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Biomechanical Overview, Tennis Elbow, Pitcher's Elbow, Treatment Strategies
Biomechanical Overview
The elbow is a fairly straightforward joint in that it has two directions of movement, bending and straightening. However the forearm has two bones and a spiralic arrangement of muscles. With the added component of forearm movement, many more movement combinations can be added to hand, wrist and elbow activity. Imagine for a moment that you find a piece of paper on the floor. You pick it up reaching out, straightening your elbow with the palm down to grasp it.
You then turn your palm up as you bend your elbow to view the paper. In various sports a player combines bending/straightening movements of the elbow with either forearm turning or flicking the hand/wrist up/down. These motions activate the wrist/finger flexors or wrist/finger extensors as well as the pronators (muscles which turn the palm down, see clip 1) and supinators (muscles which turn the palm up).
With Pitcher's Elbow or Medial Epicondylitis (See ill. 2 for location of muscle attachment), the ball is thrown with a downward flick of the wrist and with a supination motion of the forearm.
Throwing causes a forceful contraction of the muscles of the wrist, forearm and elbow extensors against the ball's weight. Strain in this muscle group may come from overuse (repetitive stress); lack of proper stretching before and after throwing; or from use of poorly conditioned muscles without the proper strength built up. Pain that develops is usually felt in the inside of the elbow joint. Injury can also occur to these muscles from forceful twisting use of a tool.
Tennis Elbow or Lateral Epicondylitis (See ill. 3 for location of muscle attachment) The muscles that contract during a backhand tennis shot (finger and wrist extensors) are usually not as strong as the forehand muscles.
The resistance of the ball against the racket during a backhand stroke may cause repeated micro-tears. Proper strengthening of the backhand stroke using progressive resistance can prevent this problem. Stretching after strengthening and playing is always advised. Injury to the forehand muscles is less likely but can occur if the resistance of the ball hitting the racket if is too great for the strength/condition of the player. At the beginning of a new season or if there has been a break in your playing schedule you should condition your elbow, forearm and wrist with exercise and stretching. Injury can also occur to these muscles from forceful twisting use of a tool.
Treatment Strategies:
At the onset of minor athletic strain, follow the general guidelines: PRAICE: PROTECTION, REST, ANTI-INFLAMMATORIES, ICE, COMPRESSION, ELEVATION
PROTECTION doesn't really apply until you return to activity, then an elbow support can be used. See: secure.roycemedical.com.
REST:
Don't play or work forcefully with a tool until the condition has resolved.
Avoid all motions of the elbow/wrist that increase the pain.
Use your other hand or use both hands so as to give the painful side a rest.
You should only return to activity if you are pain free and have reconditioned the muscles following the injury.
ANTI-INFLAMMATORY MEDICINE ANTI-INFLAMMATORY MEDICINE, either homeopathic or allopathic should be taken to reduce pain and inflammation. Take the maximum recommended dose and frequency for the most severe pain.
Ibuprofen (Motrin, Advil), Naproxin (Aleve) and Aspirin are all anti-inflammatories, but remember they need to be taken with food, plenty of water
and may require checking with your doctor to see if there may be contraindications, particularly if you are on other medications, have stomach problems, or are not to take blood thinning medications.
These non-steroidal anti-inflammatory medicines are not meant to taken for more than a month. They may in fact have a destructive effect on cartilage if taken long term. Remember Acetaminophen (Tylenol) provides pain-relief and lowers a fever; it doesn't reduce swelling and inflammation.
ICE should be used within the first 24/48 hours and if there is warmth and or swelling. For stationary ice packs, a thin, moist, protective layer against the skin is advisable. This could be a paper towel or bath towel.
Warmth can be used if swelling is gone, 48 hours after pain/strain. (See site for Bed Buddy microwavable moist heat packs) walgreens.com
Thermal therapy may be used for 20 minutes at a time, as frequently as every two hours if needed. Alternating heat 10 minutes with cold 10 minutes is also helpful after the first 48 hours has passed.
COMPRESSION: A 3 or 4 inch wide Ace Wrap may be helpful in keeping down any swelling and can support your elbow. Remember to wrap it in a figure 8 fashion starting 6" below the affected area. Each pass of the bandage should over-lap slightly. The wrap should be less tightly wrapped as it goes upward.
This provides a slight upward pressure differential to move swelling upwards. Remember, do not wrap too tightly especially around the elbow, or circulation may become compromised. Remove and reapply if any discomfort develops or if you see any swelling below the wrap. Check the skin for redness as an indication that the wrap is too tight or wrinkled.
ELEVATION: These injuries don't usually create gross swelling but if you feel discomfort, you may try resting you arm on a pillow, above or level with the heart. This is particularly easy to do at a desk, in an easy chair and in bed.
Kurashova Tissue Re-education techniques help the injured muscle heal.
Exercise: Progressive strengthening and stretching need to be included in a rehabilitation program once the pain is resolved.
Alexander and Feldenkrais work can awaken and activate more body segments into your sport, relieving localized stress and strain on the wrist, elbow and shoulder.
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The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Movementwise makes no representation or warranty regarding the accuracy, reliability, completeness, currentness, or timeliness of the content, text or graphics. Links to other sites are provided for information only - they do not constitute endorsements of those other sites. Any duplication or distribution of the information contained herein is strictly prohibited. Copyright 2006-2011
MovementWise Christine Inserra P.T.
Certified Teacher of the Alexander Technique & Feldenkrais Method
Physical Therapy serving Chicago and the Greater Chicagoland Area
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