The elbow joint is made up of the humerus, radius and ulna bones with muscle and tendon support from forearm and upper arm muscles crossing the joint at the front, back and sides. Deeper down ligaments also offer support on both sides. We also have 3 nerves (radial, median & ulnar nerves) crossing the elbow joint in various locations that initiate sensation and movement as far as the hand and fingers.
Elbow pain can come from all of the above structures including overuse, different types of arthritis, ligament strain or tears, inflamed bursa, nerve entrapment and from bone fractures. It can also be referred pain from muscles and nerves of the neck, shoulder, upper arm, forearm and wrist. Often pain is from muscles over working to protect from things like poor posture, poor work habits or not enough supportive strength in other areas. Read on to learn more about different types of elbow pain and some tips on how to get pain free!
What can cause elbow pain?
Pain can often come from overuse injuries affecting muscles and tendons. Tennis (lateral epicondylitis) and Golfer’s elbow (medial epicondylitis) are common diagnosis you may have heard of but the biceps and triceps tendon can also suffer from overuse with gym workouts, holding a iPad for too long, etc… Don’t let the names Tennis and Golfers elbow fool you into thinking you must play these sports to be affected by this types of tendon issues. They can come on from many different activities including gardening, household chores and gym workouts to name a few.
Arthritis such as osteo, psoriatic and rheumatoid can lead to inflammation and pain as well as joint stiffness. Even in cases of mild arthritis this can lead to muscles tightening to protect the joint. This tightening of the muscles is a nervous system response and is often more the cause of pain than the arthritis itself.
The medial and lateral ligaments can be sprained or torn usually from trauma such as a fall or sporting injury. They can also occur in loaded overhead activities such as gymnastics hand stands. In this case there is often weakness of the muscles around the elbow and shoulder involved.
Bursa are situated all over our bodies to cushion and protect our tendons from rubbing and wearing out against the bones. Bursitis is when these bursa become inflamed and enlarged. The olecranon bursa sits at the back of the elbow and when inflamed results in a big egg shaped lump on the back of your elbow. Mild bursitis can be a cause of pain without the lump as well. This can result from overuse or even leaning on your elbows too much!
Nerve entrapment can cause elbow pain not only from the radial, median or ulnar nerve as they pass through the elbow region but also from higher up entrapment around the upper arm, shoulder or neck. Depending on the degree of nerve irritation you may experience sensations such as burning, tingling, pins and needles, achy pain, or sharp pain. You may also have weakened muscles and reduced reflexes.
Referred pain is very common to the point where in the treatment room this is one of the first things we rule out after we have assessed the elbow. The neck, shoulder area, upper arm, forearm and wrist can all refer pain into the elbow. This pain can present as an ache or sharper pain can be quite specific or broad. To help your elbow pain in this case, the underlying cause will need to be addressed rather than focusing on the elbow itself. This can be quite confusing and frustrating as the elbow pain can have you very convinced you have a elbow problem.
Bone fractures from a traumatic fall or blow to the elbow tend to result in a deep dull ache that is worse at night and on movement. Sometimes it is worth ruling out a fracture early on in your case history if you have had a fall or some kind of trauma to the elbow.
Our Top 3 Tips for Elbow Pain
So you’ve ruled out anything serious with the elbow and are now looking for ways to improve range of movement and decrease pain. Often the elbow will over work when other structures that work together with the elbow such as the shoulder and the upper back are weak.
Tip 1 – Check your posture & technique
No amount of treatment will compensate for poor performance posture or technique. This doesn’t mean you have to sit bolt upright all the time however your muscles and nerves will work more efficiently during activities of work, daily living and leisure when we have good performance posture. In relation to the elbow this might mean making sure your desk is set up correctly for work or that you are using your core, good squat technique and strong shoulders when doing things like gardening.
Tip 2 – Stay stronger than your needs
As an example, if you love golf but can’t get out and play very often, you need to keep all your golfing muscles nice and strong to avoid injury. Staying stronger than your favourite sport, hobby or work activity will ensure the right muscles and nerves will be functioning at top capacity when you need them to.
Tip 3 – If it’s not improving, seek professional guidance
There’s plenty of info on the web these days of spots to trigger point, stretches to try as well as heat, ice and gels but the golden rule is if you’ve tried a few things and it’s not improving, have your problem properly assessed by a musculoskeletal expert such as a Clinical Myotherapist. The longer you leave certain conditions, the longer the road to recovery. Most things take 1-3 sessions to work out what’s going on and to build a successful remedy routine for you. That’s a lot cheaper than waiting and ending up needing braces and strong pain medication or MRIs and specialist appointments.
Did you know Sciatica or Sciatic Nerve pain is a term used to describe a set of symptoms caused by an underlying medical condition; it is not a medical diagnosis. It may refer to a sharp or burning pain that radiates down the legs from the buttocks.
For you to have true Sciatica, the actual Sciatic nerve needs to be compressed which only can be proven through an MRI.
Common medical conditions that may cause Sciatica type pain include:
Lower back or hip spasm and movement restriction
Muscle referral pain in your gluts, hamstrings or back
Bulging or irritated disc
Sacroiliac joint dysfunction
Lumbar spondylolisthes In most cases, the pain will affect just one side of the body.
Rarely, tumors, blood clots, or other conditions in the lower spine may cause sciatica.
SYMPTOMS OF “SCIATICA”?
A tingling feeling, known as pins and needles
A burning sensation in the leg
LET US HELP?
Try not to sit with your legs crossed.
Strengthen your Glut muscles
Heres the link for Glut Strengthening program 1 -Follow along with MyoThrive Practitioner Sarah and start to strengthen your glutes! For beginners and advanced alike. Learn how to self massage the knots away, activate the glutes to fire them up and then embrace the burn!
Did you know you can change your pain at a cellular level by how much knowledge you have about your pain? Its called Pain Re- education which turns into Cellular Adaptation. Yes, the more you know, the more you feel better. Ignorance isn’t bliss when it comes to your pain.
Current day research states, how we think about our pain can change the way it feels and how we respond to it. So lets make a conscious effort to understand pain and gain control over it.
“1 in 4 experience persistence pain”… its time to relearn your pain and tame the beats.
Did you know?, pain isn’t an actual representer of tissue damage, it is a protector. Unfortunately due life stimuli and pre-learnt predictions our pain system can be overprotective and always hurt!
“You can have pain without any physical stimuli. Thoughts and places might activate the warning signals.”
How do you know when your nervous system is learning pain? Your pain may spread or come on without warning. You are more sensitive to other life variables like sleep and movement that cause pain. When your nervous system is over active, you need to recondition it and calm it down so it can work better. In other words your body needs to unlearn your persistent pain pathways.
How can you tame the beast? Pain is a very personal thing. Theres not one size fits all strategy. Modern day medicine states the new approach to reducing your pain. One that involves re training your pain system. Moving more and being honest about your current views and attitude towards pain. The more you know, the more you can help yourself with the tools your physical therapist and you have come up with.
Flippin’ our understanding of pain
Another resource that complements what you’ve learnt from the above video and description is from a UK team that has started a campaign called the “Flippin’ Pain Formula”. It goes through 5 well researched messages and explains these concepts to you in different ways, so you can better understand pain.
Here are the 5 key concepts of the “Flippin’ Pain Formula” –
Persistence pain is COMMON and can affect anyone
HURT doesn’t always mean harm
EVERYTHING matters when it comes to pain
MEDICINE and surgeries aren’t always the answer
UNDERSTANDING your pain can be key
RECOVERY is possible
Click the link below to access these resources to help gain the knowledge you need to fix your pain.
Got something from this blog? By explaining what you’ve learnt increases your chances of this new information making cellular adaptations long term in your brain! There are so many resources out there to help YOU retrain your pain system. Reach out if you want to know more and need some guidance on where to start.
Its time to rethink pain!
REFERENCES – Flippin Pain Formula and Tame the Beast.
Chronic stress can be damaging to our bodies. It can affect respiratory, cardiovascular, digestive and even reproductive systems. But did you know that chronic stress also impacts the musculoskeletal system?
– The mechanism of stress in pain –
When stressful situations arise, the body’s response is to go into a ‘flight, fight response to protect itself against harm or injury. Physically this can be seen through tightening and spasming of muscles. This is an automatic reflex response, where the muscle tension will generally ease once the stressful situation has passed.
Why does the muscle still remain in spasm after the stress has gone?
Sometimes in the case of ongoing chronic stress, the body may have set into a cycle of pain even after the painful stimulus or stress has gone. It protects itself by staying in pain and so when stress arises again the body is already ‘protected’.
This can lead to a range of conditions such as:
Movement dysfunction – Restriction and pain on normal daily activities
Muscular spasm and muscle weakness
Headaches, migraines and Jaw pain
Neck, back and shoulder pain
The pain cycle can lead to further negative patterns
For example, fear avoidance is where a person with chronic stress and pain will start avoiding more and more things to try and stop triggering pain or stress, even though these activities may not be related. This in turn usually decreases physical activity, increases low mood and leads to further patterns around pain. This will continue in a downward spiral until something breaks the cycle.
– How to relieve pain related to stress –
The earlier we assess and treat when the body is stressed both physically and mentally, the less likely the body will get into a pain cycle. Early intervention is key!
Stopping the pain progression
If your pain has lasted more than 6 months, seek the advice of your health care professional. This is to make sure you don’t need a scan, a specialist referral or medication to help break the pain cycle.
During your consultation an assessment will be performed through movement and orthopaedic test. The key is to find out what is going on so we can offer better treatment and management advice. Often during the movement testing we discover something that can help you at home.
If a helpful, pain relieving movement is found, we will explain the what’s going on so you better understand your pain. Its really empowering! If we don’t find a movement that helps we will move on to some treatment.
Treatment can include Massage, Dry Needling, Joint Mobilisation and Cupping to name a few. As Clinical Myotherapists we have a wide range of tools in our tool kit we can draw upon. This step is about assisting the movement therapy further by reducing pain and increasing movement. Oftentimes we can get more out of the movement therapy after treatment intervention.
Lastly a Remedy Routine is given to you which outlines what you will continue doing to get out of pain. It will detail your movement therapy and may include stretches and strengthening but usually that comes a bit later. We will stay in touch via email to closely monitor progression and follow up in about a week initially to stay ahead of your pain cycle and progress your remedy routine.
– Stress reduction –
Stress reduction is an important part of reducing your pain. Things that can help reduce stress include exercise, meditation or mindfulness and talking about your problems with a friend. Sometimes the help of a Counsellor or Psychologist to learn new coping strategies or CBT for example can be very helpful.
Article by Dwan Rosairo & Sarah Hall (BHSc – Clinical Myotherapy) – If you’d like to chat, click here to book a free 15 minute consultation or book a full consult here.
Headache relief comes from a thorough assessment. We can tell in the clinic if your pain is musculoskeletal by taking a history of your headaches and assessing your joints, muscles and nerves. If we see anything of concern, we will refer you to your doctor with a letter of findings.
“more common in women than men”
Is one of the most common symptom experienced by humans. Headaches are usually harmless but can sometimes be a pointer to a more serious illness. That is why, it is always a good idea to see your practitioner or doctor to clear any serious.
“Normally the severity of the headache bears no relation to the gravity of the diagnosis” Dr. Spira.
The assessment involves differentiating between the most common forms of headache and those that may indicate an underlying illness. Here are some categories of the type of headaches:
Normal headaches eg. food reaction, exercise induced, fasting induced
Recurring headaches eg. tension the headaches, migraine, cluster headache
Nerve headaches eg. direct nerve compression – Trigeminal Neuralgia
Muscle contraction headaches
Medication misuse headaches
Head injury headache
Serious cause of headaches eg. Brain tumour
While there is no absolute cure for headaches, they are generally musculoskeletal in nature and therefore there are heaps of treatment options. PLEASE CONSULT YOUR DOCTOR IF TREATMENT OPTIONS AREN’T WORKING.
Some can be taken to prevent a headache from happening and some when the patient has a headache. CONSULT A DOCTOR FOR ADVISE ON THIS.
Other therapies – Myotherapy
Here are some factors we look at in your Myotherapy session with us –
Where is your pain? (Muscle tension can cause headache type symptoms = this tells us what muscle the headache might be coming from)
Do you grind/clench your teeth? Do you have jaw pain? (Jaw muscle tension can cause neck and head tension)
What activities/movements are you doing when the pain comes on? What repetitive movements do you do in your day?
How is your car, TV and desk set up?
Are there any movement faults in your neck/ upper body/ shoulder that we need to restore? (healthy joint = healthy muscle) Have your ever tried The Mckenzie Method?
Do you have pain at night / in the morning?
What pillow/ mattress do you sleep on? (Duck mattress and Therapeutic Pillows Australia)
What Medications are you on? (e/g/ The pill?)
Water intake? Nutritional reactions? Do you have any food intolerances?
Feel like you qualify in one or more of these dot points? Try spend some time fixing these and see if your headache gets better. We want to decrease the frequency/ intensity before getting rid of the pain all together. Book in a free 15 min chat to see if we can help you!
Migraine and Other Headaches 2000 Professor James Lance
Headaches 2000 Dr Paul Spira Health Essentials
Understanding Migraine & Other Headaches 2002 Dr Anne MacGregor
Headache 1999 British Brain & Spine Foundation
There are several reasons why you might experience pregnancy pains related to muscle, joint and nerve. Depending on where the pain is, the intensity of the pain and the type of pain will determine the best course of action to resolve your pain. If the following exercises don’t help or if your pain is intense, please get a consultation for personalised advice or visit your doctor. Furthermore If you are unsure of why you have pain (i.e. it’s an unfamiliar pain), if this is your first pregnancy or if your pain is severe, sharp, shooting, throbbing or deep you should see your doctor or specialist before all else.
Low Back Pain
This is the most common pregnancy pain we see at the clinic. The pain is usually right on the dimples at the very bottom of the low back. Sometimes there is referral up and down or across the low back as well. From how long women leave it before seeking treatment, I sense that there is a lot of pregnant ladies putting up with low back pain unnecessarily. Although low back pain is a common part of pregnancy and a lot of women experience it, this doesn’t mean you have to put up with it. Here in the clinic we find treating the gluteal and hip flexor trigger points together with some exercises and sometimes ROCK taping very effective. We treat either lying on your back, side lying or face down with a supportive belly pillow depending on how far along with your pregnancy you are, what area we are treating and depending on what you find most comfortable. We won’t keep you in any one position for too long and we will support you with pillows and towels where needed.
Try this exercise at home to see if it helps with your low back pain. Its purpose is to gently mobilise the spine allowing all the ligaments, tendons and muscles to get some blood flow and relax. If one way feels better than the other, you could try just doing one part of the cat stretch and finishing back at neutral spine (where the spine is in its natural position with the little dip in the low back).
On hands and knees gently curve your back towards the roof like you are trying to lengthen the back of your shirt. Make sure you softly drop your head as you get to the end of range.
Now do the opposite. Gently dip your stomach and ribs towards the floor this time softly lifting the head as you reach the end of your range.
Repeat 5-10 repetitions. Once you get the pattern working try moving one spinal segment at a time starting at the base of the spine and working your way up to the head. Try adding a breath, breathe out to move and take a breath in to prepare at either end.
Depending on how far into your pregnancy you are, the pregnancy rib pain your experiencing could likely be your baby pressing up against your rib cage, especially in your 3rd trimester if your baby is in the breech position. If this is the case, positional changes, heat and if really bad pain, paracetamol (at the recommendation of your doctor or specialist only) might be of assistance. The most common musculoskeletal cause of rib pain we see in the clinic however is from the change in spinal position. This is from changes to your centre of gravity along with increased levels of the hormone relaxin. This makes the deep supportive spinal muscles (multifidis & rotators) work harder and in a shortened position which activates their Trigger Points which so happen to refer around the ribs. If your pain seems to start at the back or side of the ribs and run around towards the front, this is the most likely cause of your pain. To help alleviate this pain at home, try the following stretch.
Side Lying Rib Rotations
Lie on your side and support yourself with pillows, cushions or towels as needed. One under the head, under the belly and between the knees is often helpful.
Bend your elbow of the arm that’s on top, drawing the elbow to the roof and sliding your hand along the lower arm.
If it feels comfortable open out further by extending the arm behind you until you feel a gentle stretch around the chest area.
Bend the elbow to gently bring the arm back through to the start position.
Repeat 10-15 times each side.
Notes: Shorter limbs make for lighter work, so always start with the elbow bent and lengthen it to increase the exercise. Don’t forget to breathe! Try a breath in for step 2 and a breath out for step 3. Then a breath in to hold and a breath out to come back to the start position.
Sciatica is a very common pregnancy pain. It can come from the lower back or from a deep muscle in your bottom called the piriformis muscle. Sciatica is distinguished by a pain starting around the bottom or hip area and travelling down the leg past the knee, sometimes as far as the ankle or the foot. During pregnancy the hormone relaxin increases making the ligaments soften. This increases the amount of load placed on your muscles, sometimes the muscles can cause the problem, other times you can end up hanging into new postural positions and putting a lot of strain on the joints especially around the lower back and hips which can aggravate the discs or nerve spaces in the lower back. We treat sciatica a lot in the clinic. Try the following exercise for the back and see if it helps.
4 point kneeling – The rock back
On your hands and knees make sure your hands are under your shoulders and your knees are under your hips. Also make sure you are in neutral spine (no dip, no curve).
Gently rock back towards your feet about half way then slowly return to the start position.
Repeat 10 -20 times remembering to maintain neutral spine the entire time.
There are several things that can cause hip and groin pregnancy pain depending on where the pain is therefore it is essential that you get a proper diagnosis before progressing with any exercises or stretches to help. A more serious causes of pain in this area is a DVT or deep vein thrombosis which is a type of blood clot. Some other things that can cause pain in this area are the round ligament, osteitis pubis, pubic symphysis irritation or inflammation and referral from the lower back.
In the clinic we mostly see people with pain relating to an imbalance of muscles around the pelvis and low back. Due to being right or left dominant in stance and exercises we tend to be a bit stronger on one side. As the relaxin hormone kicks in these muscles have to support your pregnant body more and more. If some muscles are stronger than others they start to play a game of tug of war which can cause pain in many different areas. We get people in who have already been diagnosed with things such as symphysis pubis, osteitis pubis, lower back disc irritation and round ligament pain just to name a few. Most people we see have more general aches and pains through the glutes, hips and groin and have not yet had a musculoskeletal diagnosis. We find either way, it comes back to this imbalance of muscles so our assessment, treatment and prescribed exercises will revolve around loosening off the tight muscles and strengthening the weak muscles. If there is inflammation we might use taping to help support to give the area a chance to heal. Taping is very safe during pregnancy unlike many anti-inflammatory medications.
One of the most common exercises I give to pregnant women is to strengthen their glutes and hamstrings. If you are still comfortable lying on your back try the first exercise, otherwise try the side lying exercise.
Pelvic Curl with Thera-band
Tie the band firmly around your thighs and lie on your back.
Place your knees and feet approximately hip width apart. Make sure your knee heights are the same before continuing, we want everything in alignment.
Next imagine dots on your shirt and pants where your spinal segments are. What colour are your dots?!
Press with 50% effort out into the band and peel one dot at a time away from the floor starting at the bottom and working you way up to your shoulders. This should take about a 5 seconds and is nice to do on a breath out.
Take a breath in at the top to prepare.
Breathe out to slowly return the dots back down to the mat, this time starting at your shoulders and working down towards your bottom, try not to skip the lower back and maintain the pressure out into the band if you can.
Repeat 5 repetitions the first time you do it and see how you feel the following day. Slowly add an extra repetition each day until you are doing 20 a day.
Sidelying leg kick with Thera-band
Tie the band around your thighs just above your knee and lie on your side supporting yourself with pillows particularly for the head and your belly.
Lift your leg to hip height then keeping your body steady, squeeze your glute muscles to take the leg behind you about 5-10 cms depending on your flexibility.
Slowly return it back to the start position and repeat 5 times each side. If you feel good the next day you can add 1 repetition each day until you are doing 20 each side.
I hope you’ve gotten something out of todays article on pregnancy pain. Please remember that these are not tailored exercises for you specifically so if your pain persists or gets worse please come in and see us or if serious problems with your doctor or specialist. Here at Waverley Myotherapy Clinic we use a pregnancy pillow so you may be able to lie face down, a real treat during pregnancy! Once you are too big for the pregnancy pillow we will support you with pillows in the sidelying position. If you have any questions please contact us.