Elbow Tendonitis
(A Complete Guide with Relief Exercises)

Written by: Nurudeen Tijani (Wellness and Pain Relief Fitness Coach)

Article Summary

• Individuals involved in strenuous hand-related occupations, physical activities, or repetitive tasks may develop tendonitis in the elbow.
• The primary causes include chronic inflammation, magnesium deficiency, and muscle restriction.
• Why it becomes chronic: Even when the elbow itself is treated, symptoms often return due to muscle stiffness, how muscles and tendons absorb stress, and compensation patterns that develop over time.
• This article explores these causes and outlines effective non-surgical self-treatment and prevention strategies for managing elbow pain and tendonitis.

Key Points

• Root Causes: Chronic inflammation, magnesium deficiency, and muscle restriction are the primary causes of elbow tendonitis.
• Conditions and Injuries: Common injuries include tennis elbow, golfer's elbow, triceps tendonitis, brachialis tendonitis, and distal bicep tendonitis.
• Symptoms: Common symptoms of elbow tendonitis include burning pain at the tip of the elbow, redness, swelling, tenderness around the joint, dull or sharp discomfort, difficulty bending or straightening the arm.
• Non-Surgical Treatment: Use self-myofascial release (SMR) exercises to massage and keep the triceps, biceps, and forearms pliable. SMR is an effective and reliable way to relieve elbow pain.

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Causes of Elbow Tendonitis

Root Cause #1: Magnesium Deficiency

According to The Magnesium Miracle, approximately 70–80% of people in the U.S. are magnesium deficient, which significantly affects tendon health, particularly in the elbow.

Calcium helps muscles contract, while magnesium aids in relaxation. Excess calcium causes muscles to remain tense, straining tendons and leading to joint inflammation and pain.

Magnesium dissolves calcium, preventing the calcification of soft tissues. Calcification hardens tendons and muscles, leading to tendonitis and joint pain.

"The Magnesium Miracle" highlights that heavy exercise, caffeine, stimulants, diuretics, stress, and dehydration deplete magnesium levels.

Further, calcium is a direct cause of inflammation. Conditions ending in "itis" (like tendonitis) indicate inflammation and lack of magnesium.

Therefore, individuals engaged in strenuous professions or physical activities must actively replenish magnesium in their bodies.

40% of magnesium in the body is in the muscles. Twitching muscles, muscle cramps, and muscle spasms are signs of low magnesium levels in the body. - The Magnesium Miracle - Discover the Missing Link to Total Health, By Carolyn Dean, MD, ND

Root Cause #2: Muscle Restriction

With the body deficient in magnesium, the elbow supporting muscles—including the brachioradialis, wrist flexors and extensors, and triceps—are more likely to become tense, lose elasticity, and contract over time.

Muscle restriction refers to inelastic, tight, shortened, knotted, or tender tissues. It occurs when inelastic fibers shorten and cannot relax to their normal state.

Lifting, pulling, or pushing heavy objects can overstretch and overload the triceps and forearm muscles, leading to restriction. This restriction is the trigger that initiates pain in the joint.

When these muscles become restricted, they shorten and tighten. The tightness puts tension on the tendons attached to the joints, leading to inflammation and discomfort.

Root Cause #3: Chronic Inflammation

When the body is deficient in magnesium, and the forearms and triceps are restricted, repetitive tendon and muscle strains can lead to chronic inflammation in the elbow.

This inflammation results in a 'burning' sensation and pain known as tendonitis.

A burning sensation and discomfort indicate acute inflammation, which is usually temporary and resolves with healing. If the pain persists for more than three months, it becomes chronic.

If the body's healing process fails, chronic inflammation can occur, which prevents proper healing of muscles, tendons, and ligaments, leading to chronic tendonitis.

Note: Apart from tendon issues, various medical conditions can cause joint problems. Visit this article from the Mayo Clinic on 19 causes of elbow pain.

Jump to a specific section of the article:

1. Tendonitis vs. Tendinosis
2. Symptoms
3. Non-surgical Treatment
4. Relief Exercises
5. Next Step & Getting Started

Tendonitis vs. Tendinosis

Stages of Tendonitis

Tendonitis refers to the inflammation of a tendon, resulting in acute inflammatory pain. Tendinosis is the deterioration of tendon collagen due to repetitive stress and chronic injury.

Tendinosis leads to a loss of tendon strength and can result in tears or ruptures. Repeatedly performing physical activity with tendonitis can lead to tendinosis.

Initially, tendonitis involves micro-tear damage. Continued activity can worsen the injury, leading to tendinosis and tendon rupture.

Types of Elbow Tendon Injuries

1. Tennis elbow (lateral epicondylitis): Pain at the outer elbow due to inflammation of the common extensor tendon.
   
2. Golfer's elbow (medial epicondylitis): Pain at the inner elbow due to inflammation of the medial tendon.
   
3. Triceps tendonitis: Pain at the back of the elbow due to inflammation of the triceps tendon.
   
4. Brachialis tendonitis: Pain and swelling at the front elbow crease due to inflammation of the brachialis tendon.
   
5. Distal biceps tendonitis: Pain in the lower biceps area due to inflammation of the tendon attaching the biceps muscle to the radius (forearm bone).

Over time, these inflammatory injuries can lead to degenerative conditions like arthritis, bursitis, and difficulties during lifting activities.

Read more about the elbow pain when lifting.

The photo below illustrates tendinosis in the medial and extensor tendons of the arm.

Symptoms of Acute vs. Chronic Pain

Acute Pain:

Acute pain is an inflammatory condition experienced during or immediately after physical activity. Symptoms include:

• Burning pain at the tip of the elbow
• Heat, redness, soreness, swelling, or tenderness around the joint
• Throbbing sensation in the affected area

Inflammation is the body's natural response to infections and injuries. Poor form during physical activities or exercise technique can strain and injure muscles and tendons, leading to inflammation. Acute inflammation typically lasts a few days to a few weeks.

Chronic Pain:

An injury becomes chronic when it persists for over three months. Symptoms of chronic elbow injury include:

• Dull and nagging discomfort
• Discomfort when bending and straightening the arm
• Joint stiffness
• Sharp, sudden, shooting, severe, or dull ache
• Weak grip strength

Non-Surgical Treatment and Prevention

Summary of Treatments

1. Cold Therapy: Use the RICE Method (Rest, Ice, Compression, Elevation) to manage acute pain and reduce inflammation.
2. Short-Term Relief Methods: Compression sleeves, joint supplements, and painkillers alleviate symptoms but don't address the underlying cause.
3. Self-Myofascial Release (SMR) Relief Exercises: SMR exercises can keep the elbow support muscles pliable, releasing restrictions and easing tension in tendons and joints.

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Relieve Acute Pain

If you feel burning pain, heat, redness, or swelling around the elbow, use the RICE Method:

• Rest the affected area.
• Apply ice to reduce inflammation.
• Use compression to support the joint.
• Elevate the arm to decrease swelling.

Applying Cold Therapy:

• Apply ice or an ice pack wrapped in a towel to the affected area.
• Ice for 10-20 minutes, four to eight times daily for the first three days.
• Avoid applying ice directly to the skin.

Limitations of the RICE Method:

While effective for acute symptoms, the RICE method doesn't address the root causes of pain, which can return and worsen with resumed activity.

Short-Term Options: Pros and Cons

Joint Supplements & Health Vitamins

• Pros: Joint supplements containing Methylsulfonylmethane (MSM) and Chondroitin support joint health and provide short-term relief for acute elbow injuries. They may help prevent tendonitis when used regularly.
• Cons: In my experience, supplements like MSM, Chondroitin, Turmeric, and Fish Oil did not significantly relieve chronic tendonitis. Additionally, these supplements do not address the root cause of tendon injuries. A 2016 study in Arthritis & Rheumatology found that MSM and Chondroitin did not significantly reduce chronic joint pain.

Painkillers (NSAIDs)

• Pros: Nonsteroidal anti-inflammatory drugs (NSAIDs) or painkillers reduce acute inflammation, providing temporary relief from joint pain.
• Cons: Painkillers only address acute pain symptoms and do not target the underlying cause. Consequently, the pain often returns. Long-term NSAID use can lead to health issues, including gastrointestinal side effects and kidney disease.

Joint Injection (Cortisone Shot)

• Pros: A cortisone shot involves injecting a steroid medication into the affected joint. It provides temporary relief by suppressing inflammatory pain. The effects typically last for three to six months.
• Cons: The relief is temporary, and discomfort often returns once the steroid's effects wear off. Repeated cortisone injections can cause long-term side effects, including damaged cartilage, joint infection, and nerve damage.

Topical Anti-Inflammatory Remedies (Oil, Cream, Spray, Gel, Poultice)

• Pros: Topical solutions like oils, creams, sprays, and gels often contain anti-inflammatory medications such as MSM. They effectively treat acute inflammatory pain, especially for new elbow injuries. They can be beneficial in a maintenance routine to help prevent tendonitis.
• Cons: For chronic tendonitis lasting three months or more, these remedies provide little relief and do not address the condition's root cause.

Strength and Physical Therapy

• Pros: Strength therapy is crucial for elbow tendinosis recovery, aiding in the healing of degenerative tendons and restoring full arm strength and mobility.
• Cons: If the underlying causes of tendon inflammation are left unaddressed, physical therapy can be ineffective for many.

Elbow Compression Sleeves and Support Braces

• Pros: Compression sleeves, straps, wraps, and support braces compress tendons and joints, temporarily relieving discomfort during physical activity.
• Cons: These aids mask the problem without addressing the underlying issue, potentially leading to prolonged symptoms and the progression to tendinosis.

Kinesiology Tape Therapy

• Pros: Sports tapes offer temporary relief for tendon strains when applied correctly.
• Cons: Relying solely on kinesiology therapy can mask the underlying issue, potentially prolonging tendonitis.

Pain Relief Patches

Medicated Patches: They contain nonsteroidal anti-inflammatory medication and are applied directly to the painful area, offering short-term relief.

• Pros: Provide temporary relief for tendon injuries, lasting for a few hours.
• Cons: Do not address the root cause of tendonitis, and the pain may return after resuming physical activity. Medicated patches can also have long-term gastrointestinal side effects. 

Non-Medicated Patches (Nanotech): Claim to utilize nanotechnology to support the body's natural pain-fighting ability.

• Pros: They can be beneficial as part of a maintenance routine to prevent acute pain.
• Cons: Cannot resolve the root causes of tendon strains and offers limited benefits in reducing chronic pain.

Stretching Therapy

• Pros: Stretching the biceps, forearms, and triceps helps elongate these muscles, improving blood flow, nutrient delivery, oxygenation, and waste removal from the muscles and tendons, aiding in faster healing. When muscles lengthen, tendon and joint discomfort decrease.
• Cons: Like physical therapy, stretching alone may provide little relief if the root causes of tendon injuries are left unaddressed.

Heat Therapy

• Pros: Heat therapy helps to relieve forearm or triceps muscle tension and improve blood flow to the elbow area, which can promote healing. When used along with myofascial release and stretching, heat therapy can help speed up recovery.
• Con: It may provide temporary relief from muscle tension that contributes to pain, but depending on the severity of the tendon injury, it does not address the underlying cause.

SMR Exercises for Elbow Pain (exercise photos below)

Self-myofascial release (SMR) uses manual therapy tools like massage balls to apply pressure to specific points on the body.

SMR helps release muscle tension, increase elasticity, improve performance and flexibility, and enhance tissue mobility by targeting trigger points in the fascia, the connective tissue around the muscles.

• Effectiveness: Massage balls are highly effective in releasing tight muscles. They are durable and inexpensive, making them a sustainable solution for pain management and maintaining healthy elbows.
• Tools: The peanut ball is ideal for releasing the biceps, forearm extensors, triceps muscles, and tendons, while the lacrosse ball is perfect for targeting the forearm flexors.

Relief Exercises (Step-by-Step Instructions)

Self-myofascial release (SMR) exercises can help relieve tennis and golfer's elbow, triceps, biceps, or brachialis tendonitis. They are simple and yet highly effective.

For best results, use a holistic approach and massage the entire forearm, biceps, and triceps.

Exercise #1 — Massage the Wrist Extensor Muscles

Massage the wrist extensor with a peanut ball.

1. Use a peanut ball.
2. Lean against a wall and place the ball on the wrist extensor muscles.
3. Roll out the muscles for 3-5 minutes.
4. The "X" shown in the image below marks the common locations where tension and trigger points typically develop in the wrist extensors. Focus on those areas.
5. Stretch the wrist extensors.

Routine:

• Perform once a day. Rest the muscle the following day.
• For faster results, perform twice a day (morning and night).

In the photo below, I demonstrate how to massage the extensors to resolve tennis elbow.

Exercise #2 — Massage the Wrist Flexor Muscles

Massage the wrist flexors with a peanut or lacrosse ball.

1. Use a peanut or lacrosse ball.
2. Sit on a chair next to a table, place the ball on the table, and position your wrist flexor muscles on top.
3. Roll out the muscles for 3-5 minutes.
4. The "X" shown in the image below marks the common locations where tension and trigger points typically develop in the wrist flexors. Focus on those areas.
5. Stretch the wrist flexors.

Routine:

• Perform once a day. Rest the muscle the following day.
• For faster results, perform twice a day (morning and night).

The photo below, I demonstrate how to massage the flexors to resolve golfer's elbow.

Exercise #3 — Massage the Triceps Muscles

Massage the triceps muscle and tendon with a peanut ball.

1. Use a peanut ball.
2. Sit on a chair next to a table, place the ball on the table, and position your triceps muscle on top.
3. Roll out the triceps muscle and tendon for 3-5 minutes, from near the armpit to above the elbow joint.
4. The "X" shown in the image below marks the common locations where tension and trigger points typically develop in the triceps. Focus on those areas.
5. Stretch the triceps muscle.

Routine:

• Perform once a day. Rest the muscle the following day.
• For faster results, perform twice a day (morning and night).

In the photo below, I demonstrate the massage exercise to resolve tricep tendonitis.

Exercise #4 — Massage the Biceps and Brachialis Muscles

Massage the biceps and brachialis muscles with a foam roller or peanut ball.

1. Use a peanut ball.
2. Lay on an exercise mat with the ball on a stool next to your body, and position your biceps on top.
3. Roll out the biceps muscle for 3-5 minutes, from near the armpit to the elbow area (avoid rolling over the joint).
4. The "X" shown in the image below marks the common locations where tension and trigger points typically develop in the biceps and brachialis. Focus on those areas.
5. Stretch the biceps muscle.

Routine:

• Perform once a day. Rest the muscle the following day.
• Perform mobility exercises on rest days.

Important Notes:

• The biceps and brachialis are responsible for bending the arm. If these muscles become pliable too quickly, it might result in temporary discomfort as the joint adapts. In this case, shorter sessions (3-5 minutes every other day) are better than longer sessions (10 minutes or more).

In the photo below, I demonstrate how to massage the biceps and brachialis muscles.

Ready to take the next step?

The TitaniumPhysique Program is designed to eliminate elbow pain, so daily activities no longer feel limited.

 Yes, I'm ready to eliminate pain 

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