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By
Charles Staley, B.Sc, MSS
Director, Staley Training Systems |
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Co-authored with Dr. Sal
Arria
Considering the incredible and
constant strain that it's subjected to, the elbow is a stoic
joint indeed. The elbow is a ginglymus or hinge type joint
formed by the humerus bone of the upper arm and the radius
and ulna bones of the lower arm. Although only flexion and
extension occur around the elbow itself, the joint also permits
rotation of the radius around the ulna.
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Like the knee, the elbow is encased
within an extensive synovial membrane, which synthesizes synovial
fluid for the purpose of lubricating the joint.The elbow is quite
stable, owing to the numerous tendons and ligaments that contribute
to it's integrity. In fact, many people are amazed to learn that
over a dozen muscles cross the elbow joint— not just the biceps
and triceps!
Causes and Pre-conditions for Elbow Problems:
A Closer Look at the Problem
Acute traumatic elbow injuries are
thankfully rare. Those that do occur are almost always the result
of extreme stress in power and explosion events such as Olympic
weightlifting and throwing. Falls (such as in skating, football,
rugby, and equestrian events) and impact (as in football, combat
sports, and hockey) also sometimes result in sudden traumatic elbow
injury. Traumatic injuries of any type must receive immediate medical
attention by a qualified sports medicine physician.
Chronic injuries in the elbow are
usually a result of overuse. Boxers often suffer from such conditions.
Of great importance is the fact that most trainees fail to consider
the cumulative impact of all stressful events on the elbow, limiting
their attention to training-related stress only. On the job, mechanics
(constant work with wrenches, screwdrivers, etc.), secretaries and
office workers (constant typing, and writing), and health professionals
(massage, physiotherapy, and other forms of physical manipulations)
are at risk for repetitive overuse syndrome (R.O.S.) to the elbow,
due to constant and excessive contracture of the gripping muscles—
all of which cross the elbow joint.
Most R.O.S. of the elbow is seen in
the dominant side, so "handedness" becomes an additional
factor to consider in these types of injuries.
Among athletes, throwing, particularly
in baseball and the javelin event are leading causes of R.O.S. of
the elbow. Boxers are also susceptible (from the high volume of
punches thrown in training and competition), as are tennis players
and golfers. Bodybuilders, fitness enthusiasts, and recreational
athletes are not by any means immune to R.O.S.
The biggest problem with the elbow
is the tiny size of the tendinous attachment sites, of which there
are many. These sites can become progressively weakened by both
impact and the dynamic forces of leverage. This leverage means that
10 pounds in the hand equals approximately 45 pounds at the shoulder
joint, for a person with average arm length.
Another way to view this phenomenon
is to compare the force you get by turning a bolt with a long handled
wrench, as opposed to a short handled wrench. Now consider that
a tennis player, for instance, makes this already long lever even
longer by putting a racquet in the hand! The impact of repetitively
hitting the ball, compounded by the very long lever arm created
by the racquet, results in cumulative microtrauma to the tendinous
attachment sites at the elbow.
Over time, if not treated, these tendons
actually begin to fray, much like a nylon rope would if stretched
beyond it's tensile strength. Eventually, the tendon can detach
from it's attachment site at the elbow, requiring surgical repair.
Treatment Options: from Conservative to Radical
- Rest:
The most effective yet overlooked aspect of post-injury recovery
is simply to become more aware of and markedly limit activities
that cause pain and swelling to the affected area! In light of
the elbows ubiquitous role in almost all human activity, this
is no easy task!
- Forearm Strap:
Used by tennis players, golfers, and other athletes with elbow
problems. The strap acts like a "shunt," absorbing impact
and vibrational forces before they reach the tendinous attachment
at the elbow. One of the best straps is the Interceptor, by Weider.
- Aspirin Therapy: Aspirin
reduces edema (swelling). Recovery simply does not begin until
edema has subsided. Experiment with dosages— in many cases,
low dosages of aspirin work just as well as large doses, with
less possibility of stomach irritation. To protect your stomach
lining even further, try crushing the aspirin tablets between
2 spoons and mixing them into a glass of milk. Since the body
eventually develops a tolerance to it., use aspirin judiciously—
only when needed most. Always check with your physician before
implementing a regular schedule of aspirin therapy, no matter
how small the dose.
- Diathermy: A
high frequency form of heat which can penetrate as deep as 2 1/2
inches into injured tissues. Administered by a chiropractor or
physical therapist, diathermy promotes circulation to the injury
site, accelerating the healing process. Diathermy should precede
cryo-therapy treatments.
- Electro-stimulation:
Moderate to intense amounts of intermittent electrostimulation
are applied directly to the injured tendinous area for 10-15 minutes
per session. This form of electrostimulation is most effective
when it follows diathermy and is followed up with cryo-therapy.
- Cryo-therapy: After
diathermy, construct an ice pack by placing crushed ice in a "zip-lock"
bag. Cryo-therapy is very beneficial in reducing edema, reducing
pain, and pumping muscular tissues free of accumulated training-induced
waste products. Spend at least 15, but no longer than 20 minutes
on the ice.
- Cortico-steroids: Administered
by injection to the injury site, corticosteroids help to reduce
inflammation and pain. The drawback, however, is that these agents
cause a breakdown of collagenous and ligamentous tissue after
repeated injections.
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Proliferent-injection
Therapy: is injected directly into the injury site,
causing an "artificial injury" which then provokes
the collagenous cells to begin restructuring themselves
more quickly.
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Surgery:
In the most extreme cases, a torn or avulsed tendon or
ligament may require surgical re-attachment. This is "the
final straw" when it comes to solutions for joint
problems! Many methods are used, including tendon grafts,
and stapling.
Prevention is the Key
Fortunately, most serious
elbow problems can be completely prevented with good training
and work habits, and immediate intervention upon the onset
of trouble. Never train through elbow pain— instead,
seek the immediate guidance of a qualified sports medicine
physician or chiropractor.
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About The Author
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His colleagues call him an iconoclast,
a visionary, a rule-breaker. His clients call him “The
Secret Weapon” for his ability to see what other coaches
miss. Charles calls himself a “geek” who struggled
in Phys Ed throughout school. Whatever you call him, Charles’
methods are ahead of their time and quickly produce serious
results. His counter-intuitive approach and self-effacing
demeanor have lead to appearances on NBC’s The TODAY
Show and The CBS Early Show.
Currently, Charles competes
in Olympic-style weightlifting on the master’s circuit,
with a 3-year goal of qualifying for the 2009 Master’s
World Championships.
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