elbow pain develops it often results in the restricted use of our arm and hand both at work
and in our free time, affecting our enjoyment and quality of life. Seemingly simple
activities such as lifting, grasping, and typing can seem like a monumental task and can
seem like a monumental task and can greatly aggravate the condition. Those who have
been unfortunate enough to suffer these types of symptoms have often been subjected to
wearing an elbow brace and changing their daily routines in an attempt to take the strain
off the painful elbow with the hope of healing the condition. Others have sought various
forms of treatment ranging from medication, ultrasound, electrical stimulation, stretches,
and exercises, only to be continually frustrated and disappointed at their continued pain
and limited use of their arm.
Fortunately, a new treatment technique known as Active Release Technique
(ART) is proving to be a very effective method to combat elbow problems and help get
elbow pain sufferers back to their normal daily activities. But before we talk about how
ART works so effectively we first need to understand how the elbow becomes injured
in the first place.
muscles of the elbow are associated with the hand. This is important because the large
majority of elbow problems are associated with strain occurring at the wrist and hand, not
just the elbow itself.
The hand is a very complicated area and as such there are a very large number of
muscles that are associated with the hand and wrist. The majority of these muscles,
especially the stronger muscles, actually run all the way from the hand, up the forearm
and attach at the elbow. You can easily test this yourself by squeezing your forearm and
firmly opening and closing your hand. You will feel the muscles in the forearm contract
and relax as you open and close the hand.
It is important to realize that even though it is a small area, there are many
different muscles that attach at the elbow and travel down the hand. These muscles are
arranged in layers, and each muscle within each layer has a different job, or function. For
example, some of the muscles in the most superficial layer, that is the layer right under
the skin, travel down and attach to the wrist. When they contract they act to flex and
extend the wrist. Some of the muscles in the middle and deeper layers attach all the way
into the fingers and when they contract they move the fingers, such as when making a fist
or picking up objects. These deeper muscles that move the fingers may have many
separate tendons that go to each individual finger. This makes it possible to move one
finger by itself, and enables us to carry out tasks requiring fine motor skills such as
typing, buttoning a shirt, or playing the guitar.
As was previously mentioned, all of these muscles attach up at the elbow. If you
were to stand with the arm straight at your side and the palm facing forward, you will be
able to feel a bony prominence at the elbow on the side closest to the body. This is called
the medial epicondyle. The muscles on the front of the forearm are collectively called the
flexor muscles. Although there are many different muscles and many different layers of
muscles, the vast majority of these muscles attach to medial epicondyle through what is
known as the common flexor tendon. There is a similar situation on the back of the
forearm as well. The muscles on the back of the arm are known as the extensor muscles.
The various extensor muscles attach to the lateral epicondyle, which is the body
prominence on the outside of the elbow opposite the medial epicondyle.
tremendous amount of strain placed on the muscles of the hand and wrist- and remember,
these muscles attach at the elbow. Every time you pick up an object, swing a golf club, or
carry a bag of groceries the muscles of the hand and wrist must be active. Even an
activity such as typing puts a tremendous amount of strain through low level repetitive
contraction on these flexor and extensor muscle groups, and also at the elbow by way of
the common flexor and extensor tendons.
In addition to high levels of muscle activity that is inherent in normal daily
activities, many factors also place additional strain and work load on these muscles. For
example, repetitive use with certain sports or occupations, joint tightness at the wrist,
elbow, or shoulder, muscles imbalances, or previous injuries that may not have been fully
treated or rehabilitated can further strain the muscles of the elbow.
Over time this strain ca develop into what is known as micro-trauma. Simply
stated, micro-trauma is very small-scale muscle damage that occurs in the muscles and
ligaments in response to small levels of stain Initially this micro-trauma is not painful,
but may be perceived as a mild ache or tightness in the muscles, or at the medial or lateral
epicondyles. Although it is only small, this damage still needs to be repaired. The body
responds to micro-trauma by laying down small amounts of scar tissue to repair the
Unfortunately over time this scar tissue will build up and accumulate into what
we call adhesions. As these adhesions form they start to affect the normal health and
function of the muscles. In fact, they will often lead to pain, tightness, lack of flexibility,
muscle weakness, compromised muscle endurance, restricted joint motion and altered
biomechanics, and diminished blood flow.
As the muscles of the forearm become strained they also become very tight, and
the common tendon with which the muscles attach at the elbow begins to pull away from
its attachment site. This leads to pain and irritation at the area of the epicondyle. These
are how common elbow conditions such as medial epicondylitis, and lateral
epicondylitis- more commonly known as golfer’s elbow and tennis elbow- develop.
In addition to causing tightness, these adhesions are also very “sticky”, and affect
the ability of the muscles to stretch, contract, and slide over one another. Recall that there
are several layers of muscles in the forearm, and that each of these muscles has different
functions, and therefore contract at different times. For this process to occur correctly the
muscles need to be able to glide freely on one another. As adhesions develop they will
cause the individual muscles and various layers to stick on each other and prevent this
normal tissue gliding. When the muscles lose the ability to slide contraction of one
muscle will cause a pull and tension on all of the muscles even when the muscle is not
being used. This in turn will cause further strain to the region, and more strain on the
muscles as well as the epicondyle.
Another common development is that the accumulation of scar tissue adhesions
can affect the nerves in the region of the elbow and forearm. This occurs because
between the layers of muscles there are nerves that run all the way from the neck, down
the arm, past the elbow and forearm, and into the hand. Just as the muscles need to be
able to slide on each other, the nerves also need to be able to glide freely between the
layers of muscles. In many cases the accumulation of scar tissue can cause the nerves to
become “stuck” to the surrounding muscles. Instead of the nerve easily gilding between
the muscles it becomes stretched and irritated and can lead to other types of elbow and
lower arm pain. When the nerve becomes entrapped, in addition to pain, other symptoms
such as numbness, tingling, and weakness are often present. This is what commonly
happens in elbow conditions such as Ulnar Nerve Syndrome, Interosseous Nerve
Syndrome, or Radial Nerve Syndrome.
on their own, or in combination with other methods. Some of the more common
approaches include anti-inflammatory medications, rest, ice, elbow splints or braces,
ultrasound (US), muscles stimulation (E-Stim), stretching, and exercise. Unfortunately
most of these traditional techniques generally require a long period of time before they
provide any significant relief, and in many cases provide only temporary relief from
symptoms instead of fixing the underlying cause of the problem.
The main reason that these approaches are often ineffective is that they fail to
address the underlying scar tissue adhesions that develop within the muscles and
surrounding soft tissues. It is these adhesions that are binding tissues together, restricting
the normal sliding of the tissues, and potentially entrapping the surrounding nerves at the
elbow and forearm.
Passive approaches such as medications, rest, ice, and steroid injections all focus
on symptomatic relief and do nothing to address the muscle restrictions and dysfunction.
More active approaches such as stretching and exercises are often needed for full strength
and function of the muscles; however, they themselves do not treat the underlying
adhesions. In fact, without first addressing the scar tissue adhesions, stretches and
exercises are often less effective and much slower to produce relief or recovery from the
hands-on treatment method to address the problems in the soft tissues of the body,
including the muscles, ligaments, fascia, and nerves. ART treatment is highly
successful in dealing with elbow conditions because it is specifically designed to locate
and treat scar tissue adhesions that accumulate in the muscles and surrounding soft
tissues. By locating and treating the soft-tissue adhesions with ART, it allows the
practitioner to, 1) break up restrictive adhesions, 2) reinstate normal tissue flexibility and
movement, and 3) more completely restore flexibility, balance, and stability to the injured
area and to the entire kinetic chain.
You can think of ART treatment as a type of active massage. The practitioner
will first shorten the muscle, tendon, or ligament, and then apply a very specific pressure
with their hands as you actively stretch and lengthen the tissues. As the tissue lengthens
the practitioner is able to assess the texture and tension of the muscle to determine if the
muscle is healthy or contains scar tissue that needs further treatment. When scar tissue
adhesions are felt the amount and direction of tension can be modified to treat the
problematic area. In this sense, each treatment is also an assessment of the health of the
area as we are able to feel specifically where the problem is occurring.
An additional benefit of ART is it allows us to further assess and correct
problems not only at the site itself, but also in other areas of the kinetic chain, which are
associated with movement compensations and are often contributing factors to the
problem. This ensures that all the soft tissues that have become dysfunctional and are
contributing to the specific injury addressed, even if they have not yet all developed pain.
One of the best things about ART is how fast it can get results. In our
experience, the majority of elbow injuries respond very well to ART treatment,
especially when combined with the appropriate home stretching exercises. Although each
case is unique and there are several factors that will determine the length of time required
to fully resolve each condition, we usually find a significant improvement can be gained
in just 4-6 treatments. These results are the main reason that many elite athletes and
professional sports teams have ART practitioners on staff, and why ART is an
integral part of the Ironman triathlon series.
To book an appointment to see if ART will be able to help with your elbow
injury, simply call our office at 248-477- 2100.