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• By Dr. Nikita Shelar
• 0 Comments
• October 30, 2022

Throwers elbow –

Javelins Thrower’s Elbow is mostly caused by overuse.

First sign of injury is sharp pain while throwing the javelin and aching pain at the medial elbow thereafter that very soon begins to interfere with the performance of the athlete.

Definition

Javelin throwers elbow is a sprain or injury to the medial ulnar collateral ligament (UCL) of the medial elbow, which is easily susceptible to injury. As

the injury is commonly seen in javelin throwers, it is named as javelin throwers elbow.

Cause of Injury–

The onset of the injury can be a direct trauma, but is more likely to be insidious due to the accumulation of repetitive forces on the UCL.

UCL stretching is provoked by poor technique of throwing the javelin. Poor technique consists of throwing with insufficient shoulder abduction (90° – 100°), where the elbow is too low resulting in a valgus force on the joint. Since the UCL is the principal structure opposing this motion, it will be the primary site of injury. 

There are two ways of throwing the javelin:

• Round arm, which causes strain on the medial collateral ligament,
• Over arm, which can lead to roughening and new bone formation at the tip of the olecranon or even might result in avulsion of the tip.

Assessment –

1. Range of motion (ROM) is important to assess the injury. Let the patient perform flexion, extension, supination and pronation.
2. The valgus stress test of the elbow that will reproduce the pain.
3. The end feel of movements needs to be assessed. A soft end feel in extension may indicate a soft tissue contracture of the arm flexor apparatus. A bony end feel in terminal flexion on the other hand may indicate anterior bony osteophytes or loose bodies.

Physiotherapy Management-

• Rest the injured limb, apply ice to the affected area, apply a compression bandage and elevate the limb if possible. This initial treatment needs to continue for at least 48 to 72 hours. This is the most critical time for the injured area; correct treatment now can mean the difference between a minor short-term injury or permanent, reoccurring injury.

• Comprehensive rehabilitation program –This should include rehabilitation activities such as ultrasound and IFT(Interferential therapy).
• Tapings – Kinesio Taping for throwers elbow helps to maintain elbow in pain-free position which further helps to reduce pain.
• Once most of the pain has gone, start conditioning the muscles around the elbow with balance, strength, agility and flexibility exercises and drills.

Exercises needs to be progress gradually-

 Steps –

1. PROM Wrist Extension Exercise 
2. Eccentric Wrist Flexion with Dumbbells. Start with small weights 1/2kg or 1 kg or Theraband with Less Resistance (Red or Green)
3. Isometric Exercises opposite to wall for wrist flexor strengthening.
4. Repetitive movement of wrist from flexion to neutral position with Elbow Flexion Extension.
5. Swiss ball exercises include Swiss ball walking followed by Push up on Swiss ball.
6. Increase weights of dumbbells 2-5kg or Increase Resistance of Theraband (Blue or Black).
7. Start doing Throwing movements with Resistance of Theraband Progress Gradually.

Prevention for Throwers Elbow –

Preventing a throwers elbow injury comes down to the conditioning of the muscles and tendons around the elbow, which ultimately involves improving both the strength and flexibility of the muscles and tendons.

• Completely rehabilitate an elbow injury before returning to activity.
• Always include a general warm up, followed by an activity specific warm up before training and especially before competition.
• Cool down thoroughly after training and competition.
• Include a comprehensive strength training program for the shoulder and arm muscles. Watch the videos below for specifically exercises that relate to throwers elbow.