With Dr. Stephen Leffler
In this Bowsite’s ER Feature we will discuss elbow pain. Judging
by the questions I receive from all of you, elbow pain is a frequent problem
for archers. In my experience it is only slightly less common than shoulder
pain. The elbow is a hinge type joint and is one of the most stable joints
in the body. The elbow permits flexion and extension of your arm and allows
you to rotate your palm up and down. Three bones make up the elbow joint. The
humerus is the upper arm bone and connects with the radius and ulna, which are
the bones of the forearm. As you rotate your palm, your radius and ulna glide
over each other. There is very little laxity in the joint and it is not often
subjected to arthritis. About 50% of the strength of the elbow joint is contributed
by the bony framework and 50% by the surrounding muscles. There is a medial
band of muscles, which are strongest when your elbow is flexed, and a lateral
band of muscles, which are stronger when your elbow is extended. These muscle
bands attach onto the each side of the bottom of your humerus. Repetitive stress
to these muscles and tendons can cause pain on the side of your elbow where
they attach to the bone. Depending on the activity, you may feel pain on the
inside (medial) or outside (lateral) of your elbow. Hopefully, this basic
anatomy lesson will help us understand and treat elbow pain.
The onset of pain, on the outside (lateral) of the elbow, is usually gradual
with tenderness felt on or below the joint's bony prominence. Movements
such as gripping, lifting and carrying tend to be troublesome.
causes of golfer's elbow are similar to tennis elbow but pain and tenderness
are felt on the inside (medial) of the elbow, on or around the joint's
Back of Elbow
due to excessive leaning on the joint or a direct blow or fall onto the
tip of the elbow.
A lump can often be seen and the elbow is painful at the back of the joint.
Both of your elbows are subject to a lot of stress as you bring your bow to
full draw. Your bow arm is held in extension and your lateral (outside) elbow
muscles are doing most of the work. As you pull the string back your bowstring
elbow is flexing and your medial (inside) elbow muscles are doing more of the
work. In my experience, most archers have problems with elbow pain on the outside
of their bow arm. The medical term for this is lateral epicondylitis. It is
also known as tennis elbow. This is because the lateral muscle complex is not
nearly as strong as the medial muscles. Also, with the elbow extended there
is less bony support of the joint, and these muscles need to provide a greater
amount of the stability. Finally, hand shock from the bow is transmitted into
the elbow and can be a factor in elbow pain.
Usually archers will complain of pain on the outside of their elbow after shooting.
The pain will be most severe over the bump on the outside of your elbow. The
pain will be worse when you straighten your arm and stress the lateral muscles.
What is happening is that there is inflammation and micro tears in the area
where the muscles attach to the outside of the humerus bone. Repetitive shooting
worsens the trauma to the area and increases the damage. Treatment of lateral
elbow pain consists of allowing the damage to heal and then preventing recurrences.
First you must allow the inflammation and micro tears to heal. This typically
involves taking a break from shooting and taking an anti-inflammatory medication
such as ibuprofen. When your elbow is no longer hurting you can gradually resume
shooting. Dropping your draw weight and using a bow with less hand shock will
give your elbow a break. A very slight bend in your elbow will also take some
of the stress off of your lateral muscles. Some people have great luck with
a tennis elbow band. It stabilizes the lateral muscles and helps prevent bow
shock transmission into the elbow. It doesn’t work for everyone but may be
worth a try. You can buy one in most sporting goods stores. Good luck finding
one in camo! The other thing that you can do to prevent recurrences is to
strengthen the muscles surrounding your elbow. Simple exercises can make the
muscles stronger and withstand greater stress. 5 minutes a day a couple times
a week will go a long way towards keeping you shooting pain free.
Medial elbow pain is slightly less common for archers. The medial muscles
are stronger and your elbow is more stable in the flexed position. Still the
repetitive trauma of shooting can cause inflammation and pain on the inside
of the elbow. The pain will usually be located over the big bump (medial epicondyle)
on the inside of your elbow. Rehabilitation starts the same. Rest and ibuprofen
until pain free. The next step is to have someone watch, or better yet, video
your shooting mechanics. As we mentioned medial pain is more common in the
drawing arm. Drawing your bow with a very high elbow could cause pain. You
should strive for an inline draw and make sure you are doing most of the work
with your back.
Some simple exercises will strengthen these muscles and help prevent recurrences.
Our exercises will be geared toward strengthening the muscles that surround
the elbow. First we will focus on the forearm. Remember that when starting
this program you will need to start with a very light weight (1 pound) and gradually
work up to about 10 pounds. If the pain begins to recur, stop for a week and
then drop down a couple pounds and start again.
The first exercise is the wrist
extension. Start with a one-pound dumbbell and start with your palm down
and fully flexed. Now slowly extend your wrist bringing the weight upward.
Do three sets of ten. As you get stronger you can increase the weight
gradually up to about 10 pounds.
Next you will do wrist curls. Start
with your palm facing up with your wrist fully extended and curl the dumbbell
up as far as possible. Your elbow should be stationary. Three sets of
ten is your goal. Once again, increase the weight as you get stronger.
You will probably be able to handle more weight with the wrist curls,
as these muscles are stronger.
|Bicep curls are the next exercise for your elbow.
For curls most of you should be able to start with between 5-10 pounds.
Start with your arms at your side and rotate your palm up as you curl the
weight towards your shoulder. Your elbow should stay tight to your body
and should not swing. Bicep curls are an awesome exercise for the elbow
because they use all the muscles surrounding the joint. The key is to perform
the curls slowly and not to swing the elbow. Three sets of ten for each
arm will help a lot.
|The final exercise is for grip strength. Your forearm
muscles provide most of your grip strength. Those soft rubber squeeze balls
that are available in most sporting goods stores provide great exercise
for your forearm muscles. I also like this exercise because it can be done
anywhere. After a couple of weeks of regular use you will be amazed at
how much stronger your grip is.
These 4 exercises should take about 10-15 minutes at the most and should be
done 2 or 3 times a week. If done regularly they will make your forearm much
stronger and help stabilize your elbow. Hopefully this program will keep you
shooting pain free for a many years.