Many people have issues with elbow pain. These issues can usually be divided into two different categories: medial elbow pain and lateral elbow pain. Medial elbow pain is commonly referred to as “golfer's elbow” or medial epicondylitis. Lateral is commonly referred to as “tennis elbow” or lateral epicondylitis. Pain can stem from multiple causes: repetitive motion injury, overuse, misuse, compensation patterns, imbalances, etc. Issues might be present because of acute injury to the site. If you play a round of golf and strain a local muscle or sprain a ligament nearby, you will undoubtedly have pain. Issues might be present if there is something faulty somewhere else. For example, if your thoracic spine does not move well, you can easily put more stress through the elbow with many activities. Bottom line, there are many possibilities that could be hanging around. For the purposes of this article, I am going to discuss specific muscle imbalances in the hands and forearms themselves that can cause issues with elbow pain, specifically medial elbow pain.
To fully grasp the information we are about to go through, we must first look at some basic anatomy. In a nutshell, we have muscles on one side of the forearm that flex the wrist and/or fingers and we have muscles on the other side that extend the wrist and fingers. We also have muscles that pronate and supinate our hand and arm (turn the hand down or up by rotating the radius and ulna around each other). The muscles that extend attach to the lateral epicondyle (that bone you feel on the outside of your elbow) and those that flex attach to the medial epicondyle (that bone you feel on the inside of your elbow). Some major extensors include the extensor carpi ulnaris and radialis and the extensor digitorum muscles. Major flexors include flexor carpi ulnaris and radialis, flexor digitorum muscles, and palmaris longus. These muscles run from the inner or outer elbow and run down to attach to various places along the wrist and hand (we won't worry about details here). If you look at the top of your hand or at the bottom of your wrist, you will see tendons of these various muscles popping out and can feel them move when you move your fingers and wrist around. If you want to get more in depth, we could also look at specific muscles that control thumb motions (pollicus muscles). For the purposes of this article, we will worry about these main structures already mentioned.
As humans, most activities we do involve flexing our fingers and sometimes wrists. Think about it; we grab things, pick things up, squeeze things, walk with things, etc. Its just what we do. Personally, I lift heavy weights and do manual therapy on people so I use mine tons. I have a client who is getting ready for his first ironman. He kept having recurring pain right at that medial elbow site. We released the muscles around it (flexor carpi ulnaris, pronator teres, etc.) multiple times and it kept coming back. Well when pain continues to return, something is missing from the equation. So think about the VERY LONG duration activities that he is doing, specifically swimming and biking. With swimming, the way he comes through and turns his arm and hand over with his stroke is very taxing to all of the muscles of this region. With biking, he basically has constant tension there as he grips the handlebars for long periods of time. So obviously, these activities are contributing to the problem. However, while we could try to modify technique, the activities are not going to stop. So, we then need to start thinking about antagonistic relationships. Just like we want to balance out pushing and pulling muscles in the shoulder girdle and balance out squatting and hip hinging patterns in the lower extremities, we also need to look at balancing the extensors and flexors of the forearm and fingers. I decided to experiment. Funny story here.
So when I was 15, I bought a “forearm blaster” from Wal-Mart and used to do 100-200 reps each way 4-5 nights a week to add some size to my forearms. Yes it worked pretty well, as funny as it is. Well, I happen to still have this nifty little tool. So I started having my client perform 3 sets of 10-15 reps of wrist extensions both days that he came in to train. There are plenty of ways to do this exercise without a “forearm blaster,” such as using a small bar, a kettlebell, cable, etc. They're just not as cool :) Interestingly enough, this exercise introduction along with some frequent active release treatments, started to make the pain subside. However, it still was not perfect. Being the obsessive perfectionist of training that I am, this frustrated me. Sooooo, I went back to the thinking box. Wrist extensors and flexors are on their way to balancing out. What about the finger extensors and flexors? Now, I'm not going to lie; as decent as I am with anatomy and balanced out training, I had never worked my finger extensors directly with resistance in my life. I hopped online, found some ironmind resistance bands for the fingers and got to work. We have now introduced a few sets of finger extensions to the program and his pain is pretty much gone. He now has a counterpull to the dominant flexor tension that his body has been used to.
Many people go on for much too long with chronic pain at this site. Soft tissue work works great to free the tissue up but you need to fix the underlying problem to keep pain at bay; and if you haven't read my article “Got CID?,” I suggest that you do to learn more about cumulative injury disorders and how these adhesions and pain come about. Although this is not a commonly discussed topic in most fitness and strength and conditioning circles, it is pretty important. Not only can this help with pain syndromes, but it also will help grip strength and wrist control, which will help with many activities, from bench press and deadlift to grappling and swinging a golf club.
So, whether you have pain near your medial elbow, just want to increase your grip strength and wrist control, or (the most obvious reason) develop sexy finger and forearm muscles for the beach this summer, give these exercises a shot. Perform 2-3 sets of 10-15 reps a few days a week. As I mentioned above, issues here can also stem from compensations such as limited t-spine mobility so be sure to address any other issues that are in the picture.