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Gardening
How are your elbows?
by James Wilson BSc (Hons) Ost Med. DO - find out more about James.
Stop press – spring is finally here!! After the last two, if not three, years when Spring came particularly early, this year it does feel late and we’re all chomping at the bit to get out and get on with that garden.
Before you go too mad take a few moments to read this, it could well save you some bother.
The wide variety of tasks performed can make gardening a great form of exercise; done with care all of these tasks can help improve strength, coordination, flexibility and cardio-vascular fitness. Unfortunately there is a problem in that many of the tasks are repetitive in nature. Repetition in itself is not a problem, but doing something repetitive with poor technique definitely is!
My last topic dealt with Low Back Pain and many of the points raised will certainly be relevant here. Another very common complaint associated with gardening is elbow pain and when bad it can be surprisingly disabling.
“Tennis” and “Golfers” Elbow
These are really only terms used to describe a particular condition and are certainly not limited to golf and tennis!
We have two main groups of forearm muscles; one on the outside called the extensor group and one on the inside called the flexor group. Their primary job is to control and move the wrist and provide grip strength. Both sets of muscles have a common insertion point on the outside or inside of the elbow respectively onto parts of the bone called epicondyles.
True tennis elbow (lateral epicondylitis) is where the extensor tendons and the membrane covering the bone itself become inflamed. This can be extremely painful and will have a profound effect on grip strength. Many people are told they have Tennis Elbow where in fact it is not that advanced; many people have inflammation localised to the flexor tendons (flexor tendonitis) and not of the bone itself. Flexor Tendonitis is more easily treated and is how most true Tennis Elbows start so early intervention is really important. Golfers Elbow (medial epicondylitis) is the same but as mentioned is affecting the inside of the elbow.
Tendonitis or Epicondylitis are almost always caused by repetitive strains or overuse. This can be because of the specific work we do but more often than not it’s because there is a problem in how the neck, mid-back or shoulder are working which is then placing too much work onto the elbow. There are very few patients that I successfully treat for Tennis Elbow that do not have any mechanical problem or dysfunction in the neck, shoulder girdle and mid-back.
Treatment of Tennis or Golfers Elbow
Early intervention is the key. As with all pains and particularly new symptoms you really must seek a professional opinion.
The aim is to reduce the existing inflammation whilst preventing further inflammation being produced. The following can be very helpful:
- Ice packs: 2-3 times per day place an ice pack on the effected part of the elbow. Try to keep it on for 5 minutes (it will ache.) Leave it off for 10-15, and then back on with the ice for 5 minutes. (Don’t place cold packs directly onto the skin.)
- Hydrotherapy (hot and cold treatment): With the shower head, run quite warm water for one minute over the elbow and forearm, followed by 30 seconds of cold water. Repeat 3 times, ideally twice per day. This often works well following at least 3 days of ice packing.
- Supports: There are a wide range of supports available which can help reduce the pressure the tendons exert onto their insertion points on the bone. The most effective have a pad (often gel) that applies pressure onto the tendons below the elbow. Although these supports will not cure the problem they can be really good in helping to manage the problem.
- Osteopathy, Acupuncture and Physiotherapy can all offer effective assessment and treatment.
- Anti-inflammatory gels, on advice from your pharmacist, can be helpful in symptomatic relief.
Other causes of elbow pain:
Pain referred from the neck or shoulder
The nerves that exit the neck and those around the shoulder can become compromised and refer pain to the arm. Certain muscles around the shoulder can do the same if they become inflamed for any reason.
Radial Head subluxation
The top of the radius (the bone on the outside of the forearm) can become restricted and sit slightly out of place where it forms a joint at the elbow.
Bony changes
After a fracture or old injury of the joint, changes in the bone around the joint can cause pressure, restriction and pain.
Arthritis and infection
As with any joint the elbow can be affected by rheumatoid arthritis (and other similar conditions) and osteoarthritis. Infection is not wholly uncommon, especially where prickles and splinters could enter the joint or surrounding tissues – gardeners beware. Any joint that is red, hot or swollen needs investigating!
So what can we do to prevent elbow pain?
We all use our arms and hands for hundreds of tasks each day so it is unsurprising that it all occasionally goes wrong. Activities such as gardening, where as already stated there is a lot of repetition, are sure to highlight a problem that has been building up in the background. I’ll cover a few of the main things we do in our gardens to help highlight areas where we should exercise caution.
Digging and raking
How many of us can dig, rake, sweep, etc. as effectively at one side of our body as the other? Not many. This shows just how one sided we can be. Do try to gently do at least a little on your weaker side. With digging take small bits of earth to turn at a time. Care should be taken as you push the shaft of the spade down to bend your knees and slightly straighten and brace your back before lifting the front of the spade. As you break up the earth use the weight of the spade to “chop” at the earth as much as you can rather than twisting the spade through it.
Transferring seedlings and potting out
Keep all the pots and trays up well above waist height and give yourself as much room as possible. As you work you will inevitably start leaning forward and twisting. This is not great for your low back but will stop you moving your torso as well thus putting all the work onto your shoulders, elbows and wrists. Again try to work to both sides of you. Sometimes you are better to purposely place items a little way apart so that you have to move your feet rather than just reaching over.
Weeding
Vary as much as you can between standing, kneeling and resting on all fours. Do make sure you protect your knees whilst kneeling. The key is getting close to the parts you are weeding. Don’t reach too far or do it for too long and try to change the hand you are pulling up with.
Watering
Particularly if you already suffer some elbow discomfort, don’t over fill the can, half fill it and do more trips to the tap. Try to use both hands to lift and don’t reach too far. When for example covering young plants with a fine spray don’t twist the can side to side with your forearm, try to get a back and forth movement by letting your whole arm swing.
Grass cutting
Try to adjust the lawnmower to your height as best you can, too high or too low will place unnecessary stress on your shoulders, elbows, wrists and low back. Care should be taken when emptying grass boxes not to jerk the neck and arms as you shake the grass out.
Pruning
Try to get close to the part you are cutting. The further your arms are from your body (both upwards or outwards) the more your shoulder blades will fix against your back and tighten the shoulders. When your shoulders are tight the elbows and wrists will do all the work.
Overall, try not to do any one activity for more than an hour; less if the activity is more physically challenging. Vary your activities and try to keep stretching in between.
Hopefully with a reasonable degree of care and some forward planning the gardening season will be a more enjoyable and successful one this year.
Further information is available on our website www.molfordhousesurgery.co.uk. Alternatively I am always pleased to answer any questions you may have. You can call me at Molford House Surgery on 01769 574830.
The information provided on these pages is intended as a general guide only and in no way constitutes a complete service for diagnosis or treatment. You must not rely solely on this information and it is therefore your responsibility to seek a professional opinion should you be concerned about your particular case.
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