Treating elbow pain is notoriously difficult because the problem invariably does not come from the elbow!

An example is a client that I have seen recently complaining of long term inner side elbow pain which is made worse with swimming, gripping and interestingly, running.

Palpation around the area showed tightness throughout the flexors of the wrist, the pronators and knowing that these problems rarely start at the elbow I investigated higher up and found pectoral tightness and very short Lats on the same side.

If you look at the image of the Superficial Front Arm line reference by Thomas Myers in Anatomy trains you will notice that these muscles are all in the same line. I was also interested in the Gluteal region on the opposite side too knowing the connections between the lats and the glutes. The opposite gluteals were all weak to muscle testing.

Arm on a dark background

How does this fit in with swimming and running? Well, the lats are very important during front crawl in the pull back phase, and when they don’t work effectively the elbow is close by to pick up the slack and do too much work.

Running needs us to think even further back to the core and pelvis. During push off phase the Gluteus Maximus and opposite lat need to work together to control extension and rotation. When the glutes are weak, the lats try to compensate. This works well, until it doesn’t! They then get tired and need help further down the line – cue the elbow and in this case symptoms in the form of pain and tightness in the area and the call for help.

So, how do we solve this problem?

The answer is to work on the deeper causes like the connection Glute / Lat. Then assess and improve the Scapula and shoulder stability because without the deeper stability, the superficial shoulder power muscles (Pec major and Lats) cannot work optimally. Then, if the problem hasn’t resolved itself, we can get to work on the elbow thinking about its functions and mechanics.

I often work with clients in weight-bearing through the upper limb using hand tripod connections to facilitate correct movement patterns through the entire chain.

This does take time and homework but it’s worth it!

For more insight into upper limb problems, there are two blog posts; Shoulder Rehabilitation and Neck Pain and Scapular Instability. Plus the Arm Analyst series of workshops available as a series or individual lessons.

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