Are you experiencing lingering elbow pain? Have you experienced elbow pain in the past and are unsure why? Weakness of the shoulder muscles and stiffness in your upper back or neck might be underlying problems contributing to these elbow injuries. Shoulder weakness and upper back stiffness are common in athletes (baseball players, tennis players, and swimmers) and most of the general population. Our sedentary lifestyles and less than optimal exercise programs are likely strong contributors to elbow pain.
Tennis Elbow Pain and Shoulder Weakness
Tennis elbow, also known as lateral epicondylitis, is a common tendon disorder which occurs in both tennis players and the general population. These individualls describe pain on the outside of the elbow aggravated by gripping or lifting activities. Local treatment to the elbow is often unsuccessful or leads to only temporary improvements. Common treatments which often produce minimal lasting benefits include medications, injections, braces, ultrasound, laser, or electrical stimulation. Often, muscle weakness at the elbow and neighboring regions of the body are contributing to the onset and persistence of elbow pain. Research suggests there is an association between posture and shoulder muscle weakness in those with tennis elbow.
Recent research shows a link between tennis elbow and muscle strength of the serratus anterior, lower trapezius, and middle trapezius. Poor scapular muscle and rotator cuff strength is linked to tennis elbow in both non-athletes and athletes (i.e., tennis players). These muscles are important for orienting and positioning the shoulder blade during functional activities involving the arm. Poor strength or endurance of these muscles can result in overload to the elbow and wrist muscles. Strengthening the scapular stabilizers is an important part of rehabilitation for patients with tennis elbow. Targeting the middle and lower trapezius muscles using dumbbells lying in the prone position is an excellent starting point.
Baseball Players with Poor Posture & Shoulder Weakness are at an Increased Risk for Elbow Injury
Youth baseball players, ages 6 to 12, with a flexed or rounded upper back are 2.5 times more likely to sustain an elbow injury. Exercises which restore mobility in the thoracic spine and strengthen the muscles of the shoulder blade are important to address these problems. Loss of mobility in the thoracic spine from a rounded back position will limit a baseball player’s ability to achieve the late cocking phase of throwing. Often, these athletes will compensate at the shoulder and elbow in order to achieve the cocked position. Over time, the increased forces at the elbow will over stress the soft tissue and bony structures leading to injury and pain.
Scapular muscle and rotator cuff weakness is associated with throwing-related elbow and shoulder pain in youth baseball players. Also, baseball players with ulnar collateral ligament injuries show decreased strength of the infraspinatus and subscapularis. Similarly, weakness of the supraspinatus muscle is linked to serious arm injury in high school baseball players. These rotator cuff muscles stabilize the shoulder joint during throwing. Weakness at the shoulder will increase stress further down the chain at the elbow. Baseball players should be performing regular arm care exercises which target the scapula and rotator cuff muscles. Examples of these exercises include shoulder external rotation and diagonal patterns with a band or dumbbell.
Strengthening the shoulder muscles is an integral component of rehabilitation from elbow injury. Perhaps, more importantly these exercises can reduce the risk of elbow injury before pain starts. Strengthening exercises for the elbow and wrist are also important considerations. However, the shoulder and upper back region is often neglected when it comes to improving elbow function. This is one reason why elbow inuries and pain often persist longer than expected. Human movement is more complex than isolated muscles or joints. Therefore, exercise programs should integrate the entire body in order to restore or optimize function. Give these 5 exercises a try and let us know how you make out.
- Bhatt JB, Glaser R, Chavez A, Yung E. Middle and lower trapezius strengthening for the management of lateral epicondylalgia: A case report. J Orthop Sport Phys Ther. 2013;43(11):841-847. doi:10.2519/jospt.2013.4659.
- Day JM, Bush H, Nitz AJ, Uhl TL. Scapular muscle performance in individuals with lateral epicondylalgia. J Orthop Sport Phys Ther. 2015;45(5):414-425. doi:10.2519/jospt.2015.5290.
- Garrison JC, Johnston C, Conway JE. Baseball players with ulnar collateral tears demonstrate decreased rotator cuff strength compared to healthy controls. Int J Sport Phyiscal Ther. 2015;10(4):476-482.
- Lucado AM, Kolber MJ, Cheng SM, Echternach JL. Upper extremity strength characteristics in female recreational tennis players with and without lateral epicondylalgia. J Orthop Sport Phys Ther. 2012;42(12):1025-1032. doi:10.2519/jospt.2012.4095.
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- Tyler TF, Mullaney MJ, Mirabella MR, Nicholas SJ, Mchugh MP. Risk factors for shoulder and elbow injuries in high school baseball pitchers: The role of preseason strength and range of motion. Am J Sports Med. 2014;42(8):1993-1999. doi:10.1177/0363546514535070.