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10 ways to avoid elbow pain

There are several reasons why elbow pain can develop, and the most common conditions are known as tennis elbow (lateral epicondylalgia) which occurs on the outside of the elbow, and golfers' elbow (medial epicondylalgia) which happens on the inside of the elbow, writes physiotherapist Jenny Branigan

Right moves: there are many useful steps to help manage elbow pain, which can be caused by doing a lot of gardening
Right moves: there are many useful steps to help manage elbow pain, which can be caused by doing a lot of gardening
Right moves: there are many useful steps to help manage elbow pain, which can be caused by doing a lot of gardening

Elbow pain can quickly prevent you from carrying out typical daily tasks, and like most things that we take for granted, you don't realise how much you use your elbows until they are painful to use.

Firstly, you need to identify the cause of the pain.

Ill-fitting sports equipment, such as an excessively large tennis racket handle, can strain tendons in your elbows over time, leading to acute pain. Meanwhile, leaning on hard surfaces for too long can cause the olecranon bursa (the fluid-filled sac at the tip of your elbow) to become swollen and irritated.

By understanding the source of the elbow pain, you can begin to address it. For example, resistance-band exercises will strengthen your arm muscles to allow them to withstand the forces transmitted during sport or manual labour.

Here are 10 tips to help you prevent or recover from elbow injury:

1. The elbow often compensates

If you suffer from neck or shoulder pain, you may start to change how you use your arm, as a compensatory mechanism to reduce pain.

This will result in your elbow taking more load than it is used to. While your elbow may cope with this for a while, ultimately, it is likely to break down and develop pain. Promptly dealing with injuries anywhere from the neck to the hand will prevent the development of compensatory elbow pain.

2. Use correct equipment

If you play racket sports, make sure you have the correct sized handle for your own hand.

Avoid rackets with excessively large, and especially very small grips. Over gripping can strain the tendons in your elbow over time.

The recommendation for tennis racket handle size is to measure from the crease across the middle of the palm (proximal palmar crease) to the tip of the ring finger. You may also need to consider string tension, weight of the ball (wet tennis balls in the rain are heavier), and the weight of your racket, to prevent tendon overuse at the elbow.

Gardening tool handles need to be considered here too. Choose hand tools that fit your hand and avoid over gripping a very small handle.

3. Ask for an assessment

Elbow pain is commonly the result of incorrect positioning in the office and comes under the umbrella terms of repetitive strain injury or occupational overuse syndrome.

Elbow height should dictate the height of your desk, whether a sitting or standing desk, and the elbows should be positioned at approximately 70°-90° of flexion as you work, and resting on a comfortable arm rest.

If your company has a health and safety officer, book a workplace ergonomic assessment to ensure you are working well.

4. Be careful where you lean

A bursa is a fluid-filled sac. We have many of them around our joints to prevent friction.

The olecranon bursa is one at the tip of the elbow that can become irritated and very swollen if you rest your elbow on a hard surface for long periods of time.

It is common around exam time in students enduring long hours of cramming.

It usually responds well to rest and compression, sometimes needing pain relief. Occasionally, it can get infected, which would necessitate a trip to your GP.

5. Don't ignore the overuse injury

There is no benefit in pushing through elbow pain. Tennis elbow and golfers' elbow are the most common overuse injuries around the elbow and are often ignored for many months, until they become so painful that there is no option but to seek treatment.

Be proactive - if you feel regular elbow pain after playing racket sports or golf, after a long stint in the garden or when using tools for DIY, you need to get assessed as soon as possible.

Technique may need to be tweaked, so get a golf or tennis lesson. A simple change in how you move can often make all the difference.

Consider also the length of time you play or work for, as prolonged exposure is a major factor in exacerbating these overuse conditions.

6. Wear the brace in the right place

We commonly see patients present with tennis or golfers' elbow who have been self-managing for a while first. Bracing the elbow when you play or work in the garden can reduce the force through the tendons.

We often advise their use during rehabilitation and on resumption of the original aggravating activity. The brace should be placed approximately 10cm below the elbow joint, not over the painful site itself.

7. Build up strength in your arms

Build up your forearms, wrists and hands using resistance balls (like stress balls), resistance bands or small weights. Your chartered physiotherapist can advise you on how to do this.

The stronger the muscles of your arms and forearms are, the easier you will withstand the forces transmitted during sport or manual labour.

Work on gradually building up the strength of your forearm muscles in the off season before you get back into tennis or golf, to enjoy an uninterrupted season.

8. See your GP urgently with sudden painful elbow swelling

There are many different forms of arthritis that manifest with sudden pain, stiffness and swelling in the elbow joint, such as osteoarthritis, rheumatoid arthritis, juvenile arthritis (aged under 16), gout and even lupus. It is best to see your GP urgently during an acute flare-up to facilitate diagnosis.

9. Is it really elbow pain?

Elbow pain is often referred from the cervical spine (neck), thoracic spine (upper back) or shoulder. Ensure that any elbow assessment involves a thorough spinal and shoulder joint examination. Elbow pain referred from the neck will not resolve unless the neck is treated.

Trapped nerves can occur at several sites around the elbow. Cubital tunnel syndrome involves the ulnar nerve, which may get trapped as it runs along the inside of the elbow, causing burning or numbness into the hand, arms and fourth and fifth fingers.

Radial tunnel syndrome describes a similar issue with the radial nerve as it passes through the radial tunnel near the outside of the elbow. Burning or numbness on the outside of the forearm and elbow indicate this diagnosis.

10. Plan DIY & garden tasks

It's easy to lose track of time in the garden or when doing DIY. Set a timer on your phone and vary your tasks every 15 minutes to avoid repetitive movements. Avoid long periods of gripping tightly on hedge clippers, using an axe, or twisting a screwdriver.

The prolonged gripping action (especially with twisting) can increase the pressure on the tendons at the elbow and cause severe pain and weakness.

Instead of pulling weeds with your hands, use an old dinner fork to grab and loosen weed roots, making them easier to pull out.

For anyone who does lots of manual work, or who plays golf or racket sports, overuse injuries of the elbow are common, and can be debilitating and very painful.

They are caused by a degenerative process in the tendon from overuse, rather than from inflammation and can take many months to heal. Prevention is better than cure as always.

Jenny Branigan is a chartered physiotherapist and owner of Total Physio. See totalphysio.ie

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