Understanding Elbow Pain
Resolving Elbow Pain with Active Release Therapy
(Tendonitis, Epicondylitis, Muscle Strains & Joint Sprains, Chronic & Repetitive Stress Injuries)
Elbow pain can have a serious impact on our lives. It will not only make sports such as golf, tennis, or paddling difficult, but in many cases even simple activities such as lifting a bag of groceries, opening a door, and typing are painful and can greatly aggravate the condition.
Those who have been unfortunate enough to suffer these types of symptoms have often been subjected to wearing an elbow brace and changing their daily routines in an attempt to take the strain off the painful elbow with the hope of healing the condition. Others have sought various forms of treatment ranging from medication, ultrasound, electrical stimulation, stretches, and exercises, only to be continually frustrated and disappointed with the slow response to these approaches.
Now for the good news…..
A new treatment technique known as Active Release Techniques® (ART®) is proving to be a very effective method to treat many common elbow problems. But before we talk about how ART works so well for elbow pain, let’s first talk about how the elbow becomes painful in the first place.
How Does Elbow Pain Occur?
All musculoskeletal injuries, including elbow injuries, occur through one simple principle, the load (i.e. the physical stress or strain) placed on an anatomical structure exceeds that structures capacity to tolerate that load. This seems logical to most people when thinking about traumatic injuries such as muscle tears or broken bones, but what most people don’t realize is that the damaging and excessive loads do not have to happen all at once. Instead, many injuries are categorized as overuse or repetitive strain injuries, meaning pain and tissue damage are not the result of strain or overload from a single event, but instead occur as the musculoskeletal system (in this case the elbow) is exposed to a large number of sub-maximal forces over weeks or months. In these cases, tissue damage occurs slowly over time, eventually accumulating to a critical point in which symptoms are felt. This is why in most cases it is difficult to trace the pain or symptoms back to a specific incident or event.
To better understand the occurrence of overuse injuries it is important to realize that there is a significant amount of stress placed on the muscles, tendons, and ligaments of the elbow on a regular basis. Even simple activities such as gardening, carrying a bag of groceries, or typing on a computer requires elbow and forearm muscles to work hard in a effort to move and stabilize the bones of the wrist and elbow. With sports such as golf or tennis the demand on the elbow is even greater. If any of the muscles of the elbow or forearm become tight or weak it will place excessive strain on the other muscles and on the elbow joint itself.
How does damage accumulate in the muscles, tendons, and ligaments?
Over time the strain on the elbow can develop into what is know as micro-trauma. Simply stated, micro-trauma is very small scale damage that occurs in the muscles, tendons, and ligaments in response to small levels of strain. Although only small, and initially is not painful, this damage still needs to be repaired, which the body does by forming new tissue in and around the injured area. This new tissue, often referred to as scar tissue or soft tissue adhesions, is very sticky and acts to ‘glue’ the damaged tissues back together.
Unfortunately, over time this scar tissue can build-up and accumulate in the muscles, tendons, nerves, and ligaments of the elbow. As this happens it places more and more strain on the area as the muscles must now stretch and contract against these adhesions (normally muscles need to be able to move and slide against each other, but these adhesion act to ‘glue’ them together…. this is a big problem). This in turn places even further strain on the elbow, which leads to even more micro-trauma. Essentially a repetitive strain injury cycle is set-up causing continued adhesion formation and further increased strain. At this point pain and tightness at the elbow, forearm, and even the wrist will start to become noticeable.
As this repetitive strain injury cycle continues the ability of the elbow muscles to meet the demands placed on them diminishes. At this point it is not uncommon for the muscles to give way and a more severe and debilitating pain occurs (this is very common with injuries such as tennis elbow or golfers elbow). In fact, many patients come into our office explaining how they have elbow pain but they did not really have any major type of injury occur. When further questioned these patients often describe some mild pain or tightness in their elbow or forearm that has been building over time. As you can see from the explanation of the repetitive injury cycle, these types of injuries build-up over time until it eventually develops into larger scale injury.
How Can These Elbow Problems Be Fixed?
The Traditional Approach….
Some of the more common approaches to elbow pain include include anti-inflammatory medications, rest, ice, ultrasound (US), muscle stimulation (E-Stim), wearing braces around the forearm or elbow, and stretching or strengthening exercises. The main reason that these approaches are often ineffective is that they fail to address the underlying scar tissue adhesions that develop within the muscles and surrounding soft tissues. It is these adhesions that are binding the tissues together, restricting normal movements, and interfering with the normal flexibility and contraction of the muscles around the elbow.
Passive approaches such as medications, rest, ice, and ultrasound, all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as stretching and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles, however, they themselves do not treat the underlying adhesions. In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery.
Our Approach: Active Release Technique® – A Better Solution
Active Release Techniques® (ART®) is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. What makes ART® different from other treatments is that it is designed to identify and address scar tissue adhesions that are interfering with the normal strength and flexibility of the body, not simply stretch out the muscles.
If you are unfamiliar with Active Release Techniques® you can think of it as a type of active massage. The practitioner will first shorten the muscle, tendon, ligament, or joint capsule, and then apply a very specific tension with their hands as you actively stretch and lengthen the tissues. As the tissue lengthens the practitioner is able to assess the texture and tension of the tissue to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area.
One of the best things about ART® is how fast it can get results. In our experience, the majority of elbow problems respond very well to ART® treatments. Although each case is unique and there are several factors that will determine the length of time it will require to fully resolve the condition we usually find a significant improvement can be gained in just 3-4 treatments.
Click here to book an appointment to see if ART® will be able to help with your elbow problem.
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“My first meeting with Dr. Nick helped to put the pain in context. Finally, an explanation and some real answers.”
– Jeff Smith, Sackville, NS