Physiotherapy and rehabilitation
Below we present in detail the most common elbow injuries. Every elbow pathology or injury has a description of general features, the cause of the injury, the characteristics of the symptoms, diagnostics, and the course of treatment.
Tennis elbow (lateral epicondylitis) refers to pain that occurs on the outside of the elbow. Tennis elbow occurs at the tendon attachments of the muscles that extend the wrist and attach to the outside of the elbow, specifically to the lateral epicondyle (protuberance on the outside) of the humerus.
What type of injury is tennis elbow?
Tennis elbow is an overuse injury to the tendons of the forearm muscles. Overuse leads to degenerative changes in the tendons, which stimulate pain receptors, with the tendons also often in the state of inflammation. Tennis elbow is not exclusively associated with tennis and the sports population, but is often an occupational injury in individuals who place above-average load on their arms – painting, using a computer mouse, screwing, carrying objects, gardening, vibrations, lifting weights, etc.
Symptoms of tennis elbow include pain that is burning and sharp, occurs when clenching the fist and limits grip strength. The area on the outside of the elbow is often tender, with characteristic unpleasant pain on stronger palpation or manual pressure. Tennis elbow is characterised by pain that radiates from the elbow down the entire forearm.
Tennis elbow occurs primarily due to poor biomechanics of the wrist, which means that the wrist positions are incorrect when performing arm movements (the wrong muscle units are overloaded during a particular activity). A frequent cause of tennis elbow is poor preparation of the forearm muscles for the activities you are performing (the right muscles are overused, but overuse occurs relatively quickly due to poor training; we are talking about poor strength endurance and poor joint mobility). A frequent direct cause of tennis elbow is muscle asymmetry, which means that the muscles on one side of the forearm are disproportionately stronger or weaker than those on the other side of the forearm (often the muscles on the front of the forearm are stronger and shortened, while the muscles on the back side are relatively weak).
Symptoms of tennis elbow usually last from 6 to 16 weeks, and if conservative treatment is not performed, the problems can last for several years continuously or in occasional outbreaks of pain, seriously limiting your function. We often resolve cases of elbow problems that have been ongoing for several years because the condition was not treated with training but was mainly focused on pain relief.
Tennis elbow is treated systematically. First, we perform appropriate diagnostics by measuring muscle properties and look for potential causes of pain in muscle tightness, imbalances, or poor strength. Once we diagnose the causes of tennis elbow, we perform the appropriate number of treatments to reduce acute pain and prepare the body for subsequent treatment process through training.
For tennis elbow injuries, shockwave therapy performed by a physiotherapist expert is highly effective in reducing pain.
The key and longest phase of tennis elbow treatment is individualised kinesiotherapy, which improves the functional muscle imbalances diagnosed during the initial examination and thereby eliminates the primary causes of tennis elbow. A characteristic of the tennis elbow pathological condition is that cases where the patient does not persist in the phase of treatment of the causes, i.e. in the muscle strengthening phase, develop recurring elbow problems once the pain subsides.
Treatment of an injury is not completed when the symptoms, i.e. pain, disappear. The injury is healed when the causes of the injury are finally eliminated.
Golfer’s elbow (medial epicondylitis) refers to pain that occurs on the inside of the elbow. Golfer’s elbow occurs at the tendon attachments of the muscles that bend the wrist and attach to the inside of the elbow, specifically to the medial epicondyle (protuberance on the inside) of the humerus.
What type of injury is it? Golfer’s elbow is an overuse injury to the tendons of the forearm muscles. Overuse leads to degenerative changes in the tendons, which stimulate pain receptors, with the tendons also often in the state of inflammation. Golfer’s elbow is often a chronic condition of golfers, but is not exclusively associated with golf and the sports population – it is very frequent occurrence in vocations and tasks where above-average load is placed on arms (painting, using a computer mouse, screwing, carrying objects, gardening, vibrations, lifting weights).
Symptoms of golfer’s elbow include pain that is burning and sharp, occurs when clenching the fist and limits grip strength. The area on the inside of the elbow is often tender, with characteristic unpleasant pain on stronger palpation or manual pressure. Golfer’s elbow is characterised by pain spreading from the inside of the elbow down the entire inside of the forearm.
Golfer’s elbow occurs primarily due to poor biomechanics of the wrist, which means that the wrist positions are incorrect when performing arm movements (the wrong muscle units are overloaded during a particular activity).
A frequent cause of golfer’s elbow is poor preparation of the forearm muscles for the activities you are performing (the right muscles are overused, but overuse occurs relatively quickly due to poor training; we are talking about poor strength endurance and poor joint mobility). A frequent direct cause of golfer’s elbow is muscle asymmetry, which means that the muscles on one side of the forearm are disproportionately stronger or weaker than those on the other side of the forearm (often the muscles on the front of the forearm are stronger and shortened, while the muscles on the back side are relatively weak).
Symptoms of golfer’s elbow usually last from 6 to 16 weeks, and if conservative treatment is not performed, the problems can last for several years continuously or in occasional outbreaks of pain, seriously limiting your function. We often resolve cases of elbow problems that have been ongoing for several years because the condition was not treated with training but was mainly focused on pain relief.
Golfer’s elbow is treated systematically. First, we perform appropriate diagnostics by measuring muscle properties and look for potential causes of pain in muscle tightness, imbalances, or poor strength. Once we diagnose the causes of golfer’s elbow, we perform the appropriate number of treatments to reduce acute pain and prepare the body for subsequent treatment process through training.
For golfer’s elbow injuries, shockwave therapy performed by a physiotherapist expert is highly effective in reducing pain.
The key and longest phase of tennis elbow treatment is individualised kinesiotherapy, which improves the functional muscle imbalances diagnosed during the initial examination and thereby eliminates the primary causes of golfer’s elbow.
A characteristic of the golfer’s elbow pathological condition is that cases where the patient does not persist in the phase of treatment of the causes, i.e. in the muscle strengthening phase, develop recurring elbow problems once the pain subsides. Treatment of an injury is not completed when the symptoms, i.e. pain, disappear. The injury is healed when the causes of the injury are finally eliminated.
Climber’s elbow refers to pain that occurs on the inside of the elbow. Climber’s elbow is a chronic inflammation of the elbow flexor attachments, most commonly the brachialis muscle group, which attaches to the ulnar tuberosity, and less commonly the biceps muscle group, which attaches to the radial tuberosity. In both cases, we experience severe pain on the front or inner side of the elbow.
Climber’s elbow is an overuse injury to the tendons of the forearm muscles. Golfer’s elbow and climber’s elbow are not the same pathological condition, although both cases are a tendinopathy. Golfer’s elbow involves inflammation of the tendons of the muscles that flex the wrist, while climber’s elbow involves inflammation of the tendons of the muscles that flex the elbow. In both cases, the pain is on the inner or front side of the forearm, except that in golfer’s elbow it is located slightly higher and more superficially, while in climber’s elbow it is a few centimetres lower and deeper. Overuse leads to degenerative changes in the tendons, which stimulate pain receptors, with the tendons also often in the state of inflammation.
Climber’s elbow is often a chronic condition of climbers, but is not exclusively associated with climbing and the sports population – it is very frequent occurrence in vocations and tasks where above-average load is placed on arms (painting, using a computer mouse, screwing, carrying objects, gardening, vibrations, lifting weights).
Symptoms of climber’s elbow include pain that is burning and sharp, occurs when clenching the fist, lifting loads, and dragging loads with arms, and limits grip strength. The area on the inside of the elbow is often tender, with characteristic unpleasant pain on stronger palpation or manual pressure. Climber’s elbow is characterised by pain spreading from the inside of the elbow down the entire inside of the forearm.
Climber’s elbow occurs primarily due to poor biomechanics of the upper arm muscles, which means that the wrist and elbow positions are incorrect when performing arm movements (the wrong muscle units are overloaded during a particular activity). A frequent cause of climber’s elbow is poor preparation of the forearm muscles for the activities you are performing (the right muscles are overused, but overuse occurs relatively quickly due to poor training; we are talking about poor strength endurance and poor joint mobility). A frequent direct cause of climber’s elbow is muscle asymmetry, which means that the muscles on one side of the forearm are disproportionately stronger or weaker than those on the other side of the forearm (often the muscles on the front of the forearm are stronger and shortened, while the muscles on the back side are relatively weak).
Symptoms of climber’s elbow usually last from 6 to 16 weeks, and if conservative treatment is not performed, the problems can last for several years continuously or in occasional outbreaks of pain, seriously limiting your function. We often resolve cases of elbow problems that have been ongoing for several years because the condition was not treated with training but was mainly focused on pain relief.
Climber’s elbow is treated systematically. First, we perform appropriate diagnostics by measuring muscle properties and look for potential causes of pain in muscle tightness, imbalances, or poor strength. Once we diagnose the causes of climber’s elbow, we perform the appropriate number of treatments to reduce acute pain and prepare the body for subsequent treatment process through training.
The last, key and longest phase of climber’s elbow treatment is individualised kinesiotherapy, which improves the functional muscle imbalances diagnosed during the initial examination and thereby eliminates the primary causes of climber’s elbow. A characteristic of the climber’s elbow pathological condition is that cases where the patient does not persist in the phase of treatment of the causes, i.e. in the muscle strengthening phase, develop recurring elbow problems once the pain subsides. Treatment of an injury is not completed when the symptoms, i.e. pain, disappear. The injury is healed when the causes of the injury are finally eliminated.
Bursitis is an inflammation of a bursa, small sacs located between a tendon and a bone. Bursae reduce friction between tendons, muscles, and other joint structures and improve joint mechanics, resulting in smoother movement. Elbow bursitis, also called olecranon bursitis, is caused by a build-up of fluid behind the elbow, where the elbow bursa is located. Elbow bursitis is more common with age and usually affects the male population on the dominant upper extremity.
The cause of elbow bursitis is unknown, but risk factors include chronic physical overload and traumatic injuries to the elbow joint. The acute form of elbow bursitis usually occurs after high exertion or specific loads. Chronic elbow bursitis that lasts for several months is usually related to previous, repeated traumatic injuries to the elbow.
Symptoms of elbow bursitis include a sponge-shaped swelling at the back of the elbow. Often, the swelling seemingly appears out of nowhere, or you do not remember exactly when the outwardly visible symptoms began to appear. Inflammation of the elbow bursa can be accompanied by pain, swelling, and tenderness in the area of the affected joint. Discomfort and pain usually occur during stretching and loading of the elbow joint or directly from blows and pressure on the back of the elbow. Chronic elbow bursitis can lead to fibrosis of the joint and limit its mobility.
A reliable diagnosis is made by puncture and analysis of the fluid in the swollen bursa, after ruling out the possibility of infection and crystal deposition in the elbow. An X-ray scan is used to rule out bone fractures, while magnetic resonance imaging (MRI) is not necessary in cases of suspected elbow bursitis, except in cases of atypical symptoms and uncertainty about the diagnosis.
Treatment includes therapy with nonsteroidal anti-inflammatory drugs and systematic individualised physical therapy. Activities that place excessive load on the elbow, impacts and pressure on the back of the elbow should be avoided.
Conservative treatment is recommended, which includes specialised exercises to correct asymmetrical patterns of elbow muscles and therapeutic techniques such as friction massage, laser therapy, and magnetic therapy. In rare cases, steroid injections and surgical treatment are also used to treat advanced forms of elbow bursitis. If elbow bursitis is not treated, it can lead to calcium deposits in the soft tissues in the long term, and thus permanent impairment of the joint. With appropriate conservative physical therapy, most patients’ symptoms improve within 6 to 10 weeks.
