Understanding Your Elbow
Our elbow is a mechanism that bends our arm into 2 levers which looks like s simple hinge. However, it is not just a simple hinge as we take a close look. In fact, there is a twisting subtlety in the working forearm which converts it from a robot-like lever to a remarkably useful functional tool. The twist is due to the 2 parallel bones in the forearm, each revolving around the other that carried the hand along.
The ulna has a major role to play at the top of the forearm where it forms the main link with the humerus of the upper arm. The radius actually takes the lead role at the bottom end, where it attaches to our hand. Our elbow is formed where the ulna links into the humerus, and the bony point at the back of the elbow (which we can lean on), is the top end of the ulna.
The front of the ulna forms a hook that look like a question mark. As such, it makes a pincer-grip into a hole located at the lower end of the humerus which allowed us to bend and straighten the entire arm halfway down its length, without falling out of the joint. The 2 bones of the forearm dancing around one another is liked a pair of chopsticks that brought about the swiveling action of the lower arm.
The radius of the mobile chopstick on the thumb side of the forearm revolves around the ulna, that is fixed to the humerus at the top end. Combined with a mobile wrist at the lower end of the forearm as well as the dexterous fingers and thumb, you will realize that what an effective tool of our upper limb is.
The arms exhibit a slight angle at the elbow so that when it hangs loosely at your side, it has a slight residual bend. In fact, this noticeable kink offers the elbow a valuable tension, allowing us to carry heavy weights without pulling it out of the joint. However, when there is a strong predominance of the elbow-bending actions over the straightening of the elbow, the elbow kink will becomes tenser. This is known as flexion contracture of the elbow. You will see this especially with over-strong weight-lifters whose arms hand bent at the sides just like a gorilla.
How Does The Elbow Work
The twirl and flourish of the hinging arm invests it with a peculiarly fluid motion, which makes it look living as opposed to synthesized. It is the element of an introduced twist to the arm’s appendages, the perfect amalgam of several movements in one that makes the actions looks unbelievable. Just imagine a young lady plucking a rose and bringing it up under her nose to smell. Her delicate, streamlined, curling quality movements combined with the graceful action of her arm is mesmerizing to watch.
Or you can watch people who practice Tai Chi and observes their movement of their forearms. Their hand motion is deliberate and slow enough to accentuate their spiraling quality. At the outside of your elbow (with your palm facing upwards), there is a scooped-out surface at the top end of the radius that articulates loosely with a small bony knob on the bottom end of the humerus, which looks like the head of a pawn from the chess game.
The head of the radius cuddles in snugly to the side of the ulna, just below your elbow crease. It is held in place by a collar of ligament running around the neck of the radius and attaching back to the ulna. As the radius spins back and forth around the ulna, the hand-by being attached to the bottom is flopped around too.
You can understand more how the radius is by bringing your hand back and forth by holding the crease of your elbow with your arm bent at a right angle. Next, turn your hand from palm-up to palm-down. When the hand is palm down, the radius lies crossed over the ulna, which remains fairly static. In fact, the main role of the ulna is to hook into the bottom end of the humerus to hinge the elbow.
Our arm required rotation motion since many unique human efforts occur at the fingertips and thumb. For example, contorting the forearm to play the violin or threading a needle. At its simplest, useful movement of your arm involves 2 specific actions of hinging the elbow, together with the swiveling the length of the arm as well as cocking back the wrist.
Visualize the movement of bringing the spoon to your mouth. What makes the movement so sensationally accurate so that we will not end up with food all over our face is the ability to bend our arm to rotate the spoon right around and direct it straight into our mouth.
The wrist action turns your hand around and at the same time aligns the thumb with your face. Once this action is set, our fingers refine the hard-nosed elements of elbow and wrist activity, honing their accuracy with unbelievable finesse.
However, there is one problem in these precise actions which is the repetitive nature of forearm activity as seen over and over in different parts of the body. A deliberate arm action invariably starts off with the elbow straighter and the hand facing down say when spearing a piece of meat with a fork. As your elbow bends and your hand approaches your mouth, your forearm twists and turns your hand up to your mouth. This flexion movement at the elbow combined with supination, or turning the forearm back is repeated again and again throughout our daily lives, in countless ways.
Cocking your wrist back is another essential movement for your fingers to work well. Observe yourself when you try to pick up a TV remote controller. You will see your wrist angling back so that you can spread your hand wide in an open-stretched grasp to approach it. This allows your fingers come forward and make their clutching movement from the right distance.
If you do not have wrist extension such as those who are suffering from wrist drop paralysis, caused by radial nerve palsy, they must lift the whole arm to drape the fingers of the flopped-down hand over the remote control before they can grasp it.
Not surprisingly, supinating the forearm and cocking the wrist back is a much stronger movement pattern than pronating the forearm. Throughout your whole day of activities, flexion or supination is repeated either strenuously in the case of pushing your body up from your office armchair or light-fingered depressing your computer keyboard. Perhaps many of you may not be aware that flexion or supination is a very strong action. Furthermore, supination is the strongest when the elbow is bent at 90 degrees.
The main muscle that bends your elbow is the biceps, which is the bulky muscle at front of your upper arm. It originates at the top of your arm and inserts into the radius just below your elbow crease. When it contracts and shortens, it bends your elbow. The triceps is its opposite number at the back of your arm and it straightens your elbow out again.
One important thing about biceps is that it always supinates the forearm as it bends your elbow. The other main player in supinating the forearm is called the supinator. It and the biceps spin the radius lengthwise on its axis, carrying your hand from palm-down to palm-up. However, the movement incorporates a degree of compression of the outside compartment of your elbow as the muscles imperceptibly make the radial head slide up.
The supinator muscle takes origin off the lateral epicondyle of the humerus, on the outside of the elbow (palm facing downwards), the lateral epicondyle forming the dome-shaped bulky mass on the outside of your forearm. The muscles which cock your wrist back also start at the lateral epicondyle of the humerus, in what is known as the common extensor origin.
In contrast to the supinator, they travel diagonally from the outside of your upper arm, across the side of your elbow and down the full length of your arm. They cross your wrist and insert into the back of your hand. As they contract (shorten), they lift your hand backwards, therefore cocking your wrist.
Do take note that both the supinator and the wrist extensors share the common extensor origin. As such, the site on the outside of the elbow is the single point of origin of muscles performing the 2 most common actions of your arm. This relates to the breaking down of the elbow which we will discuss later in this article.
Essential Movements Of The Elbow
The medial and lateral gaping is a subtle hidden movement, which is very different from the obvious bending and straightening actions governed by their dedicated biceps and triceps muscles. Small dimensions of lateral elbow freedom make a tiny but valuable contribution to wrist action and thumb orientation. The extra dimension to arm or hand movement is not great, more like the bowing bend of a green stick.
It simply gives your arm a workable compliance that makes small but critical alteration to the line of pull of the muscles working your hand, particularly the muscles that cock back your wrist, which we know to be a difficult action.
In fact, a small inward deviation of your forearm at your elbow slightly lengthens the distance of the wrist extensors span from the outside elbow to the back of the hand. It puts these muscles slightly on the stretch, which makes it easier for them to get strength of contraction to hold your hand back for your fingers to work.
Generally, the tighter the lateral compartment of your elbow (the outside when the palm is facing upwards), the harder it is to get these few vital degrees of inward angulation. As such, this makes it harder for your wrist to cock back. Therefore, excessive bending and supination of your forearm will results in an over-strong elbow. This will cause your arm to develop a slight outward kink at your elbow, and throws the hinge of your elbow slightly out of alignment, making your wrist extension weaker.
Now comes the problem. You have to compensate by supinating or turning back your entire forearm if you cannot get your wrist back into extension. This snowballs the problem especially in repetitive routine activities like using a computer mouse. Repetitive use of this combine group of muscles attached to the bone at the common extensor origin can cause inflammation.
What Can The Elbow Went Wrong
The 2 repetitive movement patterns of your arm are twisting your forearm back, thumb to face and cocking your wrist back. These are the actions which almost everyone of us are repeating over and over again, on a daily basis. The wrist extensors and supinator muscle take their origin from the same piece of bone on the outside of the elbow, which is the common extensor origin (CEO).
When these muscles develop natural pulling tension of the muscle fibers, the muscle residual tone rises. As time goes by, raised muscle tone can leads to muscle shortening. This is especially true for those body builders who need to stretch ad nauseum so as to prevent their joints crimping from their muscle strengthening programs.
The raised tone of the supinator and wrist extensors exerts a compressive effect on the lateral compartment of the elbow. Over time, this can cause adaptive shortening of the soft tissues which are holding the joint together. In effect, the lateral side of the joint capsule shrinks and the muscles as well as the tendons loses their stretchability.
This makes the arm kink laterally slightly at the elbow. The first problem that can arise is the poor angle of pull for the wrist extensors, which leads to lesser room for the radial head to move. Secondly, the harsh muscle effort of the wrist extensors exerts an upward pull along the line of the shaft of the radius. This creates incremental displacement upwards of the radial head, making it bump up under the lateral condyle of the humerus.
Over time, this impedes the swiveling freedom of the radius as the friction creates drag of the spinning radial head. When this cycle escalates, the elbow kinks more which make movements more laboured. Besides, the residual tone of the muscles on the back of your forearm rises. As over-activity of wrist extensors and supinator becomes more obvious, the pinching of the lateral compartment of the elbow becomes more marked. This lateral crimping makes your lower arm deviate outwards imperceptibly as the elbow straightens.
In the case of tennis elbow, the lateral compartment of your elbow is tightened. Sometimes, there might be a tight medial compartment, also known as golfer’s elbow. The arm will gradually acquire trick movements to compensate for the loss of compliance at the elbow.
The process of elbow breakdown is speed up by using the arm for long periods with the elbow bent and wrist cocked. The mechanical fault of the wrist extensors is further eroded as the bent elbow puts them more on the slack. In such scenario, the muscles have to contract harder to pull in their length to bring about the required backwards movement of the wrist.
You can do this simple demonstration. It is easier to lift your wrist back when your elbow is straightened out in front of you. However, the moment your elbow is tucked into your side, it is not so easy anymore. Just imagine that this awkward action is being repeated many times and over a long period. The fatigue of the muscles of the back of your forearm causes the fibers to lose contractility and develop painful, cordy strands known as fibrositis.
This condition makes your arm tight and painful in a dull sort of way and, more importantly, it lays the ground work for wider spread, less reversible trouble of your elbow. Once the muscles on the back of your forearm become permanently shortened, what follows next is acute injury where elbow problems start to emerge.
Inflammation of the osseo-tendinous junction, where the tendon joins the bone is caused by micro-trauma of the tight muscle pulling at the bone. A stronger than usual jerk to the wrist cause the pre-tensioned tendon fibers to rip off the bone, due to the fact that the muscles are too inelastic.
Without early intervention, the building up of the trapped blood can strangle the nerves and blood vessels. This simply means that it is easy to traumatize your elbow where it is the tightest. Instead of the common extensor origin being spread wide to transmit the force of muscle to bone more gently and uniformly, it is localized entirely to the outer knob of your elbow where even with healthy people, feelings of sensitiveness and tenderness can be felt just below the skin.
Repetitive or forceful activity either with sustained wrist extension or repetitive supination of the forearm can create minor inflammation even before the tendon tissue starts to pull off from the bone. The problem can snowball once your muscles adopt defensive clenching in response to irritability and pain. This guarding mechanism known as muscle spasm can often seen in different parts of the musculoskeletal system.
What Is Tennis Elbow
When you use the arm in a sustain, low intensity way over a keyboard which invites fatigue or when you use both wrist and elbow together in a powerful slashing movement under load (backhand shot of tennis sports), tennis elbow is a common problem that can arise.
This is due to the fact that a long term and gradually build-up stiffness outside the elbow compartment. Finally, tennis elbow strikes when there is a sudden one-off snap of the elbow. There is no action that is more vexations to your forearm than the tennis backhand, although it is possible that other types of strenuous exertion for example, when using secateurs in the garden that can send your elbow into active flare-up.
Invariably, the tennis backhand strikes when your muscles are twanged tight like guitar strings. The combination of overuse and protective muscle spasm pre-tenses your muscles and the crunch comes when one big action snap them off the bone. Shock waves are transmitted through the handle of the racquet into your clenched forearm, along to the point where the tendon glues to the bone.
After the first tweak, it is easier and easier to re-tweak it, with increasingly minor incidents. Each time you jar your arm, there is additional microscopic bleeding as individual fibers ping off the bone. Blood and lymph accumulates between tendon and bone, which then organize into adhesions, or scar tissue over time. Mending is made more difficult as scar tissue proliferates because it lacks an optimal blood supply and also lacks stretch. A small layer of scar tissue near your bone constitutes another interface from which your tendon can rip away.
Each painful wrench to your arm heightens the tension in the muscles on the back of your forearm. As they clench tighter, the threshold for what constitutes the injury is lowered. There is a dull pain from the tight band of muscle running diagonally down the back of your forearm, which gradually becomes shriller as the condition worsens.
Eventually, it is impossible to perform any useful task with your arm without invoking another painful tug at the outside of your elbow. Even picking up a cup is painful and it may be excruciating shaking hands or picking up a carrying bag.
As your arm gets more laid up, you have the sense of wanting to pummel and knead the tight muscles with your other hand to make the muscles let go. You will be over-sensitive of the outer knob of your elbow. If you knock your arm, the pain can be agony. Unknowingly, you will be over defensive to stay away from crowded places, fearing that the people on the street will accidentally brush again your elbow, causing pain.
What Can You Do To Treat Tennis Elbow
The first step in treatment is to reduce the tone in your muscles on the back of your forearm. Without this initial treatment step, elbow pain results in awkward function which can be worsened further. You can adopt simple exercise regime to stretch both your wrist extensors and supinator muscles so as to reduce their holding tone and makes them more accepting of shock.
This creates an opportunity to loosen the tight lateral compartment of your joint, which is the ultimate vital clue to successful management of tennis elbow. Even with the most basic restoration of medial gaping of your elbow’s lateral compartment restores a working compliance to your arm, thereby creating a better line of pull for both wrist extensors and supinator muscles.
Most importantly, it also does away with the need for both groups to over-react which accounts for the integral part of your elbow’s declining spiral of function. It breaks the cycle of the ever-tightening lateral compartment and the tugging attachment of the common extensor origin, allowing the irritable common extensor origin to have recuperation time without further flare-ups.
Once the “hot spot” calms down and the repair process is ongoing, the protective muscle spasm will be lessened. As such, it reverses the cycle where your arms get progressively tighter and more susceptible to the slightest jar or jolt. Loosening the union between your two forearm bones and restoring parity of your flexors and extensors of both elbow and wrist is the next step.
This will make your forearm more compliant and lets both sides of your elbow joint pull apart evenly to accommodate a wrench passing through. Improving all-round joint laxity and elasticity of your joint’s soft tissues allows it to absorb trauma in the normal way joints do.
The above mention is the best ways to treat tennis elbow pain naturally without drug medications or surgery. Only as a last resort should you consider injecting steroids such as cortisone or local anaesthetic into the hot spot. Even though cortisone is usually used, this alone will not rectify the mechanical cause.
In the short term, it relieved inflammation and quells the pain. However, in the long term, if the joints are not restored in all directions, and when the cortisone wears off, the problem will resurface again sooner than later.
In cases that are resistant to treatment, the best course of action is to use local cortisone, concurrently with vigorous as well as sustained muscle and joint stretches. It is no point of having cortisone on its own. It is important to take note that more than 3 cortisone injections is not advisable since it will caused a weakening of your tendon fibers and a greater susceptibility for them to rupture.
3 Stretching Exercises For Tennis Elbow Pain Relief
- Pressing Out The Elbow Kink
This exercise required you to push out your elbow with the heel of your hand. The pressure should be exerted just enough to cause a strain down your outer arm. On top of that you will also need to move your pushing arm slightly to change the angle and find the sweetest pain.
- Stretches your outer joint capsule while gapping the lateral compartment and freeing the radial head from bumping up against the lateral epicondyle. This makes pronating and supinating the hand easier.
- Stretches your very powerful supinator muscle which can loses its stretchability through dominant use.
- Rest your right hand on a low surface with your wrist extended and your fingers pointing back towards your right thigh.
- With your right elbow as straight as possible, push the heel of your left hand into the prominent point on the inside of your elbow.
- You can reinforce the strength of your left arm by tucking your left elbow into your waist and using your body to push.
- Keep changing direction slightly to find the tightest and most painful angle.
- Gently lean into the pain, right to the point of intolerance and then withdraw, oscillating back and forth several times.
- After you release your arm you may need to shake it to get rid of the residual discomfort.
- The Forearm Stretch
This is a complicated arm stretch exercise for your shoulders, elbows and wrists. Over-activity of the finger and wrist flexors causes chronic tethering of the wrists and elbows, which keeps them short of reaching their full range. The first pose mainly stretches your flexor muscles down the inside of your forearms.
Next, it turned your shoulders in by 180 degrees of your forearms which will go from maximum supination to maximum pronation. Both extremes free the radial head, though the second pose which pulls the radial head down, will be an unfamiliar action for most and may require efforts on your part to get the thumb sides of your hand flat on the floor.
- Kneel on your hands and knees on the floor. Position your knees directly under your hips and your hands directly under your shoulders.
- Turn both arms outwards at your shoulders, turning your fingers and pointing them back towards your knees.
- With your elbows completely straight, rock gently back on your knees and feel the stretch running down your forearms and under your wrists. Hold for 15 seconds.
- Gently rock forwards to your starting position, release your hands and turn them inwards, around the other way, so your fingers again point straight back towards your knees.
- Keeping your elbows straight, and the thumb-side of your hands pressed down. Then rock gently back on your knees and hold this position for 15 seconds. You will feel the pull right down the arm.
- Return to your starting position. Alternate with the arms turned in and out, doing each four times.
- The Forearm Twist
The purpose of this exercise is to loosen the radial head from its tight ligamentous collar so the radius is free to swivel along its axis. Greater twisting freedom of the radius allows the two forearm bones to cross and uncross with more ease.
As your arms are pulled out straight at the elbows, your forearms are forced into greater supination, the upper arm more than the lower. This stretches the overtight union of the 2 bones along their length, which explains why the pain is felt right through your forearm to your wrists.
- Sit comfortably in a chair with both arms extended straight out in front of you horizontally and your hands back to back.
- Bring your right hand over your left hand so the palms touch. Interlace your fingers right down to the web.
- Keeping your hands locked together, bring them down and under, towards you, then up through the space between your arms and stretch your arms out horizontally. You will realize that this causes an extreme twisting stretch to your forearms and you will want to dis-engage your fingers. Try to hold your hands tight and straighten your elbows as far as possible.
- Hold for 30 seconds and then gently release.
- Repeat 3 times.
- Change sides, bringing your left hand over the right, and do the stretch 4 times.
Keep your joints young, 2006 by Sarah Key