by Jonathan Blood Smyth

The elbow, like most of the bodys joints, exhibits what are called accessory movements, small gliding and sliding movements which occur inside the joint during movement but which cannot be performed independently. These small movements are essential to the function of a joint and are easily disturbed, reduced or lost in injury or long term postural abnormality. The elbow has small, hardly noticeable movements in a sideways direction as the joint gaps slightly under pressure. This small gapping does not contribute greatly to the positions attainable by the wrist or hand but does make a functional contribution.

The tiny joint movements which can occur do not look important enough to influence the ability to use the joint but they can allow a minor stretching of the muscles which extend the wrist as we try to achieve a grip or hold on to something. Lengthening a muscle increases its ability to contract afterwards and enhances its function. If the wrist and finger flexor muscles are going to exert the maximum control and power in gripping then the wrist extensor muscles need to work optimally.

Should the opposing muscle group, the flexors, dominate then the extensor muscle origin can become shortened and tight to a degree, limiting the ability of the extensor muscles to adapt wrist positions for useful holding and gripping. The radial head, normally rotating in its radial ligament, confers the precise positioning required to allow the hand to be placed and used in a huge variety of positions.

The two commonest and repeated movements we perform again and again throughout the day are extending the wrist with the fingers downwards and rotating the forearm so that the palm faces up. The groups of muscles which perform these two actions start life over the same patch of bone on the outer side of the elbow, leading to potential overuse and pain problems. Overuse of the muscles can increase the tone in the outer elbow compartment, reducing both the elasticity of the tissues and causing them to shorten. This can develop into a cycle of becoming tight, adapting by using the hand in new ways and then tightening further.

If the elbow is bent and the wrist is extended in an activity which is repetitive and lasts for some time then this can be damaging as the elbow bend loosens the extensor muscles a little and reduces their effectiveness to some degree. Examples of this activity are using a computer mouse or playing a piano. Continuous postural stresses from repeated actions over a long period can permanently cause tightening as the muscles continually recover. All this prepares the elbow for a time when a relatively minor added stress changes the typical, irritating achy joint into a highly acute and painful problem.

Tennis elbow is a widespread problem which often develops slowly as described, however the onset can be sudden and unexpected after a lot of physical work which can overstress the joints tissues and cause local inflammation and trauma. Typically the slower onset is more common with the more minor problems being present for some time until there is a sudden, often small trauma. The tennis backhand stroke is a good example of how to significantly stress the origin of the extensor muscles but other activities which reflect that kind of action can add up to the same.

Over tight muscles in the extensor origin are opposed by the strength of the gripping and holding applied, in cases causing an overstress to the junction between the bone and the tendon and local tearing of tissues from the bone. As a process this can repeatedly occur, with the initiating stress becoming less and less and the pain results becoming more troublesome and long-lasting. As the small scars continually form they contract and add to the local tightness and so the likelihood of painful stretching. Tennis elbow pain can be very severe so that it interferes with activities of daily living.

About the Author:
Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Bolton visit his website.

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