These little accessory movements may not seem to be able to make a difference to the use of the elbow joint but they can permit a slight lengthening of the extensor muscles of the wrist when we are trying to adjust our arm position to get hold of something. If a muscle is stretched slightly this increases the contractibility and thereby its function. In this case the extensor muscles can extend the wrist more successfully to allow the flexor muscles to apply grip strength.
The muscles of the extensor part of the forearm can become short and tight, especially if the opposing muscles become over strong, restricting their function in being able to hold the wrist in an effective posture for a functional hand grip. The ability of the radial head to rotate freely within its ligamentous strap is also key to permitting the hand to adopt a huge range of potentially required positions.
The two dominant movement patterns we perform again and again every day for hundreds of repetitions typically are turning the forearm over so the hand is palm up and pulling the wrist back with the palm down. Both the main muscles which are concerned with these very common actions originate from the same anatomical location on the outside of the forearm near the elbow. Overuse of these muscle groups can lead to increased tone in this lateral compartment of the elbow, causing shortening and loss of elasticity of the tissues. A cycle of tightening, muscular compensation and further tightening can develop.
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 common condition and typically develops as described above. It can come on acutely out of the blue after someone does an excessive amount of work, stressing the elbow very heavily and causing local injury and inflammation. More commonly there is a slow and longer term development of problems followed by a more sudden acute episode as a sudden stress is applied. Playing the backhand stroke in tennis is a particularly troublesome action to stress the common extensor origin but many other actions can produce the same result.
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.
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.
