Blog Post

The Hidden Link Between Shoulder Internal Rotation and Tennis Elbow

November 5, 2024

Tennis elbow is more than just an athlete's ailment; it's a common condition that can affect anyone engaging in repetitive arm movements. While the pain centres around the elbow, the root cause may be higher up - in the shoulder.

Specifically, shoulder internal rotation can place excessive stress on the arm muscles and tendons, leading to or worsening tennis elbow symptoms. Understanding this connection is key to effective treatment and prevention.

In this article, we'll explore how shoulder internal rotation contributes to tennis elbow and how targeted interventions can provide relief.

Understanding Tennis Elbow and Shoulder Internal Rotation

What Is Tennis Elbow?


Tennis elbow, or lateral epicondylitis, is characterised by
pain on the outer part of the elbow due to overuse of the forearm muscles and tendons. These muscles are responsible for extending the wrist and fingers, and repetitive strain can lead to micro-tears in the tendons, causing inflammation and pain.

What Is Shoulder Internal Rotation?


Shoulder internal rotation occurs when the upper arm bone (humerus) rotates inward toward the body's centerline. This posture is common in activities that involve forward-reaching motions but can become problematic when it becomes habitual due to poor ergonomics or muscle imbalances.

How Shoulder Internal Rotation Contributes to Tennis Elbow

  1. Biomechanical Misalignment: Internal rotation of the shoulder alters the natural alignment of the arm, increasing stress on the elbow joint during movement.

  2. Muscle Imbalances: This posture tightens the front shoulder and chest muscles while weakening the upper back muscles. The forearm muscles compensate for this imbalance, leading to overuse.

  3. Increased Tendon Load: The altered mechanics place additional load on the tendons connected to the lateral epicondyle of the elbow, exacerbating pain and inflammation.

Effective Exercise

Twist Bicep Curls

One of the most effective exercises to combat the effects of shoulder internal rotation is the twist bicep curl.

Benefits:

  • Strengthens Forearm and Bicep Muscles: Targets muscles strained by poor shoulder posture.
  • Improves Supination: Enhances the outward rotation of the forearm, reducing elbow stress.
  • Corrects Muscle Imbalances: Promotes balanced muscle development in the arms.


How to Perform:

  1. Starting Position: Stand with feet shoulder-width apart, holding dumbbells at your sides with palms facing your thighs.
  2. Curl Movement: As you lift the weights, rotate your wrists outward so your palms face upward by the time they reach shoulder level.
  3. Lowering Phase: Slowly lower the weights, rotating your wrists back to the starting position.
  4. Repetitions: Perform 2-3 sets of 10-12 reps with controlled movements.

Professional Help at Good Health Group Clinic

If you're experiencing symptoms of tennis elbow and suspect that shoulder internal rotation may be a contributing factor, professional guidance can make all the difference. At Good Health Group Clinic, we not only address the immediate symptoms but also focus on long-term solutions to prevent recurrence.

Our team of experts provides comprehensive care, including post-treatment exercises tailored to your individual needs. By customising exercise programs, we ensure that you receive the most effective interventions for your specific condition and lifestyle.

  • Myotherapist Ian Selvarajoo: Specialises in muscle manipulation techniques to relieve tension and correct muscle imbalances. Ian develops personalised exercise plans to strengthen affected muscles and improve posture.

  • Remedial Therapist Sam Noh: Provides targeted therapies to alleviate pain and restore function. Sam adjusts exercises to suit your individual capabilities, ensuring safe and effective rehabilitation.

  • Chiropractor Tanja Nishibata: Focuses on spinal and postural alignment to address the root causes of musculoskeletal conditions like tennis elbow. Tanja offers customised exercises to correct posture and enhance overall musculoskeletal health.

By offering personalised post-treatment exercises, we aim to empower you with the tools needed to manage your condition effectively and prevent future issues.

Conclusion

Tennis elbow can stem from unexpected sources like shoulder internal rotation. By addressing this root cause through targeted exercises and seeking professional help, you can alleviate pain and prevent future occurrences.

At
Good Health Group Clinic, our dedicated professionals not only provide expert care but also offer post-treatment exercises adjusted to your individual needs. We're here to guide you on your path to recovery, helping you return to your daily activities pain-free.

BOOK NOW

Scientific Evidence Supporting the Connection


Research supports the link between shoulder internal rotation and tennis elbow:

  • Biomechanical Impact: Studies show shoulder position affects forearm muscle load, influencing tennis elbow development.
  • Muscle Activation: EMG analyses reveal increased forearm extensor activation with shoulder internal rotation.
  • Postural Assessments: Patients with tennis elbow often exhibit internal shoulder rotation, indicating a correlation.

References

  1. Lin, J. H., et al. (2011). Influence of shoulder position on the grip strength of the rotator cuff muscles in patients with lateral epicondylitis. Journal of Shoulder and Elbow Surgery, 20(6), 893-898. 
  2. Day, J. M., et al. (2015). The effect of upper limb posture on forearm muscle activity during gripping. Ergonomics, 58(11), 1830-1840. 
  3. Cools, A. M., et al. (2014). Rehabilitation of scapular muscle balance: which exercises to prescribe? The American Journal of Sports Medicine, 42(5), 1315-1322. 

Blogs

February 11, 2025
Let me tell you about something weird I saw the other night while scrolling through YouTube. Lately, I’ve been really into watching other therapists work, checking out different approaches on Instagram and YouTube. Last night, I stumbled across a video on a fitness celebrity’s channel in the U.K. He was getting an IASTM (Instrument-Assisted Soft Tissue Mobilisation, also known as Graston technique) treatment from a sports therapist, and everything seemed normal, until the therapist made a pretty bold claim. As soon as redness started appearing on the guy’s skin, the therapist confidently said it was because “toxins were coming out.” No explanation, no scientific backing, just a statement that made it sound like IASTM was some kind of detox miracle. And of course, in the comments section, people ate it up, believing it just because the practitioner is a health expert and the channel owner is a well-known fitness personality.  But let’s set the record straight: IASTM is NOT a detox therapy, and there’s no such thing as a manual “detox” treatment.
February 4, 2025
At Good Health Group Clinic Brighton , we often hear clients say, "I've been stretching my tight muscles, but they just won’t loosen up!" Recently, a viral social media post caught my attention, claiming that stretching makes muscle knots worse and that stretching fascia doesn’t work. The video compared stretching a muscle with trigger points to pulling on a knotted rubber band, it supposedly makes the knot even tighter. The post gained a lot of traction, with many people commenting, "No more stretching for me!" But is this really true? As a clinic that specialises in myotherapy, chiropractic care, and remedial therapy , our practitioners, myotherapist Ian Selvarajoo , chiropractor Dr. Tanja Nishibata , and remedial and dry needling therapist Sam Noh , understand that while stretching alone isn’t always the solution, dismissing it entirely is misleading. So, let’s explore what the science actually says about stretching, trigger points, and flexibility. What Are Trigger Points? Trigger points, commonly known as muscle knots , are hyperirritable spots in the muscle that can cause local and referred pain. They develop due to: Chronic overuse Repetitive strain Poor posture Stress and nervous system tension Inadequate recovery after workouts A muscle with trigger points is often tight but weak , contracted and stiff, yet lacking strength. This explains why simply stretching the muscle may not provide relief. Does Stretching Really Make Trigger Points Worse? The viral video suggested that stretching a tight muscle is counterproductive because it worsens the "knotting" effect. While this analogy may seem logical, the reality is more complex. In some cases, aggressive stretching can aggravate tight muscles, especially when: The muscle is in a highly contracted state (such as after prolonged stress or poor posture). The nervous system is hypersensitive , causing muscles to tighten further in response to a stretch. You hold static stretches for too long without first addressing the root cause of the tension. However, this does not mean stretching is inherently bad, it just needs to be done correctly . What Does the Science Say About Stretching and Trigger Points? Contrary to the claim that stretching is harmful, research shows that when performed properly, stretching can actually help alleviate muscle tightness and improve function . Stretching Increases Blood Flow and Oxygenation Studies have shown that stretching enhances circulation , reducing muscle ischemia (lack of oxygen), which is one of the primary causes of trigger points. Stretching Helps Regulate Muscle Tension When you stretch, you activate the Golgi tendon organs , which help relax overactive muscles and reduce excessive tension. Stretching Restores Functional Muscle Length Chronic muscle tightness can lead to adaptive shortening , making muscles more prone to pain and dysfunction. Stretching helps counteract this. How to Stretch the Right Way Without Making It Worse Instead of avoiding stretching altogether, here’s how to incorporate it safely and effectively : 1. Start With Soft Tissue Work First Before stretching, release the muscle tension using: Self-massage (hands or massage ball) Foam rolling (avoiding excessive pressure on painful spots) Trigger point therapy, dry needling, or myotherapy , which our practitioners at Good Health Group Clinic Brighton offer. 2. Use Active and Dynamic Stretching Instead of prolonged static stretching, opt for controlled, movement-based stretches to encourage blood flow and mobility. Example: Instead of a deep static hamstring stretch, try hamstring swings or single-leg Romanian deadlifts . 3. Avoid Overstretching Painful Muscles Pain is a signal from your body— forcing a stretch won’t fix the issue . If stretching worsens your symptoms, it’s time to adjust your approach. 4. Strengthen Weak Muscles Trigger points often form because a muscle is both tight and weak . That means stretching alone isn’t enough—you also need strength training . Example: Instead of constantly stretching tight hip flexors, incorporate glute and core strengthening exercises . How Good Health Group Clinic Brighton Can Help At Good Health Group Clinic Brighton , we take an evidence-based approach to muscle health and mobility. Our team of skilled practitioners can help with: Myotherapy : Our myotherapist Ian Selvarajoo specialises in releasing muscle knots using advanced soft tissue techniques. Chiropractic S ports and Spinal rehab : Dr. Tanja Nishibata can assess your posture and spinal health, ensuring your nervous system and musculoskeletal system function optimally. Remedial Massage & Dry Needling : Sam Noh provides expert remedial therapy and dry needling to address chronic muscle tension and improve flexibility. Stretching Is Not the Enemy The idea that "stretching makes knots worse" is an oversimplification . While improper stretching can sometimes aggravate muscle tightness, when done correctly , stretching is a powerful tool for reducing discomfort and improving mobility. The key is how you stretch. By combining stretching with soft tissue release, active movement, and strengthening exercises , you can effectively manage muscle tension and enhance performance. If you’re struggling with persistent muscle tightness, book an appointment at Good Health Group Clinic Brighton , where our expert team can help you find the best approach to mobility and recovery.
February 2, 2025
Baseball is not the most popular sport in Australia, but as someone who grew up in South Korea and in a KIA Tigers supporting family, I’ve been watching KBO (Korean Baseball Organization) games since I was born. This year, I noticed an interesting development from one of the team’s top young players, Do-young Kim, who has dramatically improved his hitting performance. In the 2023 season, Kim was already a talented batter, but he only hit 7 home runs with a slugging percentage (SLG) of 0.453. For those unfamiliar with baseball, a home run is when a batter hits the ball over the outfield fence, allowing them to score instantly. Slugging percentage (SLG) measures the total bases a player earns per at-bat, indicating their power-hitting ability. Fast forward to 2024, and Kim’s stats have skyrocketed, he has hit 38 home runs with an SLG of 0.647. That’s an incredible leap! So, what changed? After closely watching his batting stance and swing, I realised he had enhanced his hip internal rotation (HIR) , allowing him to generate more torque and power in his hitting mechanics. This got me thinking, the same principle applies to improving my clients’ daily movements and sports performance.
January 31, 2025
When clients walk into Good Health Group Clinic after a musculoskeletal injury, most have one goal in mind, getting stronger. Strengthening exercises have long been seen as the gold standard for recovery, but in reality, jumping into strength training too soon can often make things worse rather than better . Over the years, I’ve noticed a common pattern, more than half of my clients experience aggravation when they begin strengthening exercises early in rehab . Their pain flares up, movement feels unnatural, and their body starts compensating in ways that lead to more dysfunction. This got me thinking 'Is there a better way?' 
January 31, 2025
When I was a sports trainer for the Ferntree Gully Football Club, I worked with many young athletes pushing their limits to perform at their best. One of them, a talented midfielder, came to me with a problem, he felt "stuck" when kicking the footy. His range of motion was limited, and his leg didn’t extend fluidly in the follow-through. He had no pain, just the feeling that something was holding him back. After assessing him, I found that his adductors were excessively tight. When I released them, he immediately felt lighter, more mobile, and his kicking mechanics improved. The issue? Adductor overactivity, a common but often overlooked factor affecting footy players.
January 20, 2025
Have you ever experienced that annoying tingling or numbness in your hand, particularly in your ring and pinky fingers? It might feel like your arm fell asleep, but if it keeps happening, you could be dealing with ulnar nerve entrapment. Don’t worry, this is more common than you think, and your posture could be playing a bigger role than you realise. Let’s break it down in a way that’s easy to understand.
January 16, 2025
If you’re dealing with tendinopathy, you know how frustrating it can be. Tendinopathy causes pain and stiffness in the tendons, making it hard to move and do the things you love. Understanding how to manage it effectively can make a significant difference in your recovery and long-term function.
January 15, 2025
Pain from injuries or daily strain is incredibly common, and if you’re dealing with it, you’re not alone. At Good Health Group Clinic , we work with clients every day to help them feel better and get back to doing the things they love. Our team combine expertise to create personalised treatment plans that make a big difference in your recovery. Let’s break it down so it’s simple and easy to understand.
January 14, 2025
Shoulder pain is something many people face at some point, and rotator cuff-related pain is one of the most common causes. Whether you’re struggling to lift your arm or finding it difficult to sleep on your side, shoulder pain can interfere with daily life. The good news? For most people, this pain improves with a combination of the right advice, treatment, and exercises. Let’s explore what causes rotator cuff pain, its symptoms, and how you can take steps to recover and regain your shoulder strength.
January 9, 2025
In May 2024, a 70-year-old retired woman with a passion for travelling the world faced an unexpected challenge. While on holiday in Italy, she suffered a serious ankle injury, a trimalleolar fracture. After returning to Australia for surgery, she was determined to recover quickly. Believing that doing more exercise would help her heal faster, she worked hard to follow a long and intense routine. Unfortunately, her progress stalled. The pain continued, walking was still a struggle, and her mobility hadn’t improved. When she visited Good Health Group Clinic, I realised that the problem wasn’t her effort, it was her approach. This story shows how understanding your injury, doing the right amount of exercise, and having a proper recovery plan can make all the difference.
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