There are a lot of potential reasons that your elbow may be bothering you. Examples of causes of elbow pain include acute trauma (a fall on your arm, dislocation, fracture), nerve entrapment (cubital tunnel syndrome, radial tunnel syndrome), or arthritis (osteoarthritis, rheumatoid arthritis). Your physical therapist will consider your mechanism of injury, behavior of your symptoms, and past medical history in conjunction with a movement assessment to help determine the root cause of your elbow pain.

The most common causes of elbow pain that we see in physical therapy are related to overuse injuries. We use our elbows all the time for daily tasks such as lifting, carrying, and gripping as well as with many sports that involve throwing and/or swinging. Many of these activities involve repetitive motions at the wrist, elbow, and shoulder. Sometimes, the repetitive movement can cause an overuse injury.

An overuse injury is usually pain that arises from a muscle or joint due to repetitive trauma, but not all repetitive motions and activity inevitably cause pain! Repetitive activities and motions can be problematic in the context of poor technique, poor posture, training errors, and an imbalance between activity and rest. An overuse injury can occur with sports and exercise or with routine daily and work duties, such as repeated work using a computer mouse, tools, or lab equipment.

Here are some tips on avoiding overuse injuries:

• Be mindful of your desk setup and workspace. Ask for an ergonomic assessment if you can.
• Gradually increase your physical activity level. This can be with respect to duration, distance, weight, or intensity level based on the type of exercise or    activity you are performing.
• Cross-train and incorporate a variety of types of exercises and movements.
• Concentrate on good form with proper posture. Don’t compromise your posture and form for being able to lift heavier weights.
• Be mindful of taking breaks and giving your body time to rest and recover.

As physical therapists, there are two common types of overuse injuries we see. Golfer’s Elbow is one type of common elbow overuse injury that involves pain on the inner side of the elbow. Another name for this injury is medial epicondylitis, which specifies that there is inflammation involving the tendons of the muscles on the inner side of your elbow- called the medial epicondyle. Medial epicondylitis can be a bit of a misnomer, however, as it implies that inflammation is the only cause of symptoms. Instead, the term epicondylalgia is being advocated for use in the medical world to recognize that it is a more complex condition with other possible mechanisms to account for symptoms. Signs and symptoms can include pain and tenderness at the inner elbow, difficulty and/or pain lifting things, making a fist, twisting motions at the wrist, and weakness in your forearm muscles on the inner aspect of your arm. Anyone who uses these muscles repetitively (including but certainly not limited to golfers) can be at risk for causing irritation at these tendons.

Another common type of overuse injury is called Tennis Elbow which is an overuse injury that involves pain on the outside of the elbow. Another name for this is lateral epicondylitis, which specifies that there is inflammation involving the tendons of the muscles on the outside of your elbow- called the lateral epicondyle. Again, you may hear your doctor and physical therapist describe this condition as lateral epicondylalgia instead, which acknowledges the wide array of potential pathophysiological mechanisms that produce pain and explains why controlling inflammation by means of ice and rest usually doesn’t solve the issue by itself. Signs and symptoms usually include pain and tenderness on the outside of the elbow, weakness in the forearm muscle group on the outer aspect, and difficulty and/or pain with lifting, twisting, and manipulating objects.

So, what can physical therapy do for your elbow pain? The type of physical therapy treatment you will receive will largely depend on your individual impairments, functional limitations, and goals for physical therapy. After an assessment, your physical therapist may decide to use variations of any of the following to address your symptoms and get you back to normal function:

• Manual therapy to improve mobility at the elbow and/or other surrounding structures and joints
• Mobility and strengthening exercises
• Postural/ergonomic assessments and modifications
• Discussion of activity and lifestyle modifications
• Discuss and modify any training and/or technique errors that may contribute to initial onset of symptoms
• Implement a home exercise program

If you feel like any of the above injuries or symptoms plague you in your day to day life, you most likely would benefit from physical therapy.

2024 Update: Advances in Understanding and Treating Elbow Pain

Updated Understanding of Tendinopathy: Since this article was first published, the science of tendinopathy (tendon-related pain) has advanced significantly. Current research strongly supports the continuum model of tendinopathy (Cook & Purdam), which describes a spectrum from reactive tendinopathy (acute load response) through tendon disrepair to degenerative tendinopathy. This model has important treatment implications: the management differs substantially depending on where on the spectrum the patient falls. Reactive tendinopathy requires relative rest and load modification; degenerative tendinopathy requires progressive loading to stimulate tendon remodeling. Anti-inflammatory approaches (ice, NSAIDs, corticosteroid injections) were previously overemphasized and are now understood to have limited benefit — and corticosteroid injections in particular have been associated with worse long-term outcomes compared to physical therapy in multiple high-quality RCTs.

Progressive Tendon Loading: The Most Effective Treatment: The strongest evidence for lateral and medial epicondylalgia treatment centers on progressive eccentric and isometric tendon loading programs. A 2022 systematic review in the British Journal of Sports Medicine found that exercise-based rehabilitation — specifically programs that progressively load the affected tendons — produces superior long-term outcomes compared to passive treatment, corticosteroid injection, and platelet-rich plasma (PRP) injections. Isometric exercises (sustained contractions without movement) are now used early in treatment due to their immediate analgesic effect, followed by gradual progression to eccentric loading and sport/work-specific functional training.

Elbow Pain in Remote Workers (Post-2020 Consideration): Since the COVID-19 pandemic accelerated remote work, physical therapists have seen a notable increase in elbow pain presentations related to prolonged computer use, suboptimal home workstation setups, and changes in activity patterns. Both lateral epicondylalgia (from mouse and keyboard use) and cubital tunnel syndrome (ulnar nerve compression at the elbow from sustained flexion) have become more common in remote workers. Ergonomic assessment — including keyboard height, mouse positioning, elbow and wrist alignment, and chair support — is now a routine component of PT treatment for computer-related elbow complaints. If you work from home and have developed elbow pain, a PT evaluation with ergonomic assessment is strongly recommended.

-Jessica Simbro, PT, MPT, CSCS