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Elbows - some hints for users

The elbow is a hinge joint, which means it can only bend (flexion) and straighten (extension). You may think you can twist it, but actually when you twist your arm it's the wrist and arm that moves.

The elbow is made up of three bones; the humerus in the upper arm and the radius and ulna in the lower arm. The radius is on the thumb side and is the larger, but the shorter, of the two. The end of the ulna is what you probably know as your funny bone but is officially known as the olecranon.

There are three main muscles which flex the elbow; Brachialis, Biceps Brachii and Brachioradialis. The first two are in the upper arm and the third in your forearm. If you hold your arm with your palm upwards, brachioradialis is the big lump on the thumb side of your arm.

To extend (or straighten) the elbow needs two other muscles; triceps and anconeus. Triceps runs down the back of your upper arm and anconeus is a little muscle which wraps around the outer back edge of your elbow (if your palm is facing forwards). Although it's by far the smallest, it's the most rarely injured of all the muscles in the arm.

The median, radial and ulnar nerves also pass through the elbow, enabling you to move and feel your hand and fingers. The ulnar nerve is nearest the surface of the skin and therefore more vulnerable than the others; it's also the one that does most of the sensation in your hand including grip strength. So if you have elbow inflammation, this may affect the ulnar nerve and thus your grip.

Muscles and tendons are designed to do a certain amount of work, obviously. They're also robust enough to withstand a reasonable amount of wear and tear in the form of contracting and relaxing, and rubbing against the surrounding structures whether that's bones or other muscles. If you do the same motion a lot, you basically exceed the design parameters of the tissues involved. They start to wear out.

Tennis and golfers elbow, RSI (or lateral epicondylitis to give them the grown-up name) or inflammation of the tendon sheath are not actually problems in any of the muscles which bend or straighten your arm, even though the first symptom is usually pain in the elbow. It comes from one of the flexors in your forearm, extensor carpi radialis brevis. We'll call it ECRB for short. ECRB runs from your palm to just above your elbow, and is joined to these two points by tendons. Tendons are stronger and more fibrous than muscles, and don't stretch so much; they are also prone to injury. What usually happens when a muscle and/or tendon are overworked is that tiny tears appear, usually where the tendon and muscle join. The body knows that's not meant to happen so it floods the area with fluid - to protect the injured part - and blood, to carry lots of healing elements to the area. This causes heat and swelling, and those two things together cause pain otherwise known as inflammation.

It may come as a surprise to you to realise that inflammation is not a symptom of the injury, but of its healing. This means that when you take anti-inflammatories or apply ice to reduce the heat, swelling and pain, what actually happens is you're inhibiting the body's natural healing mechanisms.

If you go to the doctor with lateral epicondylitis, they'll probably tell you to rest the joint affected and it will go away. They're right. As the problem is caused by wear and tear on the soft tissues, give them enough time without being used and they'll recover. However if the reason they became inflamed is something you can't - or don't want to - stop doing, then the problem is going to come back, assuming you were able to stop doing it for long enough to allow them to recover in the first place.

Let's go back to our friend ECRB. As you can see from the picture above, it runs down the thumb side of your forearm and will probably be sore to touch if you have lateral epicondylitis. When you twist your forearm, flex your wrist or bend your elbow it will let you know that it would really rather you didn't. Because it's unhappy with its life, it will be sending complaining messages to your brain who will hold it slightly tense in order to protect it from further injury. Every time you use your arm the proprioceptors in that muscle will send unhappy messages to the brain which will respond by telling it not to move. This, along with the inflammation, is what causes the pain. If you can persuade the muscle to relax and improve the flow of blood and fluid to the area to hasten healing, you will quickly find that it feels better. If only you knew something that could do that. Oh wait - you do! Bowen therapy!

Bowen therapy will relax the muscle and thus relieve the pain arising from the tension. It will promote circulation and encourage the delivery of healing substances in the blood. It will also prevent the muscle from healing in a way that impairs its function. So all good.

How long will all that take? It could happen right away. I have clients with lateral epicondylitis who get instant relief. And if the cause of your problem is something you want or need to carry on doing, regular treatments will make sure it doesn't become a problem again in future.

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