Medial elbow pain known as “golfers” elbow and lateral elbow pain known as “tennis” elbow can be quite painful and debilitating.  Most people complain of difficulty with gripping and twisting activities and can make lifting difficult.  Numerous modalities can help this condition such as rest, ice, electrical stimulation, stretches and iontophoresis.  While treating these conditions can be challenging finding their cause is often difficult too.  Understanding functional relationships can provide insite into why that elbow is taking a beating.  While most professionals should know that shoulder dysfunction can contribute to elbow pain, many dont even consider the hips role.  As discussed in previous posts shoulder elevation is coupled with extension of the hip.  Another functional realtionship of the hip and shoulder is that shoulder rotation is coupled with hip rotation.  So whats this have to do with the elbow you ask?  Well, think of a forehand shot in tennis.  Where does the power come from to hit this shot?  Thats right, form the hip in the transverse plane. (yes i know the trunk is involved too, but I want to stay focused).  To hit the forehand forcefully you must first eccentrically load the same side hip in the transverse plane. 


This requires an adequate amount oh hip internal rotation (motion).  Most people due to inactivity, sitting, driving and sleeping in the fetal position lack “normal” hip internal rotation.  Therefore their ability to eccentrically load their hip in the transverse plane will be limited which means their ability to generate concentric force is diminished.  The end result being decreased power in the forehand shot.  To make up for this most people will swing harder with the arm subjecting the medial elbow to increased strain on the medial elbow joint.  They may also flex the wrist harder to try to increase power.  All these things done repetitively can build to the point of pain.  

For lateral elbow pain, consider the backhand shot in tennis.

 In order to hit the shot with power you have to first eccentrically load the opposite side hip in the transverse plane.  Again, if hip internal rotation is limited, eccentric force production will be diminished thereby decreasing the concentric contraction and negatively effecting the power of the backhand shot.  In this scenario the stress of swinging harder with the arm (to make up for the lack of hip power) increases stress to the lateral elbow and many will  “flick” the wrist harder to try to gain power.  These relationships can also be applied to everyday tasks such as pulling a sliding glass door shut.  See, the old song we sang as kids is true…”The leg bone is connected to the hip bone, the hip bone is connected to the”…you get the picture.  Little did I know that I would make a living applying the principle of that song.  Who said kindergarten skills are’nt useful!

Get Strong! Stay Strong!


  1. Leslie says:

    Do you have a good resource for these functional relationships? I need to beef up my knowledge in this area.

  2. chriskolba says:

    Gary Grays course Chain Reaction Transformation may be one of the best courses Ive ever taken when it comes to function. Carlos Santana (not the singer) has a good book called Functional Training: Breaking the Bonds of Traditionalism. There really isnt one good book out there. Most of my knowledge has come from taking Gary’s courses many times over the years and talking with him and then just studying what he has taught me.
    Thanks for your comments and interests.

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