July 7, 2013
The other day I was riding some bike trails here in Burlington and noticed that I was getting some elbow pain. The pain was located on the inside of my elbow, the area commonly affected with golfers elbow. As we have discussed in previous blogs, the elbow pain with golfer’s elbow is usually located in the inside of the elbow, often attributed to tendinopathy of the wrist flexors. (Notice I didn’t say tendinitis or tendonitis). Yes, although the pain is in the elbow the muscles that are irritated actually work to grip, flex the wrist and some of them help to pronate or “turn over” the hand and wrist. Regardless, I found my bout of elbow discomfort interesting. I wasn’t repeatedly gripping as with most overuse / repetitive strain injuries, but I think my elbow succumbed to repeated vibration while being under tension. Let me explain…
In the picture above the red area depicts the wrist flexors. These muscles originate on the inside of the elbow and extend down the arm past the wrist. Pain with golfers elbow is usually located anywhere along the red area, but most usually at the elbow. In this picture, the wrist is in a neutral position with the flexors at a normal resting length.
In the picture above, my wrist is in extension. This lengthens the flexor muscles (in red) and places tension on the origin at the elbow (red “X”). Imagine placing any muscle under tension for a long time. It is reasonable to expect that the muscle, it’s tendon or the insertion (where the tendon anchors on to the bone) might get sore. Interestingly in the case of my elbow pain, the vibration of the handle bars while the muscle / tendon was lengthened under tension was the perfect recipe for a tendinopathy (remember – not a tendinitis or a tendonitis).
One might reason that putting slack on my flexor muscles by flexing the wrist (as pictured above) might be a good idea to allow my flexor muscles to heal and thus avoid a golfers elbow. Not really. Among other things, the exact opposite might occur and irritate my extensor muscles on the other side of my elbow. This might lead to a tendinosis or tendinopathy on the other side, which is commonly known as tennis elbow.
The take home point is that golfer’s elbow, elbow pain and tendinopathy don’t have to be associated with an obvious repetitive movement. It has been well documented that vibration has the potential to aggravate or create various conditions in the body. In this case, it seems that vibration while the muscle and tendon were lengthened (under a stretch) was the culprit for my elbow pain. So what should I do?
First and foremost I need to change my grip habit so that the flexor muscles are not constantly under stretch. Perhaps the grip pictured above might work although I would have to go and purchase bar-ends. Along with this, I would need to dampen the vibration going through the handle bars. I’ll look at the suspension and see if it needs a tune-up or modification as well as consider new grips that are softer. Gloves are also an option that might help to dampen the vibration going through the handle bars to my arms.
Working in such an awesome chiropractic, physiotherapy, massage therapy and athletic therapy clinic here in Burlington Ontario (ahem) allows me various treatment options at my disposal. At this point, I might try some Active Release, Graston and some laser therapy. Acupuncture has also shown tremendous benefit for medial elbow pain so that’s also an option. Regardless, elbow pain is something that our clinic in Burlington treats quite frequently with great success. If I don’t change my habits on the bike though, I should only expect the elbow pain to come back. Time to practise what I preach!
Also, as an aside – I just discovered the trails at Kerncliff park in Burlington…they’re great!
Questions? Comments? We’d love to hear them! Are you in the area of Burlington Ontario and you have elbow pain? We can help! Physiotherapy Burlington. Give us a call, we have lots of treatment options.