Preventing Injuries Before They Ruin Your Routine: Part 7
by Fred Dimenna

Injuries of the elbow that receive the most attention are those of an acute, traumatic nature. Falling directly on an extended arm, for example, can cause a dislocation, a malady that requires reduction (moving the bone back into place) and possibly, surgery. Once an acute, traumatic injury has taken place, it is generally a good idea to avoid exercise to allow healing to occur. Repetitive overuse elbow injuries are also prevalent. The likelihood of this type of disability can be reduced by conditioning activities designed to increase strength and range of motion in the muscles that cross this articulation. In addition, once these injuries are present and the acute phase of the problem has passed, modified training can be resumed as healing continues.

A common overuse injury of the elbow is lateral epicondylitis, which is better known as tennis elbow. While its nickname correctly indicates that the tennis stroke (specifically, the backhand) can be the cause, it's important to realize that many other repetitive movements can also be responsible. Lateral epicondylitis falls under the heading of tendinitis, an inflammation of a tendon, which is the connective tissue part of a muscle that attaches it to a bone. In this case, the muscle is the extensor carpi radialis brevis, which originates on the lateral epicondyle of the humerus (the bony protrusion on the outside of the elbow when the arm is hanging at the side with the palm facing rearward). The ECRB inserts on the back portion of the base of the third metacarpal (close to the knuckle of the middle finger) and as a result, functions to extend the hand at the wrist (decreasing the distance between the rear surface of the hand and the forearm). Activities that involve an excessive amount of wrist extension (working with a screwdriver or wrench, for example) can also be the cause.

Lateral epicondylitis is characterized by pain and swelling at the site where the tendon inserts on the aforementioned epicondyle. Usually, it will be characterized by weakness (difficulty gripping) and decreased range of motion at the wrist and elbow. Exercises that will be problematic include those where the wrist extensors must function to create movement (reverse wrist curls, for example) or prevent movement from occurring (side lateral raises where gravity exerts a downward pull on the dumbbell and neutrality at the wrist is maintained by an isometric contraction). In addition, failure to hold the wrist in neutral alignment on all exercises not designed to work the muscles that cross it's also a surefire way to aggravate this tendon. Reverse-grip triceps pushdowns, for example, should be performed with the wrist locked in a straight position throughout.

Medial epicondylitis is also known as golfer's elbow. In this case, it is the tendon that attaches to the bony protrusion on the inside of the elbow that becomes irritated and inflamed. Repetitive wrist flexion (decreasing the distance between the palm and forearm) and radioulnar pronation (turning the palm rearward when the arm is hanging at the side) are usually the culprits and gripping typically exacerbates this injury. Specifically, pulling exercises performed with a parallel grip (pulley rows, for example), as well as movements where the wrist flexors must prevent extension (flyes with dumbbells or on a seated machine) can be problematic.

Because inflammation is a key component of the mechanism of injury in any tendinitis, ice is a critical aspect of managing lateral and medial epicondylitis. While complete rest is often necessary in the acute phase of these injuries, once activity can be resumed, measures can be taken address the relative imbalances that created the injury in the first place. Unfortunately, the exercises designed to strengthen the weak areas can also restart the injury/inflammation cycle so icing the area after stressing it is important. Physical therapy modalities like ultrasound and massage can also be used for this purpose.

Once activity can be resumed, strengthening the specific muscles that are susceptible (the wrist extensors with lateral epicondylitis and the flexors in the other case) is important. In addition, stretching should also be performed to maintain an adequate movement range at the wrist. Pushing your wrist into flexion (pushing down on the back of your hand) with your hand angled toward the thumb and your elbow straight stretches the wrist extensors effectively. Pushing the fingers and hand back lengthens the flexors. Treatment can also involve wearing a wrap around the forearm, which changes leverage conditions and augments the tendinous insertion by dispersing its contact point with the bone. In addition, cortisone shots are often prescribed although this "remedy" should be used conservatively because the ramifications might include increased susceptibility in the future.

Fred DiMenna, a Certified Strength and Conditioning Specialist and Lifestyle and Weight Management Consultant, is a two-time Natural Mr. United States and a WNBF drug-free professional bodybuilder. Visit him on the web at www.freddimenna.com or email him at: mrnaturalus@yahoo.com.