any rehabilitation program designed for the elbow must address deficits in the scapular stabilizer and cervicothoracic extensor muscles, as well as proper head and shoulder posture.

Movement and Support

The humeroulnar and humeroradial articulations permit flexion and extension. The proximal radioulnar joint allows rotation (pronation and supination) to occur. Most normal activities of daily living can be performed even with partial limitation of any (or even all) of these elbow movements. However, compensations will tend to occur in adjacent body segments (such as the shoulder and spine), and performance levels in most sports will decrease quickly.

The elbow is an inherently stable joint; however, connective tissues do provide needed additional support. These include the annular ligament (encircling the head of the radius), the medial collateral ligament (the major stabilizer against valgus stress) and the interosseous membrane (which prevents separation of the radius and ulnar shafts). If any of these connective tissues are injured, an elbow sprain is the likely result.

Most of the muscles involved in elbow function and movement originate on the humerus and insert on either the radius (biceps, brachioradialis, and pronator teres), or the ulna (brachialis, triceps, and anconeus). Two additional muscles (supinator and pronator quadratus) form a radioulnar group. Two very important elbow muscles - the wrist extensors and flexors - primarily move the hand and wrist. Manual testing can often identify in a short period of time which of these muscles are weakened and painful on contraction, indicating an elbow strain. If there is nonpainful muscle weakness around the elbow and/or wrist, a neurological condition of the lower cervical nerves (C5-8) must be considered.

How Injuries Occur

Direct trauma or overuse (due to repetitive arm and hand movements) can cause elbow injuries. Here are several common elbow injury patterns:

"Golfer's elbow" (medial epicondylitis) - overuse tendinosis of the wrist flexors. Stockard reports overuse injuries are "more common among amateur golfers than among professional golfers."
"Little League elbow" - Repetitive pitching microtrauma can cause permanent damage.
"Nursemaid's elbow" - forced radial head dislocation in a young child (2-4 years of age).
Olecranon bursitis - acute or repetitive direct trauma to the bursa over the olecranon.
Panner's disease (osteochondrosis) - Overuse causes avascular damage to the capitellum.
"Tennis elbow" (lateral epicondylitis ) - overuse tendinosis of the wrist extensors.
Triceps tendinitis - acute or repetitive strain of the triceps insertion on the olecranon.
Elbow Sprain Rehabilitation

Damage by trauma to one or more of the connective tissues of the elbow can lead to joint instability and eventual degenerative changes. Work duties and sports activities often must be restricted to prevent further damage. Once the ligaments have undergone sufficient early repair, controlled passive motion, gentle sustained stretches, and friction massage will help to prevent the formation of adhesions. Resistance exercises are introduced to stimulate a stronger repair and assist in the remodeling process. Isometric forms progress to isotonic forms of resistance, based on the patient's tolerance for joint motion. Exercises for grip and proximal stability at the shoulder should also be included, especially for athletes.

Elbow Strain Rehabilitation

Overuse and repetitive strain are the most common sources of injury to the muscles and tendons around the elbow. For these conditions, a brief period of support and restricted activity is usually necessary. The use of a counterforce brace for the elbow should be implemented. However, controlled re-strengthening should be initiated early, with the brace on. Elastic tubing is a safe, easy method of providing progressive resistance exercises.

An effective elbow rehabilitation program starts with a consistent isotonic exercise routine, using elastic tubing to perform resisted pronation and supination. This should be performed initially within a limited, pain-free range of motion, building to full range as pain subsides. If the patient has tennis elbow, an overuse strain of the wrist extensors, special attention is given to these muscles. Sustained stretches are performed, followed immediately by full-range, progressive strengthening of wrist extension, with special focus on the eccentric phase of the exercise.

Eventually, the entire series of elbow exercises should be performed. This inexpensive rehabilitation program should initially be practiced under supervision to ensure proper performance. After proper exercise mechanics and control are demonstrated, a self-directed program of home exercises is appropriate.

Distortions and Alignments

Two additional factors to consider are the connection between elbow function and shoulder stability and the influence of cervicothoracic posture on elbow function. Specific postural distortions - such as thoracic kyphosis and cervical anterior translation (causing a "forward head") - must be addressed with corrective exercise training. An additional potential complicating postural factor is the alignment of the scapula on the thoracic cage - particularly when the shoulder is "rolled forward" (protracted). Correction of these chronic misalignments will significantly reduce the biomechanical stress during use of the arm and help prevent musculotendinous overload at the elbow.

Repair, Then Rehab

An appropriate and progressive rehab program should be started early in the treatment of patients with elbow injuries, but only after ligaments and connective tissues have repaired sufficiently. Simple, yet effective rehab techniques are available, none of which requires expensive equipment or significant time commitments. A closely monitored home exercise program using exercise tubing is recommended, since this allows the patient to attain cost-efficient, effective and specific rehabilitative care.

An important aspect of elbow rehabilitation is recognizing and addressing the biomechanical alignment problems and postural factors that can lead to substitution patterns and elbow overuse. This entails screening the patient for forward head and flexed (kyphotic) torso postures and protracted (forward) shoulders. Failure to recognize these complicating factors can result in a patient with recurring elbow complaints.

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thank you to fellow chiro, Dr. Kim Christen for the information

[Doc.Sust]

http://www.nismat.org/ptcor/tennis_elbow/


more rehab info with better pics

[j4ever41]

Thanks for this post Doc, I have been fighting with inner and outer elbow pain for about a year now, it has been alot better the last 4-5months I am not sure I will ever be 100% healed, I am probably about 90% healed right now, the funny thing is I used to workout alot and used heavy weights and never had this problem, I stopped workingout for a couple of years then started back again using moderate weight and after about 4 months I started having elbow pain inner then it moved to outer so I had both going at the same time, still have some inner with barbell curls so I don't do them very often. Also enjoyed your post on heat therapy.

[Doc.Sust]

glad to help

[RockyX]

nice post are you a chiro? I'm going to Parker right now. Just curious.

[Doc.Sust]

^^^yes i am. best of luck with school my friend.

[Iowa Boy]

sorry...

[Doc.Sust]

sorry for what?

[DEVILDOG MARS]

Very informative; im currently suffering from an elbow injury; this has messed up my first ever cycle. Im using testoprim-d from mexico; i was afraid t0 try steroids but eventually did. Should i stop my 3 months cycle because of the injury or should i continue using them as i enjoy my leg and back workouts??? Thanks guys!!

[Jon38z]

Hi

I'm new to this and would appreciate any advice on what course i would benifit from takling in regards to helping with joint pain. I'm 38 and over the course of the past 2 years have constantly battled with reocurring pain in my joints which has seriously slowed down my training.

[DaBullet]

awesome bro I just injured my elbow...dont know how but it stated when doing triceps. Great info!

[Td00]

awesome bro I just injured my elbow...dont know how but it stated when doing triceps. Great info!

Same here.

[Hard2Gain]

I would like to add a few things I was told from my doctor the other day.

1. Typically, physical thereapy does not do wonders for tendonitis in your elbow
2. Forearm braces do very little if you have already had a flare up if you will. It was noted that the braces do not need to be worn 24/7 but definitely worn when doing strenuous activity if you will (more of a preventive at this point), wrapping your elbows will actually help you more.
3. Recent research has shown a new training device to work very well in helping to strengthen the elboy joint, wrist flexor muscles and stretch the tendons/nerves which all contribute to decreasing the pain that is often felt when the arm is flexed (ie doing curls or french press). I was skeptical but for $20 on Amazon I figured wth!
a. It is called the Thera-Band Flex Bar. Here is a link to it as well as some videos. http://www.thera-band.com/store/prod...p?ProductID=20 http://info.thera-bandacademy.com/flexbarelbow

I have no connection with these people or this device other than now owning one. I just received it last night and did the exercises this morning. I can tell you that when doing the exercise (Reverse Tyler Twist-golfers elbow is what I was diagnosed with), I can actually feel it stretching a bit and while my hands and forearms feel pumped from doing the exercises, I can say that my elbow actually felt a little better.

My doctor also suggested that I start taking Glucoseamine but I actually started that about a week before my appointment. I can say that the brand I bought this time seems to be working much better than what I had in the past. Once again, I purchased it from Amazon. here is a link for what I bought. http://www.amazon.com/gp/product/B00...ef=oss_product Hope this helps some of you guys out.

[genakriggs]

Physical therapy is always the best method to help recuperate. But there are cases where the elbows also has a lot of scars. It's not only for the vain people but you can ask a plastic surgeon scottsdale regarding cosmetic procedures to help in faster scar healing and recovery.

[optionsdude]

Great post have dealt with tendonitis off and on throughout the last 12 years. I have been able to keep it under control with exercises and stretches. I love the bar twist video and will be looking to get one of these. All of the PT places use the therabands but have not seen the twist bar in that video before. Can't wait to give it a try.

[optionsdude]

Okay I got the theraband flex bar and used it off and on the last year. Tendonitus was still very stubborn most of this last year. Went back to the good old rubber band theraband and the tendonitus actually feels like its getting better finally. Rapid wrist curls with the rubberband and then ice afterward.

[Uptempo]

new to the site but great info. I hyper extended my right elbow in jiu jitsu. im going to try the isotonic exercise routine. thanks agian

[Emerald]

My left elbow is preventing heavy bicep work. Which is holding my progress back. Good info here but I need to be evaluated so the true injury is identified before proper rehab can begin

[Vpunishment]

How is Parker college of chiropractic? I'm current looking at Palmer of Iowa too, and before I decide and move I want real life reviews!!!!

nice post are you a chiro? I'm going to Parker right now. Just curious.

[ctenosaura]

Are painful elbows a sign of injury to come? I have a tiny amount of pain bench pressing or shoulder pressing, a little more pain doing dips, and a lot of pain doing tricep extensions. Lying and standing tricep extensions have been out of the question for years. Only compound movements.

[Thor JR]

Hey guys I'm a new member and in need of some serious help I was in the army and got injured in combat I have a ulnar nerve injury in my right arm and shrapnel in my left knee long story short I havnt done a cycle or been in a gym in a year I lost about 20lbs I'm about to start a new cycle of tren and really want to gain mass back any advice on a stack would be greatly appreciated and any advice on a training routine to ease the strain on my injuries would be even better thanks.

P.S I prefer to hear it from body building vets. (No offense I just believe experience speaks for itself)