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Elbow pain can be intense pain and more often than not, it does not occur in isolation. It can be due to many other structures like the shoulder or spine and can sometimes not give any relief unless the root cause is identified. These can be from a variety of dysfunctions namely neural, myofascial, joint-related, or even centrally mediated.
Every contact sport like tennis, cricket, squash, and badminton has a team of physiotherapists to help the players with the necessary relief treatment whenever there is any kind of elbow injury in the game. The cure for discomfort and dysfunction near elbow joints is physiotherapy, which provides significant relief. Physiotherapists are miracle workers when it comes to diagnosing and treating joint and muscle problems. Local examination of the elbow is done by physiotherapists by testing muscle strength, ligament stress, active and passive movements, and grip strength. Further tests can include shoulder, wrist, and spine tests and even an examination of the neurological system to check whether anything else contributes to the elbow pain. Based on the diagnosis and severity of pain, a treatment plan is created and is supported with elbow exercises to improve movement, massage treatment, and guidance for lifestyle improvements.
Here are some important points to understand.
Elbows can be injured by trauma, repetitive strain, and poor postures. Elbow pain is a common injury that can influence the ability to reach, grip, lift and load the arms. Tennis elbow, or lateral epicondylitis, is a painful inflammation of the elbow joint caused by repetitive stress (overuse). The pain is located on the outside (lateral side) of the elbow but may radiate down the back of the forearm. There is likely to feel the pain when you straighten or fully extend your arm.
Elbow pain of any kind, should be assessed by a medical professional, a physiotherapist, or a medicine physician especially when the pain does not subside on its own over a two to three-week period.
Elbow pain can be for different reasons ranging from ligament strains to fractures. Few major causes can be:
Elbow Pain from Ligament Sprains- When an elbow absorbs extra forces quickly, like in a fall, or from repetitive straining movements one or more ligaments may become injured. This leads to inflammation, irritation, and pain in multiple structures around the elbow.
Elbow Pain due to Arthritis- Osteoarthritis of the elbow typically occurs due to a previous traumatic elbow injury such as a fracture or bilaterally with age more than 60 due to overuse. Rheumatoid arthritis can also be isolated to the elbow or in conjunction with other affected joints in the body.
Elbow Pain due to Bursitis- Abnormal repetitive strain and or direct force on the elbow on mostly the back of the elbow is named as Olecranon bursitis. It also may have a large pocket of swelling at the back of the elbow.
Elbow Pain from a Muscle Strain or Tendinopathy- The elbow has several muscle groups that cross the joint, all of which can become strained or develop unhealthy tissue due to overuse. The most common elbow tendinopathy occurs at the forearm extensor insertion on the outside of the elbow and is known as “Tennis elbow” or golfer’s elbow.
Physiotherapists use X-rays or MRI to locate the elbow pain and accordingly, perform an objective examination of the injury. They then control elbow pain with therapeutic modalities such as shockwave therapy, acupuncture, and dry needling. They also improve range of motion of the joint with hands-on manual therapy or manipulation which increases or maintains the range of motion. Depending on the intensity of the pain and location, physiotherapists develop an exercise program for includes strength, flexibility, and motor control exercise for elbow joint pain. Soft tissue release is also important and may require adjunct massage therapy treatment. Lifestyle modifications, posture re-education and possible bracing and or taping are also recommended as part of elbow physiotherapy.
The elbow pain exercises should be performed in a pain-free range of motion and modified or stopped if pain increases during or after the exercise. Few exercises that can be performed are:
Wrist turn- The elbow is bent at a right angle and hand is extended outwards palm facing up. The wrist is twisted around gradually until the palm is facing down. The position is held for 5 seconds and repeat nine more times.
Wrist Curls- A light dumbbell is held in hand and supported by the forearm. Moving just wrist curl, the weight is lifted towards the ceiling. This should be performed by palm up and down. It should be repeated 15 times in each direction 3 times a day.
Fist squeeze- A rolled-up towel or tennis ball is placed in the palm and the patient grips the ball or towel with the fingers to form a fist squeezing it tightly for 10 seconds. It is repeated ten times.
Towel Twist- It is performed by holding a loosely rolled-up towel lengthways with one hand at each end and the shoulders are relaxed. Twist the towel by moving the hands in opposite directions, as if wringing out water, and should be repeated nine more times in both directions.
Q. How to treat elbow pain at home?
A. Icing is the first step after the injury to reduce swelling. Taking over-the-counter (OTC) painkillers such as ibuprofen or other non-steroidal anti-inflammatory drug (NSAID) helps to reduce the pain. Wearing an elbow brace, especially during aggravating activity is also advised.
Q. How long does it take to recover from elbow pain?
A. Depending on the cause, severity and duration of the injury the treatment can range up to a few weeks. A regular exercise program with proper rest is essential to make the healing process faster.
Q. When will physical therapy not be appropriate?
A. Physical therapy is usually the most appropriate treatment but may not be appropriate if the injury was caused by severe trauma that needs further investigations that may require surgery if appropriate.
Q. What is the cost of physiotherapy?
A. A typical physiotherapy session can range from CAD 70-80 per session. Number of sessions depends on the injury and the recovery period can vary from person to person.
A physiotherapist can perform a detailed assessment of the elbow and identify all contributing factors as well as co-morbidities associated with the person's symptoms. Physiotherapists personalize treatments to address specific injuries and help with personal lifestyle goals.
Physiotherapy has an important role to play in the management of pain and dysfunction around the elbow joint. Physiotherapists have a functional knowledge of the complicated 3-joint elbow complex as well as its associated anatomy. The treatments and the rehabilitation that include exercises are safe and help a patient in the long run.
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