Elbow Pain: Not Necessarily Inflammation–And Why That Matters

(view of right elbow showing medial epicondyle with connective tissue and first layer of muscle) 

If you’re enjoying a sport where the elbows are a focal point for inordinate stress–tennis, golf, baseball, weightlifting–the joy can disappear rapidly when even a slight movement or touch of the elbow elicits sharp pain. 

For years, intermittent but significant elbow pain has been part of my training. Only now do I feel confident that I understand what was, and still is, taking place physiologically to produce this pain. 

The situation regarding my own experience involved the inside, or ‘medial’ portion of the elbow. Tennis elbow typically involves the outside, or ‘lateral’ epicondyle. The forces generated by the backhand stroke are primarily responsible in that case. Complicating matters at the site of the epicondyle is added leverage straining the tendons that pass over the protrusion of the rounded bone. 
Let’s take a look at what’s happening and why. 

(next layer of muscle added–notice the major flexor muscles originating from the medial epicondyle) 

“Originally, inflammation was thought to generate the pain in medial epicondylitis. However, magnetic resonance images (MRIs) and histology show the presence of microtears in the flexor-pronator tendons without inflammation.”


(last layer of muscle from the medial epicondyle) 

“Kraushaar and Nirschl noted that histopathological studies of tendons suffering chronic injury demonstrate an absence of acute inflammatory cells. Nirschl has called this degenerative process a tendinosis, indicative of the failed intrinsic mechanism of the tendon to heal, rather than a tendinitis. A tendinitis implies an extrinsic blood borne response including the presence of inflammatory cells not evident in the histopathological studies of chronic overuse tendons.”


What we thought in the past was an inflammation problem (the suffix ‘itis’ in medical diagnoses indicates inflammation) is really a degenerative tendon condition necessitating an entirely different set of responses. 

So here I was, years ago, treating medial epicondylitis with ibuprofen and upping the dose while experiencing no relief of inflammatory symptoms. Unfortunately, I was one of the ones who later found out that the warning labels on Ibuprofen are there for a reason. You can read what happened to me in the following post:


The other recommended response to inflammatory pain is complete rest to facilitate healing. 

That’s exactly what you shouldn’t do when the healing involves tendons.

 Here’s why… 

“For healing to occur, tension is required across fibroblasts in order for cells to divide and orient themselves perpendicular along a line of stretch. 11 The stress also stimulates collagen fibrils to orient themselves in a parallel arrangement to the direction of tensile load, allowing them to resist imposed demands. 19 However, when the rate of injury exceeds the intrinsic ability of the tendon cells to repair themselves, tissue damage occurs. If the injurious behavior is continued long enough, degeneration of the tendon results.” (quoted from Nirschl Orthopaedic Center website) 

The participation in a well-rounded physical therapy regimen designed to aid in the proper repair of tendons without overuse is the best course of action. Only if this has been pursued without success should one consider surgery, suggests the information on the quoted website above. There is a wealth of information to be found on this site. 

The Latest Incident: My Acute Onset Experience 

I remember exactly where, when, and what happened regarding my right elbow problem. A little over a year ago, I’m doing chin-ups to failure and I’ve got a spotter behind me to start assisting for more reps when I’m at my limit. About the seventh assisted chin-up I feel a sharp burning pain radiating from the inner side of my right elbow. As much as I’d like to think that I can push myself as I did in earlier years, at 64 common sense is more valuable than reps to exhaustion. I’m still dealing with the resultant chronic pain. 

“Trained muscle is able to absorb more energy prior to failure, and the incidence of injury increases with fatigue. This is because as a muscle fatigues, greater stresses are absorbed by the tendons.” (Nirschl Orthopaedic Website)

For this reason, and my own training experiences through the years, I recommend that the risks accompanying extreme training definitely exceed the potential benefits. 

At this point, armed with new information, I am seeking relief of my pain with a revised plan of attack. I will update you with future results. 

Recommended in the referenced article is the use of forearm braces that help by dispersing the forces generated by muscular contraction.  

Delivery from Amazon is scheduled for Tuesday. 

Don’t Need to Train To Failure, 


The Senior Health and Fitness Blog by Steven Siemons is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Categories: Fitness

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2 replies

  1. Hi Steven,
    this is a pretty nice article about elbow disorder. It helps me a lot indeed.

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