Tennis and golf season is upon us which means those sleeping injuries re-awaken after a winter of rest. One of the most pervasive and lingering aches is tennis elbow or golfers’ elbow. These are felt in the outer (in the case of tennis elbow) or inner (in the case of golfers’ elbow) elbow joint and affect just about everything you do that requires gripping. The medical terms are lateral epicondylitis (tennis elbow) or medial epicondylitis (golfers’ elbow) which basically mean that something is irritated on the outer or inner elbow. These terms don’t actually explain what is irritated or why. There are many approaches to dealing with these injuries including forearm cuffs, painful trigger point release, or even surgery. However fixing the underlying roots of the problem resolves pain quickly and permanently.

Know Your Anatomy

The first place to start is the shoulder. Problems here affect how tennis elbow or golfers’ elbow develop. The most common issue is that the shoulder blades sit too low on the trunk and too far out to the side (I’ve mentioned this in previous posts). This sets up a domino effect whereby the upper arm bone to rotates inward which then causes the forearm to rotate as well. This is when tennis elbow or golfers’ elbow emerges.

This commonly happens in people who spend a lot of time at a computer. But, frankly, I see it in athletes or blue-collar workers as well. The muscles of the shoulder and forearm then adapt to this posture causing deep forearm rotator muscles to become lengthened or weakened while others become shortened (Figure 1.).

Figure 1. Deep Forearm Rotators (Copyright Boone Publishing. 2010)

Treatment is usually delivered to the muscles lying on top of these deep rotators. Mostly because it is in these muscles most people feel pain. These superficial muscles are merely reacting to deeper problems in the muscles lying against the elbow bones (pictured). Treatment of the superficial muscles requires multiple visits for painful therapy which delivers marginal results at best. The real problem is that the shoulder blade is not resting or moving correctly which sets up the elbow joint for problems which then leads to tennis elbow or golfers’ elbow.

The Fix

The solution? There’s good and bad news: The good news is that fixing tennis elbow or golfers’ elbow can happen quickly. The bad news is it’s not simple. You must first correct the shoulder blade issue which is feeding the recurring elbow pain. Then address the deep forearm rotators that have altered to accommodate the shoulder and arm position as well. Doing one without other can’t correct the problem for the reasons mentioned above.

However, I’ve made it as simple as possible in my new book, Fixing You: Shoulder & Elbow Pain. In it I present the problem and solution so anyone can understand the roots of their pain and fix them. So, if you’re tired of wearing that forearm strap, endless visits to a therapist for treatment, or icing your elbows after work or a game of tennis or golf, then do yourself a favor and get to the root of the problem. It’s time to fix your elbow pain!

Rick Olderman is a sports and orthopedic physical therapist, personal trainer, Pilates instructor and speaker. He is the author of Fixing You: Back Pain, available at www.FixingYou.net. Email Rick at Rick@FixingYou.net or call 303-477-4212.

I’ve had two patients referred to me recently with difficult neck and shoulder pain issues. Their complaints were of the typical pain distribution–from the base of the skull down the neck to the shoulder blade and across the top of the shoulder as well as pain in the front of their shoulders. MRIs and X-Rays were negative for disc or other pathologies. They had been through several specialists and felt no relief other than with steroids and Vicodin.

After examining both women, I found they had very similar problems in that the shoulder blades were sitting too low on the trunk (Figure 1.).

Figure 1. Depressed Right Shoulder Blade (Copyright Boone Publishing. 2009)

Also the  humeral head was sitting too far forward in the shoulder socket (Figure 2) causing pain in the front of the shoulder. I taped both the humeral head and the shoulder blades in a corrected position and their pain was eliminated–until the tape was taken off a few days later. This told me my diagnosis was correct. But how could I get them to hold these corrected positions on their own? Our attempts at specific corrective strengthening only met with irritation of their pain.

Figure 2. Humeral Anterior Glide (Copyright Boone Publishing. 2010)

Because the shoulder blades’ position on the trunk is partially determined by ribcage orientation, I revisited this aspect of their pain and found that by elevating their rib cages, pain was eliminated. This did two things: 1. it reduced the anterior tilting of the shoulder blade and, 2. activated key scapular positioning muscles that were deficient. The other maneuver I discovered to be of great help was asking them to place their painful side’s hand on the opposite shoulder. This elevated the painful shoulder blade and posteriorly  glided (pushed back) the humeral head into a corrected position in the shoulder socket. Both felt about 80-99% relief from their symptoms during the following week.

Both are now able to begin their strengthening program without pain. If  irritation does occur, they know exactly how to eliminate it, finally giving them a means to control their own pain.

Both of these women had one more issue in common. They were self-conscious of their breast size and therefore slouched  their shoulders. Over time, I believe this established the environment for these mechanical issues to become painful. Both commented that upon fixing their posture, they felt they were sticking their chests out too much, drawing attention to themselves. They clearly saw the mechanical connection, however, as their pain returned after resuming their slouched postures (Figure 3). Ultimately they needed to come to terms about their personal issues of drawing attention to themselves in order to be better.

Figure 3. Posture & Shoulder Blade Position (Copyright Boone Publishing. 2010)

This reinforces to me that, although my point of view focuses more on the mechanical causes of chronic pain, there are also significant emotional or psychological causes. I believe often there exists a combination of dietary, musculoskeletal, and psychological issues that contribute to chronic pain. There are probably others as well. Each person’s pain is a function of a different combination of these issues. My training is in understanding the musculoskeletal aspects of pain but occasionally I bump into someone with more psychological issues instead.

Most headaches and neck pain are due to the shoulder blades sitting too low on the trunk. There are muscles attaching from the shoulder blade directly to the first four neck vertebrae and skull. When the shoulders sit too low, these muscles then pull on the neck bones and skull causing neck pain and headaches. This is explained in my book, Fixing You: Neck Pain & Headaches.

Here’s a quick, simple test to see if this is the case with you. If you’re having right-sided neck pain or headaches, raise your right hand and place it flat on top of your head for 20 seconds. Make sure your head doesn’t side-bend or rotate to achieve this. If your pain diminished after this test, then your scapula may be sitting too low causing your discomfort. This is easily correctable. This is also the culprit in diagnoses such as thoracic outlet syndrome and carpal tunnel syndrome or with symptoms of pain or numbness down one arm.