The elbow, like most of the bodys joints, exhibits what are called accessory movements, small gliding and sliding movements which occur inside the joint during movement but which cannot be performed independently. These small movements are essential to the function of a joint and are easily disturbed, reduced or lost in injury or long term postural abnormality. The elbow has small, hardly noticeable movements in a sideways direction as the joint gaps slightly under pressure. This small gapping does not contribute greatly to the positions attainable by the wrist or hand but does make a functional contribution.

These little accessory movements may not seem to be able to make a difference to the use of the elbow joint but they can permit a slight lengthening of the extensor muscles of the wrist when we are trying to adjust our arm position to get hold of something. If a muscle is stretched slightly this increases the contractibility and thereby its function. In this case the extensor muscles can extend the wrist more successfully to allow the flexor muscles to apply grip strength.

Should the opposing muscle group, the flexors, dominate then the extensor muscle origin can become shortened and tight to a degree, limiting the ability of the extensor muscles to adapt wrist positions for useful holding and gripping. The radial head, normally rotating in its radial ligament, confers the precise positioning required to allow the hand to be placed and used in a huge variety of positions.

The two dominant movement patterns we perform again and again every day for hundreds of repetitions typically are turning the forearm over so the hand is palm up and pulling the wrist back with the palm down. Both the main muscles which are concerned with these very common actions originate from the same anatomical location on the outside of the forearm near the elbow. Overuse of these muscle groups can lead to increased tone in this lateral compartment of the elbow, causing shortening and loss of elasticity of the tissues. A cycle of tightening, muscular compensation and further tightening can develop.

If the arm is used for many actions and over some time in a bent position so the wrist is extended and the elbow flexed this can cause a mechanical disadvantage as the wrist extensors are slackened off and so can exert less force. A typical activity of this sort is piano playing and use of a computer mouse. If the muscles have to continually try and recover from ongoing posture stresses which persist for a long period they can shorten close to their origin. With time this sets the elbow up for the small event which will be the last straw and alter the achy, annoying problem into an acute, terrible pain.

Tennis elbow is a common condition and typically develops as described above. It can come on acutely out of the blue after someone does an excessive amount of work, stressing the elbow very heavily and causing local injury and inflammation. More commonly there is a slow and longer term development of problems followed by a more sudden acute episode as a sudden stress is applied. Playing the backhand stroke in tennis is a particularly troublesome action to stress the common extensor origin but many other actions can produce the same result.

Over tight muscles in the extensor origin are opposed by the strength of the gripping and holding applied, in cases causing an overstress to the junction between the bone and the tendon and local tearing of tissues from the bone. As a process this can repeatedly occur, with the initiating stress becoming less and less and the pain results becoming more troublesome and long-lasting. As the small scars continually form they contract and add to the local tightness and so the likelihood of painful stretching. Tennis elbow pain can be very severe so that it interferes with activities of daily living.

Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Bolton visit his website.

Tags: alternative medicine, back injury, Back pain, back pain relief, Fitness Tips, Frozen Shoulder, health, injury management, pain management, physical fitness, physiotherapists, physiotherapy, Piriformis Syndrome, sciatica

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