After finishing a set of dynamic stretches, Nestor, one of our personal training clients, mentioned, “The inner part of my elbow is flared up. I think I have a case of tennis elbow from going crazy on the drums last night. I’d like to take it easy on a few of the more rigorous strength training exercises requiring gripping.” First off, Nestor had symptoms of golfer’s elbow, not tennis elbow. These terms are commonly misidentified because both sides of the elbow can become irritated from overuse injuries, usually stemming from repetitive movements that accumulate stress on the connective tissue of the elbow joint. These symptoms commonly arise with the individual not even realizing they’re overworking the area. These conditions produce pain in the inner and outer portions of the elbow, which can affect forearm and grip strength and be a distraction during everyday physical activities.
To build a path to recovery for Nestor’s golfer’s elbow, we first needed to enlighten him about the cause of the injury. Additionally, it was beneficial for him to understand the difference between golfer’s elbow and tennis elbow. The elbow has a network of muscles that span from the fingers, hand, and wrist and originate from the bony knob of the elbow. This bony prominence of the elbow is called an epicondyle. Our plan, as his health and fitness coaches, is to enhance his performance in his drumming sessions and in other aspects of his life that require hand grip and forearm strength. Therefore, we needed to ensure we were strengthening the correct muscles and mindfully avoiding overworking the areas of his elbow that were causing pain.
The outside, or lateral, portion of the elbow is the lateral epicondyle, which has a bony knob akin to its neighbor on the opposite side of the forearm, the medial epicondyle. This is where the finger and wrist extensors attach. Imagine your hand is pronated as if your knuckles are facing you. If you can see your fingernails, that means you can identify where the extensor muscles start. The extensors trace along the back of the fingers, down the back of the hand, along the top of the forearms, and attach to a common tendon at the lateral epicondyle. These muscles contract to bring the fingers and wrist toward the top of the hand, similar to the action of looking at your fingernails after a fresh manicure. When the extensors are overworked, they can lead to symptoms of tennis elbow.
On the inside of the elbow, the wrist flexor muscles are secured via a set of tendons. Imagine turning your palm upward as if you’re holding a mirror and facing it toward your face. The muscles originating from the palm of the hand, passing through the wrist, running along the bottom of the forearm, and finally attaching to the medial epicondyle are your flexor muscles. This is the site of tendinous attachment that can become stressed, producing golfer’s elbow.
Golfer’s elbow is named for the repetitive wrist flexion and forearm rotation demands of the golf swing, which repeatedly load the common flexor tendon at its attachment to the medial epicondyle. Over time, this stress can exceed the tendon’s capacity to recover, leading to irritation and pain on the inside of the elbow. When we review Nestor’s issue of pain in his inner elbow, we can see how the motion of lifting a drumstick and percussively striking the surface of his drum kit mimics that of a golfer. The difference is that Nestor was using lighter, shorter-length instruments to strike objects at an increasingly intense cadence than that of a golf swing. These similar mechanics seemed to align with the site of injury Nestor reported for his elbow. Therefore, we programmed exercises into Nestor’s exercise prescription that could not only rehab his golfer’s elbow (in his case, “drummers’ elbow”) but also enhance his drumming performance and decrease the likelihood of future injury.
An injury prevention exercise we conduct with our personal training clients to stave off golfer’s elbow and strengthen forearm and grip strength is standing wrist supination and pronation:
To perform the standing supination and pronation exercise, stand upright with both arms extended in front of the body at about armpit height. Simultaneously, rotate both arms toward the midline of the body as if you are rotating your hands up like you’re holding a plate, and then downward as if you’re pouring a cup of coffee. Reverse this motion by slowly rotating both arms toward the outside of the body with an emphasis on obtaining as much range as possible to achieve a sense of muscular activation around the wrist, forearms, and shoulders. You should feel muscle tension in the shoulders, triceps, and forearms. Repeat these movements for five to ten repetitions.
Discovering the causes of musculoskeletal injuries is an important part of our lifetime fitness efforts. If something is hurting, it’s beneficial to our everyday quality of life and functionality to educate ourselves about the causes of injuries and practice exercises that help prevent them from coming back.
Sean McCawley, the founder and owner of Napa Tenacious Fitness in Napa, CA, welcomes questions and comments. Reach him at 707-287-2727, napatenacious@gmail.com, or visit the website napatenaciousfitness.com.