Managing Elbow Pain in Athletes: Expert Tips

By Bruce Steinberg, MD

Exploring Elbow Pain in Athletes

Elbow pain in athletes is a common concern that can significantly impair their performance and overall well-being. Whether you’re a seasoned professional or a recreational player, understanding the origins, signs, and treatment options for elbow injuries is crucial. This article explores the common causes of elbow pain in athletes, the signs and symptoms of common elbow injuries, available diagnosis and treatment options, as well as strategies for prevention and recovery.

At joionline.net, our mission is to provide valuable resources and expert advice to help athletes overcome elbow pain and achieve peak performance. Continue reading for a comprehensive understanding of elbow injuries and the necessary steps towards recovery.

Injuries are a very common part of athletic injuries, and elbow pain in athletes is a common injury. There are many sports that have colloquial names for the commonly associated injuries that sport. Most people have heard of tennis elbow which refers to pain along the lateral aspect of the elbow with a backhand maneuver. The lateral side of the elbow is the point farthest away from the body with the arm held at the side (tennis elbow will be discussed in more detail later).

The Elbow Joint

The elbow is a well-fitted hinged joint which allows for a very small amount of excessive motion or toggle. The bony complex of the elbow allows for two complex motions including elbow flexion and extension as well as pronation and supination. Pronation of the right forearm is the motion used for loosening a screw with a screwdriver, whereas supination is the motion used for tightening a screw with a screwdriver.
A fully functioning elbow is extremely important to facilitate the use of the hand. The complex wide motions of the elbow allow the hand to be placed in space for grasp, pinch, and pushing activities. Injuries of the elbow involve muscles, ligaments, tendons, capsules, bones, and articular surfaces as well as nerves.

In order to diagnose elbow injuries, clinical examination is performed as well as obtaining X-rays and obtaining a magnetic resonance imaging (MRI) study. MRI has allowed for better visualization of the soft tissues about the elbow joint.  Therefore, improvements are made in our ability to diagnose overuse problems such as tennis elbow (lateral epicondylitis). In addition to MRI, minimally invasive surgical procedures have shown improvements in our ability to both treat and diagnose elbow problems.

Understanding the Causes of Elbow Pain

Elbow pain in athletes can stem from several factors. Identifying these causes is key to preventing further injury in elbow and ensuring proper treatment. Some common causes include:

Overuse injuries: Athletes involved in activities requiring repetitive elbow movements, such as throwing or swinging a racket, are susceptible to overuse injuries. These are common elbow injuries where the elbow’s surrounding muscles, tendons, or ligaments become strained or inflamed due to excessive stress.

Impact injuries and trauma: A direct blow to the elbow or a fall can cause impact injuries, leading to pain. These injuries of the elbow can range from mild sprains or strains to severe conditions like fractures or dislocations.

Improper technique and form: Incorrect form while performing sports or exercises can put unnecessary strain on the elbow. Poor biomechanics, like improper throwing or swinging, can lead to overloading of the elbow, causing an elbow joint injury.

Muscle imbalances and weakness: Imbalances and weakness in the upper body can contribute to elbow pain in athletes. When certain muscles are stronger than others, it can create an imbalance in the forces applied to the elbow, causing discomfort and damage to elbow.

Addressing these underlying causes through physical therapy, rest, proper technique, and strengthening exercises can alleviate pain, promote healing, and prevent future elbow injuries. Persistent or severe elbow pain should be evaluated by a physician for a proper diagnosis and personalized treatment plan.

Recognizing Common Elbow Injuries

Elbow injuries are common in athletes, especially those involved in sports requiring repetitive throwing or gripping. Early diagnosis and effective treatment hinge on recognizing the signs and symptoms of common elbow injuries. Key indicators include:

Pain during activity: Pain during activities like throwing or gripping should raise concerns about potential injuries. This pain can vary from mild discomfort to sharp, intense sensations indicating an elbow injury.

Swelling and inflammation: An injured elbow may swell and feel warm, often accompanied by redness and tenderness around the joint.

Limited range of motion: Injuries of the elbow can decrease the ability to fully extend or flex the arm, leading to stiffness or restricted movement.

Weakness and instability: A weakened grip or instability in the elbow can indicate an underlying injury in elbow. Athletes may struggle with strength-requiring activities or find it challenging to maintain control over objects in hand.

If you’re experiencing any of these signs, consult a medical professional specializing in sports injuries. They can conduct a comprehensive evaluation and recommend suitable treatment options to help you recover from an elbow joint injury and prevent further damage.

Sport Related Elbow Injuries

Baseball

Baseball elbow injuries occur secondary to stresses placed across the elbow during pitching.  This can cause a traction injury along the medial (the side of the elbow closest to the body when held at the side) aspect of the elbow. This injury can lead to instability of the elbow, leading to a surgical reconstruction. Many youth baseball players who do not take a break from the sport may experience baseball elbow. Many are aware of Tommy John, a former pitcher for the Los Angeles Dodgers, who underwent a medial collateral ligament reconstruction for elbow instability for this particular type of problem.

Tennis Elbow

Please watch this informative video on Tennis Elbow

The most common elbow injury that will occur is lateral epicondylitis.  It can also be caused by repetitive activities that occur in the workplace. Anyone who has had this problem knows that this can be a chronic debilitating problem. It can make it difficult to even perform the small activities of daily living such as lifting a coffee cup. This injury occurs most often in tennis players ages 35 and 50 who play 3-4 times per week.

Causes of Tennis Elbow

Several factors have been attributed to causing tennis elbow including:

• Heavier, stiffer, and more tightly strung racquets.
• Incorrect grip size.
• Metal racquets.
• Inexperienced players.
• Poor technique, especially backhand.

Advanced tennis players who warm up, use good technique, and are well conditioned rarely endure this problem. The treatment for tennis elbow (lateral epicondylitis) is similar to many other overuse syndromes. To do this, one must rest the elbow but still maintain cardiovascular fitness. Ice, elevation, and compression also can be helpful along with non-steroidal anti-inflammatory medications.

Diagnosing and Treating Elbow Pain

An accurate diagnosis is key to determining the appropriate treatment for elbow pain in athletes. This involves a thorough physical examination, including an assessment of the elbow’s range of motion, strength, and stability to identify any elbow joint injury.

Imaging tests, such as X-rays and MRIs, play a crucial role in diagnosing elbow pain by detecting bone abnormalities, fractures, or giving a detailed view of soft tissues like tendons, ligaments, and muscles which can lead to injuries of elbow.

Non-surgical treatments, such as rest, ice application, and physical therapy, are often the first line of defense against elbow pain. A qualified physical therapist will develop a personalized treatment plan, including exercises and manual techniques, to cater to the athlete’s specific needs and address the injured elbow.

In some cases, surgical intervention may be necessary to address underlying issues causing elbow pain. Procedures like arthroscopy, ligament reconstruction, or nerve decompression can repair damaged structures and relieve pain. A comprehensive rehabilitation program following surgery is crucial to restore the elbow’s range of motion, strength, and functionality, and to recover from an elbow injury.

Physical Therapy for Tennis Elbow

Rehabilitation should include stretching of the muscles that insert at the level of the elbow. In addition, several new modalities are now available to the therapists. Modalities including high voltage galvanic electrical stimulation and laser. Certainly, changing one’s technique such as a poor backhand in tennis and modifying or improving one’s equipment can be very helpful for elbow pain in athletes.

If after several weeks the above treatment fails to improve the patient’s pain, consideration of an injection is an option.  An injection with a steroid deep into the extensor tendons that insert at the level of the elbow can be helpful. Many also use a so-called “tennis elbow strap or brace.” Essentially, this is a band that you wear over the forearm region close to the elbow.  By applying force across the muscle reduces abnormal tension of the muscle tendon unit at its origin.

Surgical Intervention for the Elbow

If the above treatments fail and an MRI demonstrates a pathological lesion, consideration of surgical intervention is then undertaken. The surgery includes a small incision with excision of the degenerative tendinous tissue at the level of the elbow. There is an increase to the blood supply to the region by placing small drill holes into the bone. Then normal muscle is rotated from nearby to replace the excised compromised tissue. The rehabilitation post-operatively from this particular procedure takes several months to return to a previous high level of play. The success rate, however, is very high. Above 85% returning to full activity without pain, 12% with lower symptoms but with some pain with vigorous activities and 3% showing no improvement.

Preventing Elbow Pain and Aiding Recovery

Effective prevention and recovery from elbow pain in athletes involve certain strategies. These guidelines can reduce the risk of injuries of the elbow and enhance performance:

1. Thorough warm-up and stretching: A comprehensive warm-up routine before exercise increases blood flow to the muscles and prepares them for physical activity. Dynamic stretching exercises can improve flexibility and range of motion in the elbow.

2. Gradual training intensity progression: Avoid sudden increases in training intensity to prevent excessive stress on the elbow. Gradually increase workout duration, frequency, and intensity to allow the body to adapt and build strength.

3. Sport-specific conditioning exercises: Conditioning exercises that mimic the demands of the specific sport can develop necessary strength and stability in the elbow’s surrounding muscles. These exercises can help prevent an elbow joint injury.  The core muscles are often overlooked with throwing athletes.

4. Post-injury rehabilitation and strengthening: Following an elbow injury, proper medical evaluation and guidance are crucial. A comprehensive rehabilitation program, including exercises to improve range of motion, strengthen muscles, and address any underlying imbalances, can aid recovery and prevent future injuries of elbow.  It is important to also have your biomechanics looked at if you are a throwing athlete.

By following these strategies, athletes can minimize the risk of elbow pain and maintain peak performance.  We hope that this article will help you manage and prevent elbow injuries.

Related Articles

To learn more about tennis elbow, please go to lateral epicondylitis tennis elbow and throwing injuries of the elbow. 

Conclusion

The elbow joint is a complex anatomical structure that allows for precise placement of a hand in space. Athletics and many activities of daily living subject the elbow to great stresses that result in a wide variety of injuries. With the recent advances in diagnosis with MRI and with the procedures such as elbow arthroscopy, we have improvements in our ability to diagnose and treat elbow problems.

By: Bruce Steinberg, M.D.

Dr. Bruce Steinberg is a graduate of the University of Pennsylvania and Harvard Medical School. His residency was completed at the Harvard Combined Orthopaedic Surgery Program. Followed by a fellowship in Hand and Microvascular Surgery at the Indiana Hand to Shoulder Center. Board Certification by the American Board of Orthopaedic Surgery.

If you would like to learn more about throwing injuries, please watch this video.  JOI has several orthopedic physicians who specialize in the treatment of elbow injuries.  Our expert team of physicians work closely with our JOI Rehab clinicians to get you back to doing the activities you love.  We are here to help you!  If you have any questions, please feel free to give us a call.  To schedule for physical therapy, please call 904-858-7045.

Finally, to schedule an appointment with Dr. Steinberg, please call 904-JOI-2000 or click the photo below.