Monday, January 26, 2015

Overuse injuries in CrossFit athletes and cyclists

With the rise in popularity of CrossFit and activities like cycling, we are seeing more and more inside elbow pain. This injury is called medial epicondylitis, or golfer's elbow, as it was typically seen in golfers.

Overuse injuries in CrossFit athletes and cyclists

With the rise in popularity of CrossFit and activities like cycling, we are seeing more and more inside elbow pain. This injury is called medial epicondylitis, or golfer’s elbow, as it was typically seen in golfers.

Now we are seeing more and more cyclists and CrossFit athletes with this type of elbow pain. This type of pain is a tendinitis and will not go away with rest alone. You need to fix the reasons for the pain, not just try to stop it from hurting.

If you wind up just icing and treating the elbow, you will not fix the problem. This is a very complicated problem as the reason it develops is weaknesses in other areas, outside of the elbow. While rest will calm the inflammation in the elbow, it will not fix the cause of inflammation. It is important to understand how and why this pain occurs and why just treating the elbow or resting will not yield optimal long term outcomes.

Medial elbow pain is due to lack of core strength and lack of scapular muscle strength, called the scapular stabilizers. Many of those who do CrossFit or who cycle are very strong and can perform many movements and very heavy lifts without being strong in these areas. Your body will find ways around the weak muscles and you will lift the weight and cycle the distance. The body is very good at coming up with other muscles to use in the presence of weak ones. The problem is, is as this compensation pattern is occurring, unbeknownst to you, it is causing an overuse of other muscles. It is this overuse that eventually develops into tendinitis.

More coverage
 
Exercise and pain: Why rest isn't always the answer

In order for there to be distal mobility there must be proximal stability. That means in order for your hands, wrist and elbow to operate in the strongest, most efficient way, the shoulder and the muscles that stabilize the shoulder—the rotator cuff—need to be at their strongest. If these muscles are weak, then you will need to stabilize the arm with other muscles. You will need to grip the bar harder; you will need to grab the handle bars with more force in order to stabilize the arm. The hardest part about this is that this is an unconscious decision that is made. You have no idea that you are gripping harder than you need to. Your body just does it because you want it to do an activity. So instead of your rotator cuff being the stabilizer of your arm, your wrist, your elbow and your hand stabilize as best they can.

Bench press, dead lift, pull ups, etc., do not specifically work the rotator cuff. The exercises shown in this video are specifically designed to strengthen the core and the scapula stabilizers. There are no short cuts; specific exercises need to be done to strengthen the stabilizers. And these are not heavy weight lifting exercises; they are isolated, specific movements with lighter weights.

If there is a lack of core strength, then the scapula is unable to stabilize correctly—meaning that the hands and wrists are forced to work harder. The abdominals need to be solid before any extremity moves and if they are not, the body starts going down the chain looking for the stability. It will recruit the scapula stabilizers and if they are deficient, then the elbow and wrist muscles will start to have to work harder. This overuse will cause a tendinitis to develop.

But why is it the inside or medial elbow that winds up hurting? After the core is deemed weak and the scapula stabilizers are found to have deficiencies, the body looks to the elbow and wrist to help stabilize and generate power and lift the weight. As you grip something with your palm down, the harder you grip, the more your hand goes into the motion of an upward palm. Your thumb will start to try to rotate upwards. It does not succeed because your fingers are wrapped around the bar, preventing rotation. But the body is recruiting the strongest muscle patterns. The muscles that control the fingers and the wrist attach on the inside and the outside of the elbow. Because of the gripping pattern and the motion you are trying to perform, you are overusing the muscles that attach on the inside of the elbow. Therefore, the inside elbow is much more apt to be irritated.

Whatever exercise method you choose, think abdominals, followed by hips/shoulders, followed by knees/elbows, and finally feet/hands in terms of strength. Your body is an excellent compensator and by the time you feel pain it has exhausted several muscles before it lets you know what you are doing. If you do wind up feeling pain make sure that you treat the cause, not just the symptoms.


Read more Sports Doc for Sports Medicine and Fitness.
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
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