Focal elbow pain and elbow pain triggered by hand movements may severely impact enjoyment and performance in life and work. After all, we are always using our hands—in self-care, writing, preparing food, using hand tools of all kinds, typing on keyboards and texting our friends—and bending our elbows to lift, sweep, play sports, strum a guitar, and myriad other movements we tend to take for granted when all is well.
Tennis is the classic example of an activity that, played intensively or with poor form, may stress the elbow joint and lead to lateral epicondylitis or “tennis elbow”, just as golf can cause medial epicondylitis or “golfer’s elbow” However athletes and nonathletes alike may experience pain, strain or inflammation of the elbow. In current times, poor ergonomics with computer use is one of the main tennis elbow or golfers elbow culprits.
It is important to recognize that attention to fitness, posture and ergonomics can help prevent elbow pain; and mild cases may respond to a brief course of ibuprofen or resolve without treatment. However recurrent, persistent or severe elbow pain should be evaluated and treated by an expert in musculoskeletal health. Fortunately, treatment with a handheld transdermal laser system known as low level laser therapy (LLLT) or cold laser therapy has been shown to reduce elbow pain for patients suffering from chronic upper extremity musculoskeletal pain, including tennis elbow, and is increasingly available to patients at wellness centers such as Synergy Wellness Chiropractic and Physical Therapy in New York City’s East Village.
Anatomy of the Elbow
To brush your teeth, ice a cake, dig a hole, or conduct an orchestra with any kind of precision and fluidity, the elbow must combine hinge-like flexion and extension (bending at the elbow) with pronation and supination of the forearm (turning a doorknob). The elbow holds three separate articulations—ulnar humeral, radiohumeral, and proximal radioulnar joints—within a common synovial-lined cavity. Bony stability is provided by the humerus of the upper arm and the radius and ulna of the forearms; the medial and lateral collateral ligaments, the radial head, joint capsule, and flexor and extensor muscles and tendons (that stretch from the fingertips to the biceps and triceps) provide function and stability to the elbow. (Aquilina et al.)
Tennis, Golf, or Something Else-Elbow?
Elbow pain may be acute or chronic and may be precipitated by overuse (repetitive microtrauma), excessive load, or trauma. Common causes of elbow pain include:
• Torn ligament – often caused by excessive load injury
• Tennis elbow (also called lateral epicondylitis or lateral epicondylalgia) – an overuse and overload injury to soft tissue around the extensor tendons and insertion points on the lateral (outside) side of the elbow (think tennis backhand motion)
• Golfer’s elbow – typically an overuse injury to soft tissue around flexor tendons and insertion points on the medial (inside) side of the elbow (think golf swing)
• Bursitis – inflammation of the bursa or sack lining the elbow joint
• Elbow fracture – in any of the three bones that meet at the elbow; can be caused by a fall or trauma
• Dislocated elbow – common in sports, typically after a fall or trauma
• Little Leaguer’s elbow – also common is sports, an overuse injury
• Arthritis – due to longstanding inflammation or degeneration
• Ulnar neuritis – due to nerve impingement
We explore these and other possible root causes of elbow pain during an initial workup at our clinic.
Beware Elbow Aggravators
Unfortunately, life doesn’t stop when we get hurt. It is all too easy to aggravate an existing elbow injury, since most daily living tasks involve rotating the hand, gripping and grasping with the fingers, and/or flexing/extending the elbow. Simple things like cleaning, carrying heavy objects, childcare, and tasks that require fine hand movements like typing can contribute to pain and impede healing.
As an advanced certified ergonomics specialist, I know that sound ergonomic practices are integral to achieving and maintaining a pain-free upper body, especially in today’s computer-centric era. My practice is to combine in-office therapeutic modalities with personalized ergonomic counseling so that patients heal as quickly as possible, and re-injury risk is minimized.
Treating Physical Injuries Physically
Traditional approaches to treatment for elbow conditions typically center around rest, by-mouth anti-inflammatory medication, physiotherapy, and, if necessary, corticosteroid injection. I agree with encouraging rest (as one is able) and will sometimes recommend oral anti-inflammatory medications such as ibuprofen if there is evidence of acute inflammation on the physical exam. I find the use of corticosteroids problematic, however, even when infrequently dosed.
Corticosteroids employ a broad, potent and imprecise mechanism of action, sort of bulldozing all inflammation in the joint. As such, they are not entirely nontoxic to healthy soft tissue in the area, especially with repeated dosing. There is evidence to suggest that corticosteroid injections may increase the risk for pain recurrence compared with other approaches, and repeated injections may become less and less effective in controlling pain over time, possibly increasing one’s risk for needing surgical intervention. (Bisset et al)
Our approach at Synergy Wellness is comprehensive, physiologic, and I believe, optimally precise and nontoxic. We start by taking a complete history and performing a full examination to assess the involvement of the elbow as well as adjacent joints, ie, the neck, wrist, hand, or shoulder. Once we feel confident in our diagnosis, we go straight to physical, non-pharmaceutical techniques to align the joint, relieve pain, and prevent a recurrence., but more importantly allow the tissues to heal properly and effectively.
Manipulation of the elbow, wrist, cervical spine and thoracic spine are well-studied tennis elbow treatments, having been practiced and refined for nearly a century. (Vicenzio et al; Kushner et al) Manually adjusting the elbow likely relieves pain by multiple mechanisms: by correcting misalignment and alleviating compression of pain-sensing nerves. (Vicenzio et al) At synergy, we perform localized muscle testing before and after adjustments so we can adapt the method according to individual treatment response.
We also are happy to now offer brand new soft tissue rental cold lasers for treatment at home (also called low-level laser therapy or LLLT) to reduce inflammation, spasm, and directly heal and repair tissue. LLLT, a real game-changer in the treatment of soft tissue injury, has been shown to reduce disability and short term pain in patients with tennis elbow, possibly by reducing inflammation and promoting biosynthesis of collagen. (Bjordal et al) We are beyond pleased that patients with tennis elbow, golfers elbow, and even arthritis who undergo treatment with LLLT in our clinic are experiencing excellent results.
I suggest reading this article if you would like to know more about cold laser therapy.
Okuni I, Ushigome N, Harada T, Ohshiro T, Musya Y, Sekiguchi M. Low level laser therapy (lllt) for chronic joint pain of the elbow, wrist and fingers. Laser Ther. 2012;21(1):15-37.
Aquilina AL, Grazette AJ. Clinical Anatomy and Assessment of the Elbow. Open Orthop J. 2017;11:1347-1352.
Bisset L, Coombes B, Vicenzino B. Tennis elbow. BMJ Clin Evid. 2011;2011:1117.
Vicenzino B, Cleland JA, Bisset L. Joint manipulation in the management of lateral epicondylalgia: a clinical commentary. J Man Manip Ther. 2007;15(1):50-56.
Kushner S, Reid DC. Manipulation in the treatment of tennis elbow. J Orthop Sports Phys Ther. 1986;7(5):264-272.
Bjordal JM, Lopes-Martins RA, Joensen J, et al. A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord. 2008;9:75.