Elbow injuries can be acute or chronic. The former occur in an instant (e.g. an accident) and the latter over a longer period of time, due to overuse (e.g. tendinitis). An elbow injury may be classified as mild, moderate or severe. Elbow strains (i.e. tendon injury) and sprains (i.e. ligament injury) are classified in severity from first degree to second degree and third degree (most severe with complete rupture).
The elbow is a hinge joint in which the upper arm bone (humerus) is connected to the two forearm bones (ulna and radius). The ulna is the largest forearm bone and positioned on the side of the little finger. Two main ligaments stabilise and support the elbow joint; the radial (lateral) collateral ligament and the annular ligament. The former ligament reinforces the lateral side of the elbow capsule.
Some typical elbow injuries include:
1. Fracture of one or more of the three main arm bones, in the region of the elbow, caused by a blunt impact or twisting of the elbow beyond its normal range of motion (e.g falling over in football).
2. Elbow strain occurs when any of the elbow ligaments are stretched or torn (e.g. the medial collateral ligament in a throwing sport such as javelin).
3. Elbow dislocation is defined as a condition in which the upper arm bone is forced into the wrong position relative to the forearm bones (e.g. an outstretched arm struck in a contact sport and it may also be accompanied by fractures, artery and nerve damage).
4. Tennis elbow (lateral epicondylitis) is the most common overuse injury and is caused by irritation of the muscle tendons attached to the upper arm bone at the lateral epicondylitis (a bony protrusion).
5. Golfers elbow (medial epicondylitis) is similar to tennis elbow but inflammation occurs on the inside (medial side) of the elbow due to overuse of the muscles (and bone insertion points) used to bend the wrist downwards (e.g. in lifting or grasping) or direct blunt impact.
6. Elbow bursitis (olecranon bursitis) is caused by inflammation of the largest fluid filled sack (that reduces friction between bones and soft tissues) located above the tip of the elbow (the olecranon process). Typical causes include leaning on the elbow too much or direct impact.
Immediate treatment normally includes RICER (Rest, Ice, Compression, Elevation and immediate Referral to an injury specialist) for the first three days. Prompt medical care is essential for all injuries where elbow misalignment or fracture occurs to ensure that elbow recovery occurs with the bones and ligaments set in the correct position.
This should be followed by at least three weeks of rehabilitation with a physio or specialist personal trainer to restore the function of the elbow (e.g. normal range of motion, strength, power, endurance and proprioception) and speed up recovery in gentle work out routines. For a complete recovery, the final stage involves up to 3 months of conditioning with more strenuous work out routines to strengthen the arms and elbows to reduce the risk of future injuries.
Regaining the full motion of the elbow with simple bending, straightening exercises and gentle rotations is the first priority. This may be followed isometric exercises (e.g. statically pushing the hands against a wall with the elbows bent), rubber tube, free weight and finally full body weight exercises. A progressive set of work out routines may include for example:
1. Sitting down on a chair with good upright back posture, place your arms by your side hanging down. Then twist and lift your lower arms up until your elbow has a 90 degree bend and your hands are palms up. This is the starting position. Holding your elbows still, simply twist your forearms until your palms are facing down, twist them back so that your palms are facing up again to facing up and then repeat as many times as possible. The main goal is to increase the range of motion with each twist but you will also begin to give the muscles a work out as well.
2. Remaining in the seated position start by letting your arms drop down straight by your side. Then simultaneously rotate your arms upwards from the shoulders (in front of you) and try to bend your elbow as far as possible so that your hands are in contact with your shoulders. This is mainly a stretching exercise in which the key factor is taking your time to relax into the final stretched position with your elbows above your shoulders. Hold for 30 seconds and repeat if desired.
3. Again from the seated position you can use a similar exercise to the last one except this time, instead of lifting the elbows in front you, first bring the hands to the shoulders and then lift the elbows upwards but to each side. As before hold for 30 seconds and repeat if desired.
4. The next exercise involves both a stretch and an isometric exercise. Stand upright in a doorway and then raise your upper arms out to your sides until they are horizontal. At the same time keep your elbows bent at 90 degrees and resting against each side of the door jambs. Slowly lunge one leg forward and bend your back knee so that you can feel both a stretch in your arms/chest/shoulders and a force in your elbows.
5. Once you begin to regain the full range of motion of the elbow you can start to use rubber tubes for strength exercises. These will allow you to load your elbows in any direction (unlike gravity dependent dumbbells) and in a very controlled manner. As with other types of injury rehabilitation it is best to mix up locally focused exercises (e.g. for just the arms) with compound exercises (i.e. involve more of the body, such as the shoulders and chest as well). This ensures that both the injury site and all the related muscle systems are strengthened together.
In this case use a bench with a seat back at 45 degrees to do chest presses with a tube attached to the bench. With both hands starting at the nipple line height simply slowly push your hands away from you until your arms are almost straight, return slowly and repeat at least fifteen times. The strength rating of the tube should be high enough so that you can only just manage fifteen reps with good form.
6. Once your strength begins to return you can use more load in the form of dumbbells. Start with a single dumbbell and a one arm bent over row. To do this lunge forward with one leg, bend your straight back forward at 45 degrees and with one arm on your hip (the arm that is on the same side as the leading leg) lift the dumbbell in your other hand slowly towards your side. Lower it slowly to starting position and repeat fifteen times. Swap the dumbbell to your other hand and swap the leading leg so that you can do the same number of reps on the other side.
7. Another simple exercise is to sit or stand up and do bicep arm curls using one or two dumbbells. Try to keep your elbows stationary by your side and just move your lower arm up and towards your shoulder. If you use two dumbbells it is best to alternate the arm curl on each side.
8. The final example exercise is the press up. This is a great all round exercise for many purposes and you can easily change the intensity from press ups in a kneeling position (easiest) to press ups with a straightened body on tip toes and many more difficult variations (e.g. hands touching, one foot in contact with the ground). For the purpose of elbow recovery it is better to start from the kneeling position and progressively make the exercise more difficult if desired! Try to find a position of the arms that does not put excessive strain on the elbows and feels more natural. This will vary slightly between individuals.