You’ve probably realized (or are in the process of realizing) that any part of the body can come under some serious strain in the box, especially if form is bad and flexibility is poor. The elbows are no exception to this rule. In fact elbow tendonitis is a very common ailment that affects huge swaths of the population—not just CrossFitters (although it’s very common amongst box-goers). In fact, the nagging pain from elbow tendonitis is more commonly known as tennis elbow (lateral epicondylitis, sharp pain at the outside aspect of the elbow over the bone), which is ironic given that fewer than 5% of patients with this condition actually play tennis.
What exactly is elbow tendonitis?
Essentially, tendonitis refers to the inflammation of the tendons as they insert on the related bone. The suffix “–itis” means inflammation and is usually paired with the associated body part—so think Achilles tendonitis, etc. Tendons are elastic ropes in our body that connect muscles to bone and absorb a lot of stress. Now inflammation is a normal process in our bodies, and we have all experienced the pain, swelling, redness and warmth that comes with an acute inflammation response. This inflammation response is supposed to be fast and direct, not extended. Unfortunately, the tendons have very poor blood flow, which can result in failed healing and an inflammation response that becomes chronic or even systemic, making it incredibly difficult to manage and annoyingly painful. Common symptoms include:
- Recurring pain on the outside of your upper forearm, just below the bend of the elbow, is the most frequent sign of the injury.
- Pain may also be felt down your arm towards the wrist.
- Feeling pain when lifting or bending the arm.
- Pain when performing basic actions such writing, or when gripping small objects like a pen is also a possible symptom.
- Pain when twisting your forearm – for example, when turning a door handle also can be lateral epicondylitis , or difficulty extending your forearm fully.
- Pain can last from anywhere between 3-12 weeks.
What causes it?
Elbow tendonitis is classified as a repetitive strain injury and is actually caused by overuse of the wrist despite the pain being felt in the elbow. But because the muscles that control wrist extension and flexion run along the forearm (and underarm) and connect around the elbow joint, repeated strain on the wrist can lead to elbow tendonitis, which is why it is a frequent problem for professional tennis players—hence the name (you’ll never look at a tennis racket the same way again). It’s also a common among people who are brand new to certain sports (like CrossFit) and are eager to attack it with full gusto. Unfortunately, the body (including the joints and tendons) is not conditioned to weather the onset of new and sudden—and often times thousands of repetitions of—movement thereby causing irritation to the supporting tendons. Repetitive movements such as high volume pull-ups, push-ups (Murph anyone?), gardening work and even typing for most of the day can lead to tendonitis—not to mention ignoring the early warning signs (tenderness, swelling and soreness) and ‘playing through the pain’. Furthermore, previous injuries such as sprains can lead to tendonitis, and joints that have been previously injured are more susceptible to develop the condition. A diet that is filled with sugar, grains, trans fats, alcohol, Omega-6 fatty acids, dairy, MSG, and processed foods is inflammatory, so it shouldn’t come as a surprise that consuming these types of food in high quantity leads to inflammation. A lack of balance in one’s diet that is low in essential nutrients including vitamin c, magnesium, and quality protein (i.e. lean and grass-fed) can also increase the likelihood of someone developing tendonitis.
How can I treat it/reduce my chances of getting it?
Generally speaking, if symptoms persist for longer than four weeks more serious intervention is needed and a visit to the physical therapist may be in order. But there are a few ways that you can ace tennis elbow on your own, before it becomes a more troubling issue:
1. Check your technique. If the pain is sport or activity-specific, you must improve your technique or ergonomic setup. Consult your coach to ensure that you are performing each movement at the box in the right way.
2. Stretch. Perform gentle stretching to the forearm musculature. These stretches should be performed in a PAIN-FREE manner, which is to say that you should feel a slight stretch or pull along the muscles, but elbow pain should not be present.
a. Wrist Flexor Stretch:
i. Extend your arm in front of you with your palm up.
ii. Bend your wrist, pointing your hand towards the floor.
iii. With your other hand, gently bend your wrist further until you feel a mild to moderate stretch in your forearm.
iv. Hold for at least 15 to 30 seconds. Repeat 2 to 4 times.
b. Wrist Extensor Stretch:
i. Repeat steps 1 to 4 of the stretch above, but begin with your extended hand palm down.
c. Voodoo Floss:
i. Wrap elbow with voodoo floss (or mobility bands) across the joint and add tension.
ii. Turn your palm down and straighten your elbow.
iii. After 30 seconds to a minute release the band.
Check out this video of Kelly Starrett voodoo flossing some poor soul’s elbow.
3. Clean up your diet. As I mentioned above, you want to make sure that you limit the amount of inflammatory foods you consume to the odd treat now and again, and keep the essential nutrients and good quality lean meats coming. Just another reason to give paleo a go.
4. Don’t play through the pain. You’ll know when something feels off. Sure, our muscles and joints get sore all the time, but your body will let you know if something just doesn’t feel right, so there’s no point in forcing the issue just to complete a workout. Remember, we want to come back to fight another day, so if this means dropping the weight, adding a band to the pull-ups or swapping out arm-intensive exercises for something else, so be it.
5. Use a rubber flex-bar. The New York Times ran a story back in 2009 detailing the results of a study that utilized an 8-inch, low tech rubber bar on patents with chronic, debilitating elbow pain. They had two groups – a control group doing regular physical therapy (PT) and a second group that did PT and used the rubber flex-bar therapy technique. After about 8 weeks, the trial was halted as those using the flex-bar were effectively cured, reporting an 81 percent improvement in their elbow pain and a 72 percent improvement in strength.
6. Get deep tissue work or a massage to help improve blood flow. Doing so will help break up scar tissue to facilitate healing when the issue is new within the first six weeks. At this point, seeing a PT or a sports massage professional is probably a good idea.