When Your Elbow Problem is Your Shoulder.
The majority of the muscles of your forearm are dedicated to moving your wrists and fingers. The most common source of elbow pain and injury comes from an irritation of the tendons that anchor these muscles to the elbow. If you are experiencing elbow pain, you have most likely irritated either the common extensor tendon or common flexor tendon of the forearm. Lay your forearm and hand, palm down, on a table and then lift just your hand and fingers up off the table without lifting your forearm. The muscles you used in that motion (extension) share a common tendon that anchors them to the outside of your elbow, the common extensor tendon. When that tendon becomes irritated, you have acquired lateral epicondylitis, or tennis elbow. Now lay your forearm and hand, palm up, on a table and lift just your fingers and hands off the table without lifting your forearm. The muscles used with this motion share a common tendon that anchors them to your elbow, but on the inside of your elbow. When that tendon becomes irritated, you have acquired medial epicondylitis, or golfer’s elbow.
Golfer’s or Tennis elbow is a relatively easy injury to acquire and participation in either of those sports is not a pre-requisite for injuring your common extensor or flexor tendon. If fact, the majority of people I see with these injuries don’t play either. To understand why you have injured your elbow you only have to observe what is going on both upstream and downstream from the elbow joint. While you are driving, sitting at your desk typing(or gaming…you know who you are), standing over a stove cooking dinner, etc. your hands and wrist are hard at work while your shoulders are slumped forward. In other words, your elbow is sitting at the intersection of constant stress from overworked fingers and wrists layered on a weak and unstable foundation provided by poorly positioned shoulders.
Our slumped shoulders fail to support our elbows because the muscles anchored onto a poorly positioned shoulder joint cannot do their intended job. Our biceps muscle bends our elbow and helps rotate the forearm. The longer portion of that muscle is anchored at the shoulder joint and runs down the upper arm, crossing the front of the elbow inserting into the forearm (radius to be exact). When your shoulders are slumped, the biceps is now out of position and does not adequately stabilize your elbow joint. Our triceps muscle extends our elbow. Like the biceps, the longer portion of the triceps is anchored at the shoulder joint and runs down the upper arm, crossing behind the elbow joint, inserting into the forearm. Again, with slumped shoulders the triceps is out of position and cannot adequately stabilize the elbow.
If we have now removed the stabilizing forces of the biceps and triceps muscles from the equation, the forearm muscles have to work that much harder to do their job. Like every other muscle in the human body, when the forearm muscles are exposed to chronic stress, the pathology often shows up in its tendons, not the muscle belly itself. This is why we develop tendinopathy (or incorrectly termed, tendinitis). So when your elbow begins to hurt, you actually need to address two problems; An injured tendon at the elbow, and weak shoulder stabilizing muscles.
To heal an injured tendon we have to compel the body to pay attention to it. Tendons are notoriously poorly perfused with blood, as such, they are slow healers. However, if we perform eccentric contractions with our forearm muscles we can stimulate healing in their tendons quite effectively. To perform an eccentric contraction to heal your Tennis Elbow (pain on the outside of the joint) grab a 3-5lb weight and lay your forearm on a table, palm down, with your wrist hanging off the table. With your opposite hand, bend the hand holding the weight up as far as it will go without moving the forearm off the table. The injured extremity should not do any work to lift the weight up. Now this is the important part. Very slowly lower the weight, using only the injured extremity, until your wrist is fully flexed and hanging off the table, in the original starting position. Repeat this 10-15 times, for 2-3 sets. Be prepared for your elbow pain to be a little worse for a few days, but keep doing the exercises daily. You will start to see progress in 7-10 days.
What about Golfer’s elbow? Do the same thing but orient your palm up, facing the ceiling.
To address the weak stabilizing muscles of the shoulder, we have to get the shoulder girdle resting comfortably on top of your ribcage, not slumped forward. Stand straight up with your shoulder back and your chest out. Grasp a resistance band or any stretchy material in both hands with your palms up, elbows bent and pinned to your ribs. Pull your hands away from each other while pulling your shoulder blades towards each other. Then slowly let the resistance pull your hands back towards each other. Repeat this motion 10-15 times, for 2-3 sets, daily.
Elbow tendinopathy(tendinitis if your old-school) can be a difficult problem to solve and there is a tendency, due to the pain and frustration involved, to focus only on the elbow joint. But, like so many other musculoskeletal issues, we need to ask ourselves what is going on above and below the painful area if we want an efficient and robust solution to our problem.