Elbow tendinitis, often referred to as tennis elbow (lateral epicondylitis) or golfer’s elbow (medial epicondylitis), is a common condition that results from repetitive stress on the tendons around the elbow joint. While the pain is typically felt at the elbow, many people don’t realize that symptoms can sometimes be referred from the cervical spine (neck). Physical therapy plays a crucial role in not only treating the local inflammation and dysfunction, but also identifying and addressing underlying sources of pain, including referred pain from the neck.

Understanding Elbow Tendinitis

Elbow tendinitis occurs when repetitive movements—such as gripping, lifting, or typing—cause small tears in the tendons of the forearm. This leads to inflammation, pain, and reduced grip strength. Common causes include overuse, improper biomechanics, and muscle imbalances.

The Role of Referred Pain from the Neck

Pain in the elbow can sometimes originate from the cervical spine, particularly from nerve root irritation at C5-C7. Cervical radiculopathy or trigger points in the upper trapezius and scalene muscles can refer pain to the lateral or medial elbow, mimicking tendinitis symptoms. This is why a thorough assessment by a physical therapist is essential to determine whether the elbow pain is due to local tendon irritation or is being referred from the neck.

If your elbow pain is actually referred from your neck, rather than true elbow tendinitis, here are five common signs to look out for:

1. Pain That Worsens with Neck Movements

• If turning, tilting, or extending your neck increases your elbow pain, it could indicate cervical nerve involvement rather than local tendon irritation.

2. Numbness or Tingling in the Arm or Hand

• True tendinitis usually causes localized pain, but if you experience numbness, tingling, or a burning sensation down the arm into the elbow or hand, it may stem from a pinched nerve in the cervical spine.

3. Weakness Beyond Just the Forearm and Grip

• While tendinitis can cause grip weakness, nerve compression from the neck can lead to broader weakness in the shoulder, biceps, or wrist extensors, affecting multiple muscle groups.

4. Pain That Extends Beyond the Elbow

• If the pain is present in the shoulder, upper arm, or forearm along with the elbow, it may be referred pain from a cervical nerve root (commonly C5-C7).

5. Postural and Neck Tension Issues

• Poor posture, forward head position, or chronic neck stiffness can contribute to nerve irritation and referred pain down to the elbow, mimicking tendinitis symptoms.

If you’re experiencing these signs, a physical therapist can assess whether your elbow pain is truly tendinitis or if it’s originating from your cervical spine. 

How Physical Therapy Helps

A well-structured physical therapy program for elbow tendinitis incorporates several key components:

1. Pain Management and Inflammation Reduction

• Modalities such as ice, ultrasound, and electrical stimulation can help decrease pain and inflammation.
• Manual therapy techniques, including soft tissue mobilization and joint mobilization, can reduce muscle tension and improve circulation.

2. Addressing the Cervical Spine and Neural Involvement

• If referred pain is suspected, physical therapists may perform manual therapy on the cervical spine, including joint mobilizations and postural corrections.
• Nerve protection education is given to decrease nerve irritability and pain.

3. Strengthening and Flexibility Exercises

• Strengthening exercises for the forearm muscles to maintain a neutral position of the wrist decreases tension on the overworked musculature.
• Stretching the forearm flexors and extensors helps to reduce stiffness and improve mobility.
• Strengthening postural muscles (such as the scapular stabilizers) can help offload stress from the elbow.

4. Activity Modification and Ergonomic Training

• Adjusting workstation setup, improving grip mechanics, and modifying sport or work activities can prevent further strain on the tendons.
• Bracing or taping techniques may provide temporary relief and support during activities.

5. Patient Education for Long-Term Management

• Teaching patients about proper body mechanics, use of braces, incorporating regular stretching and strengthening exercises, and avoiding repetitive strain can help prevent recurrence.

Conclusion

Physical therapy offers a comprehensive approach to treating elbow tendinitis by addressing both the local tendon irritation and potential underlying sources, such as referred pain from the neck. If you suspect your elbow pain may be due to tendinitis or referred from the neck, call CGPT today for a comprehensive evaluation by a licensed physical therapist.

References

1. Brukner, P., & Khan, K. (2019). Clinical Sports Medicine. McGraw-Hill Education.
2. Dilek, B., & Arslan, I. (2021). “Cervical Radiculopathy and Its Relationship with Elbow Pain.” Journal of Orthopedic Research, 39(5), 1123-1130.
3. Nirschl, R. P., & Ashman, E. S. (2003). “Elbow tendinopathy: Treatment strategies and outcomes.” Journal of Hand Therapy, 16(2), 104-116.