Elbow Pain Treatment in Burlington

Most elbow pain does not need imaging to start physiotherapy. Tennis elbow and golfer's elbow are clinical diagnoses built from history and exam. Imaging becomes useful when the picture points to a structural problem that would change the plan: suspected fracture after trauma, progressive neurological symptoms, a case not responding the way a careful exam predicted, or when a ligament rupture is in question. When imaging would change the plan, I flag it to your family doctor or specialist and refer you.

Yes, tennis elbow can develop without playing tennis. The name sticks, but tennis elbow is a lateral elbow tendinopathy often associated with desk work, trades, gripping sports, or repetitive lifting. In a population study (Shiri et al., American Journal of Epidemiology 2006), definite lateral epicondylitis affected 1.3 percent of adults aged 30 to 64, and the odds were higher in people whose activities combined forceful work with repetitive arm movements. What matters is the pattern on exam, not the sport.

Usually not as a first step. The Bisset BMJ 2006 trial compared physiotherapy, corticosteroid injection, and wait-and-see. Injections felt better at six weeks but produced worse outcomes at twelve months, with high recurrence. The Coombes JAMA 2013 trial found worse outcomes and more recurrence at one year after a corticosteroid injection than after a placebo injection, and physiotherapy made no significant difference at one year. I usually start with structured rehabilitation, and any injection decision belongs with a physician.

Many people improve over a few months of structured loading, though the timeline depends on how long the symptoms have been there and how well the load plan can sit alongside work and training demands. The 2022 JOSPT clinical practice guideline for lateral elbow pain (Lucado et al.) recommends resistance exercise for the wrist extensors, often combined with manual therapy such as elbow joint mobilization.

Usually yes, with adjustments. Complete rest does not usually build a tendon's tolerance for the work you need it to do. The typical move is to keep the activity but change the dose, grip diameter, tool weight, volume, or which arm leads, and pair it with a targeted loading program. A simple guide I use in clinic: pain under 3 out of 10 during an activity, settling inside 24 hours, is usually fine. Pain that lingers for days or swelling that keeps returning means the plan needs to change.

That pattern usually means the ulnar nerve is being irritated, most commonly at the inner elbow in what is called cubital tunnel syndrome. Prolonged elbow flexion, resting the elbow on hard surfaces, or sleeping with a bent elbow all provoke it. The plan focuses on unloading the nerve at the inner elbow, addressing wrist and shoulder positions in the day, and progressively adding strengthening exercises once symptoms settle. Progressive weakness or wasting in the hand needs medical review.

They are the same type of problem on opposite sides of the elbow. Tennis elbow is lateral epicondylopathy, involving the wrist extensor tendon origin on the outside of the elbow. Golfer's elbow is medial epicondylopathy, involving the wrist flexor and pronator tendon origin on the inside. Resisted tests help tell them apart: wrist extension against resistance often provokes tennis elbow, wrist flexion against resistance often provokes golfer's elbow. Inner elbow pain can also come from the ulnar nerve or a ligament, so I check those too. Treatment principles are similar but the loading target is different.

No referral needed in Ontario. Most extended health plans cover physiotherapy and I offer direct billing where available. Initial assessments run about 45 minutes and include history, examination, a working diagnosis, and a clear plan. If I think something is outside physiotherapy scope, I coordinate with your family physician or an appropriate consultant rather than push on regardless.