Elbow pain can wreak havoc on our daily lives. It limits our ability to lift, grip, and open a jar. Even simple things like brushing your hair and turning a doorknob can be difficult and painful. We will do anything for relief, but sometimes the things we do are detrimental!
The 5 biggest mistakes that most people make when they have elbow pain:
1. Masking elbow pain with medication or even a steroid injection rather than addressing the problem.
Instead of covering up the symptoms with medication, you should address and CORRECT the problem.
The initial focus of care must be to determine the root cause of your pain, not cover up symptoms with medication. Pain is your body’s way of letting you know something is wrong. We can do more damage when we quiet pain with medication and cortisone injections without correcting what is wrong.
Pain relief is essential but uncovering and fixing the problem is critical. Often the initial insult gets better by itself, and that’s why medications are so popular; they buy time and allow the body to correct on its own. But we are left with not understanding what caused the insult – poor mechanics when using our elbow/wrist. We are prone to re-injury and worsening of the insult.
Whenever there is pain, we often blame inflammation. The first treatment is an anti-inflammatory or a steroid injection.
But inflammation is not the cause of intermittent pain. Pain from inflammation must be constant, like a toothache. Pain that is intermittent and only brought on with activity or when using your elbow is from a mechanical cause, NOT inflammation. Treating a mechanical problem with medication is the wrong treatment and can lead to a chronic condition.
Uncovering the actual cause of your symptoms is critical to receiving proper treatment.
Masking your pain with medication often leads to delayed healing and even worsening symptoms.
2. Settling for a general diagnosis of Epicondylitis
Elbow pain can be caused by trauma, overuse, infection, inflammatory conditions, and even referred from your spine. It is critical to have a thorough mechanical assessment to uncover the true cause of your symptoms. 43% of isolated extremity symptoms result from a spinal problem causing the nerve to refer pain to the joint. Those with elbow pain have a chance that their symptoms are referred from their neck. A proper assessment always starts with ruling out the spine.
Understanding the cause of your elbow pain is essential for proper treatment and to prevent reoccurrence. If you do not address the causative factor, you will continue to reinjure.
3. Using a Brace and Avoiding Activity
A short rest period is essential to remove the mechanical overload and allow the initial healing process. But complete rest is counterproductive as it leads to deconditioning and regression.
An overuse injury only requires a few days of rest, and then there should be a gradual return to activity.
Splits: Some patients need a period of complete rest, but this is rare than the norm. Splinting the wrist into extension (upward position for lateral Epicondylitis) does remove the stress and pain on the muscle-tendon as it attaches to the bone. But splints should only use this for a short time in severe cases. Splinting has led to delayed healing and has caused an increased rate of limited work duty, increased costs, more medical visits, and longer treatment time. When the tendon is frayed and damaged, it needs t to be stretched and strengthened to return to its normal state. Not using the muscle and tendon makes it weaker and more prone to reinjury.
Forearm Counterforce Straps: Straps apply compression to reduce the muscle pull, so there is less stress on the tendon. Straps do reduce some pain, but the evidence is lacking on whether they are beneficial to healing.
An “active rest period” is the best option for proper rehabilitation.
Active rest consists of continuing limited activity. Stretching and light strengthening exercises should also be gradually introduced. The goal is to remodel the healing tendon to its original flexibility and strength. A flexible and robust tendon is less likely to be reinjured.
4. Demanding an MRI for Elbow Pain.
MRIs are a highly profound picture of our internal structures and show a lot of detail. But they are still just a black and white picture. They do not indicate which structures are painful. It is like taking a picture of your phone’s circuit board. It may show water damage, but it cannot tell you if your phone is working or not. Only by using your phone can you tell if there are any problems.
An MRI may show arthritic changes and damage to your tendons, but we must be cautious when we automatically blame any changes we see as the reason for pain. Only a physical assessment of your elbow muscles, ligaments, and joints can determine what structures are painful and damaged. It is normal to have age-related changes in our joints, tendons, and bones as we age. Just like grey hair and wrinkles, many of these changes are asymptomatic. Relying on an MRI often leads to blaming age-related changes rather than taking the time to determine the actual cause of pain. A physical exam is much more accurate than an MRI in identifying the function of your muscles, tendons, and joints and if they are painful. A physical exam is the only way also to determine if the pain in your joint is referred from your spine or has a nonmechanical origin.
5. Taking a passive patient role.
Research has shown that the more involved you are with your care, the better the outcome. Healing is an active, not a passive process. Most current protocols for treating musculoskeletal disorders are passive, including medication, massage, injections, TENS, surgery…although these are all common treatments, research has only found questionable benefits. It has shown that the more passive care you receive, the longer you suffer and the higher your potential rate of chronicity and disability.
Instead, learn what caused your elbow pain, how to treat it, and what you can do to avoid re-injury!
Video overview: https://www.youtube.com/watch?v=QxG0x4JZovo&t=7s