Elbow pain can make surprisingly simple things difficult — gripping a coffee cup, using a mouse, lifting at the gym, carrying the kids, gardening or playing sport.
At TLC Osteopaths in Hamilton, we assess and treat a wide range of elbow problems, from recent sporting injuries to persistent elbow pain that has been hanging around for months.
One of the most common problems we see is tennis elbow, but pain around the elbow can also come from the muscles and tendons, the elbow joint itself, irritation of nearby nerves, or occasionally from the neck and shoulder.
The first step is working out what is actually causing your elbow pain and what is keeping it irritated.
Tennis Elbow
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Despite the name, you definitely don't need to play tennis to develop tennis elbow.
Tennis elbow, also known as lateral elbow tendinopathy or lateral epicondylalgia, causes pain around the outside of the elbow where several of the forearm muscles attach.
These muscles and tendons are heavily involved in gripping and controlling the wrist, which is why tennis elbow often becomes painful during everyday activities involving the hand.
Common symptoms of tennis elbow
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You may notice:
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Pain or tenderness on the outside of the elbow
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Pain when gripping or squeezing
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Pain lifting a kettle, pan or coffee cup
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Discomfort using tools
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Pain with repetitive computer or mouse work
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Pain during racquet sports
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Pain during gym exercises such as rows, pull-ups or curls
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Reduced grip strength
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An ache extending into the upper forearm
Symptoms can develop suddenly after an increase in activity, but often build gradually over several weeks.
Why Does Tennis Elbow Happen?
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Tennis elbow is generally considered an overload problem affecting the tendons on the outside of the elbow.
The tendon is being asked to tolerate more load than it is currently capable of recovering from.
Sometimes there is an obvious trigger, such as:
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Starting a new gym programme
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Increasing weights or training volume
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Playing more tennis or squash
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Gardening or DIY
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Repetitive lifting at work
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Using tools
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Increased computer or mouse use
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Returning to sport after a break
Other times there isn't one obvious injury.
Instead, repeated smaller loads gradually exceed the capacity of the tendon.
This is important because persistent tennis elbow usually isn't simply something that needs to be "rested until it disappears". Reducing aggravating load may help initially, but rebuilding the tendon and forearm's ability to tolerate load is often an important part of recovery.
Do I Need to Completely Rest Tennis Elbow?
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Usually, no.
Complete rest may temporarily reduce symptoms, but it doesn't necessarily improve the elbow's ability to cope when you return to your normal activities.
Instead, we generally look for a manageable level of activity.
That might mean temporarily changing:
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Training volume
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Grip position
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Exercise selection
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Workload
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Repetitive gripping
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Racquet activity
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Heavy pulling exercises
We can then progressively rebuild strength and tolerance.
The goal isn't simply to protect your elbow forever.
It's to get it capable of doing the things you want it to do again.
How We Assess Tennis Elbow
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Not every painful outer elbow is tennis elbow.
During your appointment we may assess:
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The exact location of your pain
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Grip strength
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Wrist and forearm strength
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Movements that reproduce your symptoms
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Elbow joint movement
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Forearm rotation
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Neck and shoulder movement
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Nerve function where appropriate
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Your work, sport or gym activities
This helps us determine whether the symptoms are coming primarily from the tendon or whether another structure may be contributing.
​Treatment for Tennis Elbow
There isn't one single treatment that works for every case.
Depending on your presentation, management at TLC Osteopaths may include a combination of:
Load management
We'll identify activities that are repeatedly aggravating the elbow and work out how to modify them without unnecessarily stopping everything you enjoy.
Strength rehabilitation
Progressive strengthening is often an important part of treating persistent tennis elbow.
This may include exercises targeting:
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Wrist extensors
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Forearm muscles
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Grip strength
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Biceps and triceps
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Shoulder and scapular muscles
Exercises can then gradually become more specific to your work, gym training or sport.
Hands-on treatment
Where appropriate, osteopathic treatment may be used to improve movement and reduce symptoms around the elbow, forearm, shoulder or neck.
Dry needling
Some patients may benefit from dry needling as part of their treatment programme.
Exercise modification
If your elbow hurts during gym training, we don't necessarily want you to stop training.
Small changes to grip, exercise selection, range of movement or training volume can sometimes allow you to continue exercising while the elbow recovers.
Other Common Causes of Elbow Pain
Although tennis elbow is extremely common, it isn't the only reason your elbow might hurt
Golfer's Elbow
Golfer's elbow, or medial elbow tendinopathy, affects the tendons attaching around the inside of the elbow.
Like tennis elbow, you don't need to play golf to develop it.
Symptoms commonly occur with:
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Gripping
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Pulling exercises
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Throwing
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Golf
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Repetitive manual work
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Wrist flexion
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Heavy lifting
Treatment commonly involves identifying the aggravating loads and progressively rebuilding strength through the forearm and upper limb.
Triceps Tendon Pain
Pain around the back of the elbow may involve the triceps tendon where it attaches onto the elbow.
This can be particularly noticeable during:
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Bench pressing
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Push-ups
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Dips
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Overhead pressing
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Throwing
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Heavy pushing activities
For active patients, treatment usually needs to address training load as well as progressively restoring the strength and capacity of the tendon.
Tennis Elbow
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Distal Biceps Pain
The lower attachment of the biceps can also become painful near the front of the elbow.
Pain may be aggravated by:
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Curls
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Pull-ups
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Rows
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Carrying
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Lifting with the palm facing upwards
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Repetitive manual tasks
Sudden pain, bruising or a noticeable change in the shape of the biceps after heavy lifting should be assessed promptly to exclude a significant tendon injury.
Elbow Joint Pain and Arthritis
Sometimes elbow pain comes primarily from the joint itself rather than the surrounding tendons.
People may experience:
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A deep ache
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Stiffness
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Reduced ability to straighten the elbow
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Pain at the end of movement
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Clicking or catching
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Swelling
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Reduced movement
Previous fractures, dislocations and years of heavy loading can contribute to degenerative changes within the elbow.
Importantly, changes seen on an X-ray or MRI don't automatically tell us how painful or functional an elbow will be. We assess the imaging alongside your symptoms, strength and movement.
Ulnar Nerve Irritation
The ulnar nerve passes around the inside of the elbow — the area commonly referred to as the "funny bone".
Irritation of this nerve can produce:
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Tingling into the little finger
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Tingling into the ring finger
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Numbness
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Burning or electric sensations
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Symptoms when the elbow is bent for prolonged periods
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Reduced hand strength in more significant cases
Persistent numbness, weakness or loss of hand function deserves proper assessment rather than simply treating the elbow as a muscle or tendon problem.
Elbow Joint Pain and Arthritis
A small fluid-filled sac called the olecranon bursa sits over the point of the elbow.
It can become irritated and swollen following repeated pressure, trauma or inflammation.
This often produces an obvious lump or swelling directly over the back of the elbow.
A hot, red, significantly painful swelling — particularly if you also feel unwell or have a fever — should be medically assessed promptly.
Elbow Bursitis
Can Elbow Pain Come From the Neck?
Yes.
Sometimes pain felt around the elbow isn't primarily an elbow problem.
Nerves supplying the arm originate in the neck, and irritation around the neck or upper limb can occasionally produce pain, tingling, numbness or weakness further down the arm.
This is one reason we may examine your neck, shoulder and nerve function, even when your main complaint is elbow pain.
When Should Elbow Pain Be Investigated?
Most elbow pain is musculoskeletal and can be managed conservatively.
However, further investigation or medical assessment may be appropriate if you have:
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Significant trauma
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Obvious deformity
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Inability to move the elbow following an injury
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Significant unexplained swelling
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A hot, red elbow with fever or feeling unwell
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Persistent numbness or tingling
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Progressive weakness
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Significant bruising after a sudden injury
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Symptoms that aren't improving as expected
If we think imaging or another medical opinion is appropriate, we'll discuss this with you and help organise the appropriate next step.
Can Elbow Pain Come From the Neck?
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Do I Need an X-Ray, Ultrasound or MRI?
Usually not immediately.
Many elbow problems can be diagnosed from your history and physical examination.
Imaging may become useful when we suspect a significant tendon tear, fracture, joint injury or another condition that requires further investigation, or when persistent symptoms aren't behaving as expected.
Depending on the suspected problem, this may involve an X-ray, ultrasound or MRI.
Can Elbow Pain Come From the Neck?
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Sometimes elbow pain comes primarily from the joint itself rather than the surrounding tendons.
People may experience:
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A deep ache
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Stiffness
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Reduced ability to straighten the elbow
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Pain at the end of movement
-
Clicking or catching
-
Swelling
-
Reduced movement
Previous fractures, dislocations and years of heavy loading can contribute to degenerative changes within the elbow.
Importantly, changes seen on an X-ray or MRI don't automatically tell us how painful or functional an elbow will be. We assess the imaging alongside your symptoms, strength and movement.
Elbow Pain From the Gym
We regularly see people who develop elbow pain while strength training.
Common aggravating exercises include:
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Bench press
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Pull-ups and chin-ups
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Rows
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Biceps curls
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Triceps extensions
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Dips
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Deadlifts
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Olympic lifting
Stopping the gym completely isn't always necessary.
We can look at which movement is irritating the elbow and why, then modify your training while gradually rebuilding capacity.
Our goal is to get you back to training, not simply tell you to avoid everything that hurts.