Pain in the elbow is a common issue, particularly in tennis players, which is where we get the term. The traditional description of this condition would identify the common tendon of the wrist extensors as the problem area. There are a number of muscles in the top of the forearm that control elbow, hand and wrist movement. All originating from one similar location. Classical thinking points to a repetitive stress injury at this location causing symptoms which usually include difficulty grasping objects due to pain. There may in fact be a repetitive nature to the issues, however the underlying movement strategies are more nuanced.
The elbow is made up of three bones, the humerus (upper arm), the radius and ulna (two forearm bones). They intersect at the joint we call the elbow. Multiple muscles attach at this junction, and the extensor group specifically is pointed to when we discuss tennis elbow. They, and others like triceps, impart motion that creates elbow and wrist extension. The elbow is often described as a hinge that only bends and straightens, but it actually rotates. That rotation is limited by the extensor musculature and promotes a position we’ve all seen as “hyperextension” of the elbow. If we cannot unlock that position fully, then we end up placing focal pressures in the same area repeatedly.
One way to promote a change in mobility at the elbow is via a concentration curl. We can arrange the wrist and hand in such a way that it facilitates the unwinding of the elbow, along with the shoulder because they all play a part. Start with the palm up, as the curl begins the hand turns to face you and the movement is completed once the dumbbell reaches the shoulder. That motion, the rotation of the hand concurrent with the elbow, restores the bending capacity which is underpinned by rotation of the radius.
Tennis elbow has historically been described as essentially a tendonitis or in some cases a chronic overuse of the muscles that extend the wrist and originate at the elbow. They have lost their ability to create rotation, which may be placing focalized pressures on local tissues. If we can restore the bending capacity of the elbow, via rotation, then those muscles have an opportunity to diminish their activity. The decrease in activity allows for greater motion to be achieved, and pressure is relieved.
Austin Ulrich, Physical Therapist
