Elbow pain- A Learning Lab

Despite the simple labels of “tennis elbow, little leaguer’s elbow, golfer’s elbow or epicondylitis, bursa, tendonItis or tendonOsis.” Elbow pain is mind-numbing. Especially when it is sabotaging your ability to have fun and play.

Like my article on foot pain and plantar fascia, the idea in today’s article isn’t the debate on which diagnosis fits you best; it is a general understanding of the What’s and Why’s to help you take a step forward.

For as many names and diagnoses as I can come up with, there are hundreds of braces, miracle promises, and YouTube ideas on what to do about them to get your game back.

Play through?


Ice? Inject? Heat? Pre-Pay for 16 visits? Deep Blue it? Smash it to submission? Wear a black velcro band?

I also hear weekly from clients, “I Hoped it would just go away” , “I guess I’ll have to Find a new Sport” and “I guess I’mjust getting older and cant hang anymore?”

C’mon man!

There are many different versions, and the fight to diagnose it correctly and the argument over who has the proper diagnosis slow your recovery. It focuses you on words and descriptions rather than on treatment.

Sorry, if this article was your stop hoping for the miracle fix for your specific pain, you’re out of luck. The reality is elbow pain takes a little work. What I can offer is a better explanation allowing you to take a step forward.

More importantly than, “Does it hurt here?” Treatment for elbow pain should have a few other parameters that need to be addressed. Such as:

Is it primarily:

1) inflammatory (most often overuse or strain)

2) positional (joint and sometime muscle balance – common with baseball/tennis)

3) grip related (incredibly common, especially in pull ups, curls and tennis/golf)

4) biomechanics or coming from somewhere else (golf and other sports)

5) most likely a bicep tendon complex (overhead sports)

Treatments are different for each, and the order of your rehab counts.

So I understand that the middle and the lateral elbow are different issues and that pain from a grip problem differs from pain from a weak bicep and a muscular ratio/balance injury. I treat these differently clinically. But there are a few rules you can use right now to help take steps to work on these issues at home and make progress. This “experiment” on your own body will also help if you seek care in my clinic or with a PT, Athletic trainer, chiro, or Physio.

Like many injuries I want you to understand that it is a road to recovery. See my infographic and write up if you need help digesting this.

There is a better order for coming back from injuries. Injury, Mobility, Activation, Strength, Endurance, and then the other factors of Fitness. Doing these all simultaneously can loop you back into the overuse cycle and start you at day one in a never-ending cycle.

The injury needs to be addressed first. Nothing will get better when the body is “on threat.” Meaning. If it hurts and sets you back 5 days every time you do a bicep curl with dumbbells, then you need to stop that mechanism while you work up the road. This shouldn’t be the heartache that my clients think it is. There are plenty of other options to get the same result out of your workout. But common sense screams, “If it’s hurting you when doing this, try something different.” Not forever, for now.

Inflammation is a crucial aspect of this phase. It needs to be addressed and controlled. Nothing really heals when it is inflamed. You are responsible for this part!

Next: Restore proper mobility before “rehab.” Does the body even work correctly? There are more than 50 joints and over a hundred muscles I could name than could be affecting your elbow. Rubbing and smashing the area of pain simply doesn’t work. A lack of proper motion through the shoulder and thoracic spine causes elbow pain in many baseball players suffering from Tommy John type Injuries. The human body works together in motion.

Movement is an integral part of what we do as clinicians. This has to happen very quickly in our process. Injury first. Pain is what brought them in.  You win that day if you go ahead as a clinician and fix their pain.   But if the client has a motion that is off and they return to doing that poor movement, they are destined to repeat the process that caused the injury in the first place. It’s a “Win the battle but lose the war” process. I deal with this daily. Once the pain is gone, I typically don’t see the athlete. Until they come back 3 months later with the same issue. Elbows issues follow this pattern 99% of the time.

After the injury, maybe even during or along side with…View the movement.   It’s fine to call it a “tendonitis” but what caused this?   Typically over movement as a stable area or a loss of movement at a mobile area.    True treatment takes this into account.

You may need help with this part. But a fundamental analysis at home is better than just rubbing deep blue on your pain spot. Many of my clients have never even looked at this level with any of their pain. Many just don’t give a damn. It hurts, so they either quit or push through. Be a detective-look for clues.

Do your wrists flex and extend the same. Is it more painful with grip, especially a barbell, tennis racquet, or opening a jar at home? Does it only hurt upon impact with a golf club or softball bat, or does the swing itself cause the pain? Ask these questions, experiment – gain awareness and body control.

Because as you start to be a detective and unravel the mystery it will lead you to a better treatment protocol of:

Activation and balance and then strength.

Refer to the infographic picture again. Doing these steps out of order will re-irritate the injury itself. A step backward.

Probably the most significant part of elbow pain I’ll address before finishing up this article is to be aware that the pain is not a very good indicator of the problem, nor does the decrease or lack of pain mean the issue is resolved. Too often, I have clients that get an injection and assume that was the fix. That was only the start.

The body has a miraculous way of dealing with pain and restriction issues via compensation, freeing up areas while restricting others to source out pain and movement. Be more comprehensive in your treatment and understanding of elbow pain.

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