ELBOW
Lateral epicondylitis (Tennis elbow)
What Is It?
From an osteopathic perspective, this condition involves tendinopathy of the extensor muscles of the forearm, which are responsible for extending the wrist and fingers. Commonly referred to as "tennis elbow" or lateral epicondylitis, it is actually a frequent overuse injury that affects a wide range of people, not just athletes. The condition stems from repetitive strain or microtrauma to the tendons where they attach to the lateral epicondyle of the humerus, causing pain and inflammation. Over time, this can lead to degeneration of the tendon tissue if not addressed properly.
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How Does It Present?
The hallmark symptom is pain located on the outer part of the elbow, radiating down into the forearm. This pain is often exacerbated by activities that involve gripping or extending the wrist and fingers, especially under resistance, such as lifting objects, typing, or even shaking hands. Simple everyday tasks like opening a jar or holding a cup can become painful. In addition to localised pain, some may experience weakness in the affected arm, making it harder to carry out normal activities.
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Why Has It Happened?
This condition is caused by repetitive strain or overuse of the forearm extensors, leading to tiny tears and inflammation in the tendons. It's not limited to tennis players or athletes, but is prevalent among people who perform repetitive hand and wrist movements. Typing for long periods, using a smartphone extensively, or engaging in tasks like DIY or manual labor are all common triggers. Poor posture and muscle imbalances, where the extensor muscles are overworked without sufficient counterbalance from the flexor muscles, can also contribute to this issue.
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How Can Osteopathy Help?
Osteopathic treatment for tennis elbow focuses on addressing both the localised injury and the broader musculoskeletal system to encourage healing and prevent recurrence. By evaluating the entire kinetic chain—from the wrist and elbow to the shoulder and spine—an osteopath can identify and treat underlying imbalances that may be contributing to the condition.
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Manual Therapy: Osteopaths use hands-on techniques such as soft tissue massage, joint mobilisation, and stretching to reduce tension in the forearm muscles, improve blood flow, and relieve pain. These techniques also help to break down adhesions in the tendons and promote tissue healing.
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Eccentric Strengthening Exercises: A key part of rehabilitation is strengthening the extensor muscles through eccentric contractions (where the muscle lengthens under tension). These exercises help stimulate tendon repair, restore function, and reduce the risk of re-injury.
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Posture and Ergonomic Advice: Since poor posture and repetitive strain are common contributing factors, osteopaths provide guidance on ergonomics, suggesting adjustments to workstations, typing positions, and smartphone use. This helps reduce ongoing stress on the affected muscles and tendons.
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Additional Therapies: Osteopaths may also incorporate adjunct therapies such as dry needling or acupuncture to help release muscle tension and stimulate healing. Techniques like ultrasound or kinesiology taping can also be used to support the healing process and alleviate pain.
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By taking a holistic approach that looks beyond the symptoms and addresses the underlying causes, osteopathic treatment can help reduce pain, restore mobility, and improve long-term outcomes for those suffering from tennis elbow.
Medial epicondylitis (Golfer’s elbow)
What Is It?
From an osteopathic perspective, this condition is known as medial epicondylitis, commonly referred to as golfer’s elbow. It involves tendinopathy of the forearm flexor muscles, which are responsible for bending the wrist and fingers. Unlike tennis elbow, which affects the outer side of the elbow, golfer’s elbow occurs on the inner side. While it is less common than tennis elbow, it affects both athletes and non-athletes alike, often as a result of overuse or repetitive strain. Osteopathically, we view this condition not only as a local tendon injury but as part of a broader functional imbalance involving muscle tension, joint alignment, and biomechanical stress patterns in the arm and upper body.
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How Does It Present?
Golfer’s elbow typically presents with pain and tenderness on the inside of the elbow, particularly during activities that involve flexing the wrist or gripping. Common triggers include carrying bags, performing overhand motions like a tennis serve, or manual tasks such as using a hammer or screwdriver. Pain can radiate down the forearm and is often aggravated by repetitive motions or heavy lifting, particularly if the wrist and elbow are not properly aligned during movement.
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Why Has It Happened?
From an osteopathic perspective, medial epicondylitis can result from both acute injury and chronic overuse. A single, forceful contraction of the forearm flexor muscles may cause an initial strain, leading to microtears in the tendon. Alternatively, repetitive activities that strain the wrist and elbow, such as gripping, lifting, or swinging motions, can result in cumulative overload, leading to inflammation and degeneration of the tendon over time. Poor posture, imbalanced muscle use, or joint misalignment—either locally or in the upper body—can further exacerbate the strain placed on the forearm flexors, making the condition more likely to occur.
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How Can We Help?
Osteopathic treatment for golfer’s elbow focuses on restoring balance and function to the affected area and the body as a whole. This includes hands-on techniques to release tension in the forearm flexor muscles and surrounding tissues, such as deep tissue massage, myofascial release, and medical acupuncture. In addition to addressing the immediate area of pain, osteopaths will also assess the mechanics of the shoulder, upper back, and wrist to identify any contributing postural or movement imbalances.
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Rehabilitation exercises, particularly eccentric exercises targeting the forearm flexors and biceps, are crucial for promoting tendon healing and strengthening the affected muscles. These exercises help improve tissue resilience and restore optimal movement patterns. By treating the whole body, we not only aim to resolve the local pain but also address the underlying biomechanical issues that may be contributing to the injury, helping to prevent future recurrence.
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Ongoing advice on ergonomics, movement habits, and posture will also be provided to support long-term recovery and prevent re-injury.
Olecranon Bursitis
What Is It?
The olecranon is the bony prominence of the ulna, one of the two bones in the forearm, forming the hinge joint of the elbow with the humerus (upper arm bone). Covering the outer surface of the olecranon is a small fluid-filled sac known as the olecranon bursa. Bursae, which are present in various joints throughout the body, are designed to reduce friction between moving structures like bones, tendons, and muscles. However, the olecranon bursa can sometimes become inflamed, leading to a condition known as olecranon bursitis.
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From an osteopathic standpoint, this inflammation may not just be an isolated issue but could also be influenced by muscular imbalances, joint misalignment, or repetitive strain affecting the mechanics of the elbow. The body's holistic structure plays a role in how stress and strain are distributed across the joints, potentially predisposing the bursa to irritation.
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How Does It Present?
Olecranon bursitis is usually quite noticeable and easy to identify. It typically presents as a visible swelling over the tip of the elbow, which may range from mild to significant, depending on the extent of the inflammation. In more severe cases, the skin over the area may become red and tender, indicating deeper inflammation. The condition may cause discomfort, especially during movements that involve bending the elbow or leaning on it.
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From an osteopathic view, there may also be associated muscular tension or imbalance, particularly in the surrounding muscles like the triceps, which could aggravate the bursa further and contribute to the presentation of pain and restriction in movement.
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Why Has It Happened?
Olecranon bursitis can develop for several reasons, though continuous pressure or friction on the elbow, such as leaning on hard surfaces like a desk, is a common cause. The bursa becomes irritated as it is repeatedly compressed, leading to inflammation and swelling. Repetitive elbow movements or minor trauma can also contribute.​ In some cases, it could result from an infection (septic bursitis), although this is less common.
An osteopath might also consider how postural habits, such as leaning or improper use of the upper limb, create unnecessary strain at the elbow joint, leading to bursitis. Muscular imbalances, particularly tightness in the triceps brachii, can exacerbate the issue by putting additional pressure on the bursa.
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How Can We Help?
From an osteopathic perspective, treating olecranon bursitis involves more than just addressing the inflammation. We consider the whole body's mechanics to uncover any underlying imbalances that may have contributed to the condition.
Manual therapy can be used to release tight muscles, especially in the triceps brachii, and improve mobility in the surrounding joints, which can alleviate pressure on the bursa. Osteopathic techniques aim to restore proper function and alignment to the elbow, shoulder, and even the cervical spine if necessary, improving overall movement patterns.
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Lifestyle advice is key in preventing further irritation. This may include recommendations to avoid prolonged pressure on the elbow, such as not leaning on hard surfaces, and modifying workspaces to reduce strain. In some cases, wearing an elasticated sleeve or elbow pad may help protect the area and control swelling.
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Exercise prescription may be given to strengthen and support the muscles around the elbow and shoulder, which can help to balance the load on the joint and reduce the likelihood of recurrence. Education on posture and body mechanics will further aid in recovery and prevent future occurrences, ensuring the bursa can heal properly while addressing any contributing factors.
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In severe or persistent cases, additional treatments like ultrasound therapy or referral for further medical evaluation may be considered, but osteopathic treatment aims to manage the condition holistically, helping to restore function and reduce inflammation naturally.
Carpal Tunnel syndrome
What Is It?
From an osteopathic perspective, this condition—commonly known as carpal tunnel syndrome—results from the compression of the median nerve as it passes through the carpal tunnel, a narrow passage in the wrist. The carpal tunnel is bordered by bones and a fibrous ligament, and when the median nerve is compressed, it leads to characteristic symptoms like pins and needles, numbness, and weakness in the hand and fingers. Osteopathically, this is seen as not just a localised issue in the wrist, but potentially influenced by muscular imbalances, fascial tension, or poor biomechanics in the forearm, shoulder, and even the neck.
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How Does It Present?
Carpal tunnel syndrome typically presents with neurological symptoms, such as pins and needles, numbness, and weakness, specifically affecting the thumb, index, and middle fingers. Symptoms are often worse at night and may interfere with gripping or fine motor activities, like holding a pen or using a phone. The distinct pattern of sensory loss and discomfort, combined with the typical history of gradual onset, makes it relatively straightforward to diagnose through a comprehensive case history and specific osteopathic examinations that include assessing not just the wrist, but also the entire upper limb and neck for contributing factors.
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Why Has It Happened?
Carpal tunnel syndrome often develops gradually rather than from acute trauma. Overuse of the forearm flexor muscles, repetitive wrist movements, and poor posture can contribute to the condition. In an osteopathic framework, additional factors such as restricted shoulder movement, poor ergonomics, or tension in the neck and upper back can create compensatory patterns that add strain on the carpal tunnel region. Hormonal changes (such as during pregnancy) and conditions like diabetes can also increase the risk of developing this condition by affecting tissue and nerve health.
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How Can We Help?
Osteopathic treatment for carpal tunnel syndrome focuses on both the local wrist area and the broader musculoskeletal system. Manual techniques such as myofascial release, stretching of the forearm flexors, and gentle mobilisations of the wrist and carpal bones can help reduce compression on the median nerve. Additionally, osteopaths often address contributing factors, like tightness in the neck, shoulders, and upper back, which may be exacerbating the problem.
A combination of treatment techniques—including soft tissue massage, joint mobilisation, and medical acupuncture—can relieve pressure on the nerve. Exercises aimed at improving flexibility and strength in the wrist and forearm are also important for long-term relief. Homecare advice, such as ergonomic adjustments and the use of a wrist splint, can further support recovery and prevent recurrence. From an osteopathic viewpoint, balancing the entire upper body’s biomechanics is key to resolving the issue and promoting sustained health.