Tennis Elbow

These injuries are very common not only with athletes but also with people who happen to be involved with manual work. Usually they try to get relief by treating the symptomatic areas with a brace or a band to hold and support the joint, or different hot and cold therapy. Most of the time with limited success.

The elbow area is not the cause of the pain and discomfort; it is only the symptomatic area. The elbow joint is only an extension of a bigger bio-mechanical and neuromuscular dysfunction related to the hips and spine position. The biomechanical mechanism (movement pattern) will affect the neuromuscular activity of the body.

The human body must obey certain physical laws in order to survive its environment. These laws act on the body and trigger compensatory neurological and muscular activity, which commonly result in distortions of the human skeleton and muscle over activity known as muscle spasm. The body-gravity-center in a normally aligned human skeleton is located midway between the hips at the level of the second sacral vertebra. This location is affected by the position of the hips. The hips must be horizontally level in order to maintain the gravity center in its correct location.

Hip position determines the susceptibility of the body to injury and its ability to cope with the various stresses of daily life. If the hips are not level, usually the right hip is rotated between ¼ of an inch to 1 inch forward and will cause the spine to rotate to the left all the way up to the neck. The thoracic spine (upper back vertebrae) muscles will get spastic (locked in contraction), increasing the pressure on the nerves exit, shooting pain towards the shoulder area and from there down the arm, elbow and fingers. The thoracic spine is the source of constant barrage of nerve impulses, which will feed the pain in the shoulder, arm, elbow and fingers.

The muscles in these areas will get spastic also. The muscles, which involved in this kind of in jury, are:

• Scalenes - - The Scalenes muscles, which located in front, side and back of the neck has a powerful impact on neck structure and function. They can straighten the normal neck curvature, or even reverse it. The anterior and lateral scalenes could compress nerves, and will produce pain and radiation (tingling sensation and numbness) to the neck, shoulder, and arm down to the fingers.
• Supraspinatus - This muscle is originated in the upper part of the scapulae (shoulder blade) and is connected to the shoulder joint. When in a spasm, the pain would befelt in the shoulder and allthe way down the arm to the wrist.
• Infraspinatus - This muscle covers the lower part of the scapulae (shoulder blade) and is connected to the shoulder joint from the back... When in a spasm, the pain would be felt between the scapulae and the spine and down the arm all the way to the fingers.
• Subscapularis - This muscle is originated in the anterior (front) part of the scapulae and is connected to the front part of the shoulder joint. When in a spasm, the pain would be felt the top and back of the shoulder and downthe inner part of the arm and the wrist.
• Pectoralis Major - This muscle is originated in the chest and is connected to upper part of the arm from the front. When in a spasm, the pain would be felt in the shoulder, chest and down the inner part of the arm to the elbow area.
• Pectoralis Minor - This muscle is originated in the third, fourth and fifth ribs in the side of the rib cage. Itis connected to the front tip of the scapulae (coracoid process) in the shoulder joint. When in a spasm, the pain will be felt in the front part of the shoulder, the chest and down the inner arm to the fingers.
• Serratus Anterior - This muscle connects the outer surface of the rib cage to the inside of the scapulae (shoulder blade). When in a spasm the pain would be felt in the rib cage, shooting down the arm to elbow and fingers.
• Serratus posterior superior. This muscle connects the upper spine to the ribs under the scapulae (shoulder blade.) When in a spasm, the pain would be felt in the shoulder down the arm to elbow and fingers.
• Triceps and Anconeus- These muscles are connected between the shoulder joint and the posterior (back) forearm. When in a spasm, the pain would be felt in the shoulder and the back of the arm and forearm.
• Coracorachialis- this muscle connects the front tip of the scapulae (coracoid process) to the anterior arm. When in a spasm, the pain would be felt in the shoulder and down the arm to the fingers.
• Biceps Brachi and Coracobrachialis.These muscles are connected between the arm and the forearm. When in a spasm, the pain would be felt in the shoulder and down the arm to the thumb.
• Supinator and Pronator- These muscles originated in the elbow and connected to the wrist and hand. When they are in spasm the symptoms will be felt in the wrist and the hand.

Elbow Pain Referral Patterns