Throwers Elbow, Elbow Tendonitis and Elbow Pain, By: Brad Walker

A Guide to the Treatment and Prevention of Throwers Elbow!

Although not as common as tennis elbow, throwers elbow is just as debilitating and painful. The condition is most prevalent in baseball pitches but is equally common in any sport that requires a throwing motion, including cricket, javelin, tennis serving and volleyball spiking.

Unlike tennis elbow, which predominantly effects the lateral side (outside) of the elbow, and golfers elbow, which predominantly effects the medial side (inside) of the elbow, throwers elbow effects both the inside and outside of the elbow.

What is Throwers Elbow?
Before we can understand exactly what throwers elbow is, it's important to have a general understanding of the structure of the elbow joint, and how the muscles, tendons, ligaments and bones help the elbow joint to function.

As you can see from the diagram to the right, there are many muscles and tendons that make up the elbow joint and forearm. The diagram shows the anterior (or front) view of the forearm. The left picture shows the muscles and tendons closest to the surface of the skin, while the picture on the right shows some of the muscles and tendons deeper within the forearm.

There are also three bones that make up the elbow joint. They are the "Humerus," the "Ulna" and the "Radius."

Now that we can see how the elbow functions, lets look at what exactly throwers elbow is.

Throwers elbow occurs when there is damage to the bones, muscles, tendons and ligaments around the elbow joint and forearm. The throwing motion causes the structures on the medial side (inside) of the elbow to stretch, while at the same time compresses the structures on the lateral side (outside) of the elbow. Over time the constant compression on the lateral side can result in micro fractures in the arm bones and can eventually lead to bone spurs and bone chips. While the constant stretching on the medial side can result in severe ligament strain.

The damage eventually causes a restriction of movement, inflammation and pain, and leads to the formation of scar tissue, bone spurs and calcium deposits. If untreated, this damage can put so much pressure on the muscles and nerves that they can cut off the blood flow and pinch the nerves responsible for controlling the muscles in the forearm.

Causes!
By far the most common cause of throwers elbow is overuse. Any action which places a repetitive and prolonged strain on the forearm muscles, coupled with inadequate rest, will strain and overwork those muscles.

There are also many other causes, like a direct injury, such as a bump or fall onto the elbow. Poor technique will contribute to the condition, such as using ill-fitted equipment, like golf clubs, tennis racquets, work tools, etc. While poor levels of general fitness and conditioning will also contribute.

Symptoms!
Pain is the most common and obvious symptom associated with throwers elbow. Pain is most often experienced on both sides of the elbow joint, but can also be experienced anywhere from the elbow joint to the wrist.

Weakness, stiffness and a general restriction of movement are also quite common in sufferers of throwers elbow. Even tingling and numbness can be experienced.

Prevention!
There are a number of preventative techniques that will help to prevent throwers elbow, including bracing and strapping, modifying equipment, taking extended rests and even learning new routines for repetitive activities. However, there are three preventative measures that I feel are far more important and effective.

Firstly, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the forearm area, which will result in a lack of oxygen and nutrients for the muscles. This is a sure-fire recipe for a muscle or tendon injury.

Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity.

Secondly, flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. When this happens, strains, sprains, and pulled muscles occur.

To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine. For a comprehensive reference of over 100 clear photographs of every possible sports related stretch, consider getting a copy of The Stretching Handbook. If you're interested in stretches for the forearms and shoulders, The Stretching Handbook has 18 different stretches you can do

And thirdly, strengthening and conditioning the muscles of the forearm and wrist will also help to prevent throwers elbow. There are a number of specific strengthening exercises you can do for these muscles, but instead of me going into the details here, I have simply found another web site that has already done all the hard work.

The following site explains a number of exercises you can do, both with, and without weights, and also includes diagrams and comprehensive explanations of each exercise. Although the site is specifically about tennis elbow, the exercises also relate very well to throwers elbow. You can find these strengthening exercises by going to http://www.physsportsmed.com/issues/may96/nirscpa.html.

Treatment
Throwers elbow is a soft tissue injury of the muscles and tendons around the elbow joint and therefore should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regime should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis.

It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The application of heat and massage is one of the most effective treatments for removing scar tissue and speeding up the healing process of the muscles and tendons.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.