On average 80% of Americans will experience low back pain at some point in their lives and more than a quarter of the population currently deals with low back pain on any given day.
Not only do most people have some form of back pain, but it many cases it is the result of poor movement patterns that have been abused for years causing the root of their problem to be both incredibly complex and multifactorial.
An exercise once thought to be dangerous (something that has been debunked by a multitude of recent studies), there is arguably no other lift that is more functional than the deadlift. The deadlift is a hinge type movement pattern, which is used every single time you bend over to pick something up off the floor, so you better be efficient with this movement. This article is Part I of a two-part series covering the common mistakes I see in the clinic and will teach you how to prevent low back pain while deadlifting.
This exercise can be moderately complex to perform correctly and the number one mistake that I see most in the clinic is a poor set up. There is a lot that goes on to get into this position but by bringing your shoelaces to the bar and remembering the “3 B’s” (Bow, Bend, Blades), most people will be able to get into a solid starting position.
So in review, to be in a good set-up position you need to “bring your shoelaces under the bar," bow until you feel tension in your posterior chain, bend your knees until you can grip the bar, and engage your shoulder blades. Doing this will get you into a good set-up position, which will protect your low back and allow you to lift bigger weight.
Thanks for reading,
Strength and flexibility training along with skill practice are usual as we train for marathons, weightlifting competitions, tennis matches and golf tournaments. But have you ever thought about training your diaphragm? What about your pelvic floor?
What if I told you there is one major key to training that many folks skip right over? Would you try it? Here is your chance. The diaphragm is a large muscle in the body with direct connections to the lumbar and thoracic spine and ribs. The pelvic floor mirrors the diaphragm- like the younger sibling that mimics the older- and has connections to the pelvis, sacrum and hip rotator musculature. What are the most common injuries and dysfunctions that WE see? Low back, SI joint and hip!
“Core strength” is definitely a buzz word in the fitness industry these days. And if you ask 5 people what it means, you are likely to get 5 different answers. So first, let’s talk about the “core.”
What is the core?
Your core, or the “soda can," is made up of your deep abdominals in the front, back muscles in the back, pelvic floor on the bottom of diaphragm on the top. These muscles work on concert to create pressure on your midline- think a full can of soda that has not been opened. If there is weakness or dysfunction in one of these muscles, then the midline is depressurized- the can has been opened.
So as you run, lift weights, swing a tennis racket or play with your kids, this pressurized can is helping you create torque and move through space with both dynamic stability and mobility. To learn more about this system, check out my blog about pelvic floor anatomy and leaking with exercise.
How can I train it?
No doubt your diaphragm works; you’re sitting here breathing right? But you can train it to be strong and more effective with your training. A great place to start is the diaphragmatic breath. Not only does this help us work towards full excursion of the diaphragm with a deep breath but it also help relax the pelvic floor. Relaxation of the pelvic floor is just as important and being able to contract it!
Try the 90/90 breathing drill and see if you are able to focus on the moving the ribs cage out and up rather than shallow chest breathing. This is essential for control. To add more strength work, try blowing up a balloon in the same position and breathing pattern!
As far as the pelvic floor goes, I am definitely a proponent of seeking assistance from a women’s health PT before starting specific strengthening programs. They can give you a better idea of what YOUR body needs- strength, endurance, relaxation. But a great place to start is imaging creating controlled amounts of tension through your pelvic floor. This can be cued for most folks as avoiding passing gas or gently stopping a stream of urine. (Don’t ever actually stop your stream of urine, this is just a cue for a gentle contraction.)
So this contraction should be as intense as the activity that you are performing. Lifting a pencil would be perhaps a 2% contraction, where lifting a heavy couch might be closer to 100%. This sliding scale applies to both pelvic floor and abdominal contractions. Only as much tension as needed for the task!
How does posture relate?
Going back to the soda can analogy- can you picture how bad posture is equivalent to having dented and bent my soda can? Not idea for keeping that pressurized cylinder! An easy example for this is running. If you have the “grandma lean” from the hips rather than the ankles, your can is bent. These folks tend to have back issues with running, perhaps some leaking and dysfunctional breathing. Straighten up the can and breaths are less challenged and your back feels better!
If you are dealing with back, hip, pelvic pain with activity try some of these strategies. This can also improve your breathing and postures/form with fitness. This merely scratches the surface but may stimulate some ideas about what is holding your training back. After you try these, if you are still having issues or questions, come see us! We love to help people like you get back to doing what they love and living a high functioning, pain-free life.
Thanks for reading,
Youth sport participation is growing around the globe, and the increasing trend is to have youth athletes specialize in one just one sport. With the goal obviously being to maximize a kid’s potential to play in college/pros/olympics, parents are having their kids spend 20+ hours working on very specific skill sets, going to countless camps, and squeezing out every last opportunity by playing on multiple teams in a single season. On the surface, it's easy to see why parents would think this… ”to get better at basketball, play more basketball." However, let's take a deeper look as to why this may not be not be the best (nor safest) route to making your kid the next Michael Jordan.
Playing multiple sports makes you more competitive
Weather your goals are set on college or the pros, top recruiters are looking for the most competitive athletes they can find...regardless of sport.
Want to play baseball? Check in to what Scott Upp, the leader of a baseball program that has been ranked as high as number one in the country and has more than 35 IHSAA sectional baseball championships, has to say. “If there are coaches out there that are telling kids to play one sport, I think they’re crazy,” Upp said. “Because while you’re working on drills and everything else like that, he’s out competing...running from 6’2”, 280-pound linemen. He’s trying to get away and make plays. So he’s competing, and you can’t really substitute that. And basketball, with time winding down, he’s got the ball in his hands, he’s learning how to compete. And all those things that happen in other sports just make him that much better in baseball.”
What about soccer? Abby Wambach, a member of the 2015 US Women’s World Cup team, is known is the best header in sport history, and guess what she attributes her success to...basketball. “Playing basketball had a significant impact on the way I play the game of soccer," Wambach said. "I am a taller player in soccer, in basketball I was a power forward and I would go up and rebound the ball. So learning the timing of your jump, learning the trajectory of the ball coming off the rim, all those things play a massive role." In fact, when the 2015 Women’s World Cup Champions were surveyed, they had collectively competed in more than 14 different sports growing up in addition to soccer.
Dreams of playing in a College Football National Championship Game? Clemson’s Head football coach, Dabo Swinney, who continuously has his team in playoff contention and won a national championship in 2016 famously recruites multisport athletes and had this to say about them. “I just think that the cross-training, the different types of coaching, the different types of locker rooms, the different environments that you practice in, the different challenges — I think it develops a much more competitive, well-rounded type person”
Playing multiple sports makes you more athletic
This one gets a little touchy...your kid has the best hands on his middle school football team, so naturally he needs to go to every SEC camp available and work year-round to improve his route running; right? Or, your daughter is the tallest on her 7th grade volleyball team so of course she's going to play year-round club volleyball to perfect her swing; right? Sure...practicing a skill is important, but the data doesn’t lie and improving overall athletic ability trumps all.
Demarco Murray, one of the most decorated running backs in Oklahoma who also led the NFL in rushing yards in 2014, didn’t seal his fate with Oklahoma until the coach watched him dunk a basketball during a game. Sam Bradford played basketball, football, golf, and hockey all throughout his high school and then went on to be a heisman trophy winner and number 1 overall NFL draft pick. In fact, 91% of the athletes drafted in the 2018 first round of the NFL played multiple sports in high school and 96% of the players who played in last years superbowl were multi-sports athletes!
However, the impact on athletic development goes well beyond the NFL and football. For example, a study in the American Journal of Sports Medicine looked at first found draft picks from 2008-2015 and found that athletes who played multiple sports in high school played in more NBA games, had a lower significant injury rate, and had more longevity in the spoty. The exposure to different athletic and movement demands, especially as an adolescent has been well documented in countless studies to have a strong carry over effect into your primary sport. The reason is simple, when you limit yourself to a single sport at a young age, the lack of diversified activity may stunt neuromuscular control development, leading decreased overall athletic ability.
Playing multiple sports decreases your risk of injury.
I’m a doctor of physical therapy, so I may be a little biased, but I’ve saved the best for last as a reason for playing multiple sports as a youth athlete. I don’t care how skilled your kid is, how physically gifted they are, they will never reach their full athletic potential if they can’t stay healthy and on the field and specializing into one sport has been shown time and time again to increase your risk of injury.
Think about this, only 65% of athletes report returning to their previous level of play 1 year after an injury and up to 20% of elite athletes say an injury is what caused them to stop playing their sports. When you specialize into a single sport at an early age you’re risking increased exposure to repetitive technical skills and high risk mechanics, Over-scheduling leads to decreased time to recover from competition and early psychological burnout, all of which have demonstrated to statistically increase your risk of injury.
So in review, let kids be kids. Don’t force their hands by specializing at an early age. Let them become a more competitive, athletic, and healthy athlete by playing in multiple sports.
Thanks for reading,
First things first, let’s clear up the pronunciation of the name. It’s kegel- as in “bagel” with a K. Kegels were named after Dr. Arnold Kegel who performed research on the pelvic floor after child birth. Just a fun fact—Thanks, Tracy Sher! Kegels are contractions and relaxations of your pelvic floor with the goal of strengthening those muscles.
Ok, now that we cleared that up, the true debate is: To Kegel or Not To Kegel?
Many post-partum patients have told me that after the birth of their child, they are never given instruction or care past “perform kegels daily” to address their pelvic floor. They are never taught or checked to be sure they are performing them correctly! You can only imagine the frustration when they learn there is more to the puzzle. Especially after years of leaking with exercise, painful sex or other related symptoms. Others, who may or may not have given birth, read in magazines that the best way to “stay healthy down there” and “please your partner” is by performing kegels daily.
The full spectrum of pelvic floor movement is contraction, relaxation, and bulging. It is important that we maintain all of these functions for optimal strength, control, and length of the pelvic floor. The popularity around kegels emphasizes the contraction and strength part. It seems that women think they tighter and harder they can squeeze, the better. This is true for certain situations- think sneezing. But it is also important to be able to relax the pelvic floor fully.
Re-lengthen before we strengthen
For much of the active population, pelvic floor over-tension is a problem. For these women, we want to focus less on the contraction and more on the relaxation and lengthening. Once full relaxation and length is achieved, THEN kegels are needed to strengthen in the new range of motion achieved. Strength comes in many forms- quick bursts, endurance, holds, etc. These are exercises specific to YOUR needs and deficits that a pelvic floor PT will prescribe to you. There is also a piece to the puzzle of timing of the pelvic floor contraction.
Look back to a blog I wrote about 7 Habits That May Be Stressing Your Pelvic Floor to start addressing these issues now.
How are you performing a kegel?
Remember how we said a kegel is a pelvic floor contraction? Well, all of these muscles are deep so if I can SEE you performing a pelvic floor contraction, you’re doing too much. Sometimes it is hard to know what you are squeezing in the nether regions. Is it pelvic floor? Is it my glutes? Am I just squishing my legs together?
The easiest way to know if you are performing a kegel correctly—see a women’s health PT and learn!
So, to kegel or not to kegel? It depends!
The best place to start - regardless of age, sexual activity, pre or post-partum - is to see a women’s health (aka pelvic floor) physical therapist. We can help you with a plan to decrease pain, improve function, and stay active without you having to guess what is right for you and if you are performing contractions correctly.
Thanks for reading,
Pain is NOT fun. When it interferes with daily life, playing with kids, taking the dog for walks or fitness, it becomes very inconvenient. Chronic pain is an interesting phenomenon because we often don’t know the true cause. Also, the intensity does not necessarily indicate the severity of the injury. Pain does not equal damage!
With chronic pain, imaging should have limited bearing on the decision for course of action. Although the images may show changes- tears, arthritis, etc.- what’s to say that is the pain generator? Studies have been performed that demonstrate the 60%+ of people WITHOUT low back pain have imaging that shows bulges or degenerative changes. So just because you have changes on images and pain, there is not definite proof of correlation for chronic pain. We suggest to skip the routine imaging until you have tried other options to decrease the pain.
Can you get rid of pain even without “fixing” the tissue with surgery? Yes! The body is incredibly resilient and resourceful. The body has the ability to heal; this coupled with strategic strengthening in supporting musculature can knock pain out completely. There are exceptions to every rule, but at our clinic I have seen more “injuries” successfully treated with mobility and strengthening than with surgery. Honestly, some that chose surgery realized the recovery was more tedious and painful than managing the pain while we worked through a rehab program.
Don’t get me wrong, surgery is absolutely necessary sometimes. If there is major instability around a joint or a traumatic event, we are so thankful for surgery! But it definitely something to avoid if you don’t absolutely need it.
Do I need surgery?
Have you tried physical therapy?
How much of your function is compromised?
Did you get a second opinion?
What are your goals?
How is your overall health?
Don’t settle for a “quick fix” and think that going under the knife is the first and only option. Work with a physical therapist to decrease the pain, improve the function and teach you how to keep your body healthy! We would love to help you get back to a pain-free and high functioning life.
Thanks for reading,
We hear this too often:
“I’ll wait until I’m injured to go to physical therapy.”
“My shoulder hurts but I’m just going to wait a few weeks and see if it goes away.”
“When my knee started hurting I went straight to the ortho surgeon for recommendations.”
“I’ve had back pain for 15 years. It is just a part of being old; there is nothing they can do!”
Many people still picture physical therapy as the place your grandma goes when she has a hip replacement or after a shoulder injury when you perform simple band exercises for 6 weeks. Unfortunately, this leads people to think that physical therapy isn’t for them.
If folks don’t go to a physical therapist first, they go to their primary care doc or other medical docs. Many times they end up seeing an orthopedic surgeon who suggests expensive imaging that often elevates fear but also may lead to unnecessary procedures. Ok, so surgery is the extreme. Many times, people will wait a few weeks (or months!) to get it checked out. For most injuries or pains, physical therapy sooner rather than later will decrease the time it takes to get you back in the game and decrease your cost.
But what about those of us who have had pain for 6 months or 6 years?! You will see the best results from a movement specialist (that’s us!) watching you move—carry objects, bend and lift, run, lift weights, etc—and correcting any dysfunction. Hopefully the surgeon suggests physical therapy first! Then you know where to call. ☺
Physical therapy at Athletes’ Potential is different from your usual PT clinic:
- One on one with a Doctor of Physical Therapy
- One hour per visit
- Skilled hands-on techniques
- Personalized homework- not just therabands and hamstring stretches!
- No referral needed
Case Example: A middle aged, male patient with chronic shoulder pain for over 15 years! Imaging showed a massive rotator cuff tear and labral tear. Orthopedic surgeon was ready for surgery ASAP; just to be clear, this is a pretty severe injury so surgery is often first thing on the table. However, this patient wanted to try anything BUT surgery. After 12 weeks of commitment to rehab homework, coming in weekly for hands-on work and slow return to golfing, he was pain-free and beginning to have full range in his swing. Now a year later, he has no shoulder pain and a pretty solid golf swing. We focused on decreasing pain and improving function rather than harping on “fixing” the tear. It takes patience, dedication and active involvement from the patient—but it is possible!
All of this to say, if you have pain with sitting at your desk, picking up the kids or during your fitness routine, DON’T WAIT until it take you out of the game. The earlier we can address it, the sooner it will feel better. Less time and money than the other options!
Why is physical therapy at Athletes’ Potential different? As Danny always says, if you have a body you’re an athlete. Your “rehab” should prepare you to play with your kids on the ground and carry 15 grocery bags at one time! Pelvic tilts and therabands won’t get you there.
Give us a call and let us know how we can help YOU!
Thanks for reading,
Here at Athletes’ Potential, we’ve had the opportunity to work one-on-one for an hour with over 1,200 people. We’ve worked with people with all kinds of different training backgrounds and by doing so we started noticing some trends. Common weaknesses and movement deficiencies that were not only creating injuries, but hindering performance and preventing people from living an active lifestyle.
So our team of doctors and strength coaches set out to create a solution to this problem and this article highlights that solution as well as some of the problems we kept seeing that were creating injuries, decreasing performance, and preventing people from living a healthy lifestyle.
Problem #1: Lack of Training Variability
Whether your training modality is CrossFit, running, powerlifting, olympic lifting, triathlons, dancing, or any of the other infinite training options out there, there are biases in your programming that cause you to perform some movements all the time and others hardly at all. If we never leave our comfort zone with our training, there’s going to be simple movements that we miss, which overtime can lead to aches and pains and even injury.
Let’s take CrossFit for example. Now obviously we love CrossFit at Athletes’ Potential, all of our physiotherapists are CrossFit coaches themselves, but even for a training program who boasts they “employ a constantly varied approach to training, functional movements, and loads” there are still biases. Tell me...when’s the last time you gripped the bar with a supinated grip (your palms turned up) during a workout? The answer is almost never. Deadlifts, cleans, snatches, pull-ups, toes-to-bar, jerks, dips, rows, etc...all these movements have you in a pronated (palms tuned down) grip. This creates a huge movement bias, and is one of the main reasons I see patients with elbow pain in the clinic.
Try this: Next time you’re in the gym hang on a pull-up bar with your palms down and then with your palms up. You’ll be shocked at how different this feels on your wrists, elbows, and shoulders.
Problem #2: Training Volume
This graph dramatically oversimplifies the concept of training volume, but essentially training volume is based on two primary variables: load and frequency. As you can see, there is a sweet spot you want to hit called the “Zone of Supraphysiological Overload.” This is where the magic happens, meaning it’s where you get stronger, leaner, healthier, more resilient. However, more often than not I’m seeing people in the red highlighted areas, especially in the zone of structural failure. This is essentially where you get an overuse injury such as biceps tendinopathy, nagging low back pain, or vague knee pain. However, doing nothing is just as bad as doing too much. That’s even true in the medical community, which is why if your healthcare provider is telling your to just rest for a weeks as a way to treat your low back pain, you need to give us a call.
Check this out though, one of the best ways to ensure that your not overloading your muscles and joints at a frequency that is too high is training variability (see above). Training volume and training variability go hand in hand and varying up your training is a great way to prevent tissue failure.
Problem #3: Poor Mobility
What that graph on training volume above failed to mention, is that if you’re moving with poor mobility, your going to fly through those zones until you hit tissue failure. This can’t be overstated. If you’re only deadlifting once a week but your deadlift looks like crap because you lack the requisite hip mobility to pull weight from the floor, you’re tissues will fail faster and you will eventually have an injury.
Looking at people's programming, almost nobody is spending an adequate amount of time focused on improving the mobility. Which is a problem. Being able to move through a full range of motion is crucial for not just training, but for being able to get through life’s demands. Think of your body as a Ferrari, lifting with poor mechanics due to limited mobility is like driving that Ferrari with low motor oil and with the hand brake hand. Sure it’ll still drive, but you’re leaving performance on the table, and eventually it’s going to break down.
Training variability, volume, and mobility are all related and after countlessly having the same conversation with the people we see in the clinic we decided enough was enough. We decided to create a solution that would benefit damn near everyone, and that solution is the Athletes’ Potential Pain-Free Training Plan. Whether your goal is to prevent injuries at CrossFit, improve your running times, or simply become a healthier version of yourself; we’ve created a unique program that requires minimal equipment and minimal time help you reach your goals.
There is simply nothing on the market like this program. It has been developed from the ground up by new-age healthcare professionals who blend the fields of rehabilitation and human performance and we couldn’t be more excited to offer this service to you.
You only get one body, so if you’re ready to stop beating it up, click the link above or fill out a contact request form. We’d love to answer any of your questions. Until then, happy training!
The CrossFit Open is finally here. After all of the countless hours spent in the gym perfecting your craft, it’s time to see just how far you’ve come in year’s time. I’ve got some good news for you too, simply by signing up for the CrossFit Open you’ve set yourself apart from your peers as only approximately 20% of CrossFit members worldwide have the moxie to put their money where their mouth is and actually sign up for the Open.
Now that you’re here though and you’ve made it through that miserable 18.1 workout, it’s time to grind through another 4 weeks designed to push you to your absolute limit. As daunting as that sounds, there’s a secret out there that elite athletes figured out a long time ago, yet it still gets ignored by most people in the gym. Recovery.
No matter how much you train, most of your hours during the day will be spent recovering. Recovery is undoubtedly the most overlooked aspect of training. Tell me if this sounds like something you (or let’s just say somebody you know). You rush from work to get to the gym, get there barely in time to hear your coach going over the day’s workout, then after blasting through a max level workout you rack your weight, grab your keys and head out to your car to get to the responsibilities waiting for you at home. Rinse and repeat throughout the week.
I see this all the time in the gym, and quite honestly I’d be lying to you if I said I haven’t had this happen to me as well. The issue with this all-to-common scenario though is that when you do this, you are skipping out on arguably the most important aspect of any training program. If you are not recovering appropriately then you’re leaving performance on the table and setting yourself up for injury.
Elite athletes and their trainers know exactly how important it is to recover appropriately, they spend endless resources monitoring their athletes’ bodies vital signs and other physiological functions in order to objectively determine when they are ready to go full throttle. However, for those of us who don’t have the ability to measure things like heart rate variability 24/7, there are a few things you can do to optimize the speed and effectiveness of your recovery:
1. Post Workout Cool-Down: Immediately following a workout do some form of very light activity (ex: walking, light row, light bike, etc) and then take another 10-15 minutes to work on soft tissue and joint mobility. Doing these things will not only decrease the soreness you experience after workouts, but it will allow your body’s heart rate, blood pressure, and nervous system to return to baseline levels. All of which are crucial to optimizing recovery. While you should choose which soft tissue and joint mobilizations you should do based on the movements performed in the WOD, some of my favorites are listed below. Perform each drill for 2 minutes.
2. Get Appropriate Sleep: I cannot overstate how important it is to get appropriate sleep. You should be getting approximately 7-9 hours of sleep per night, and during the open you need to towards the higher end of that range. To find out more information on how to optimize your sleep, check out our previous blog article "Top Two Ways To Improve Your Sleep."
3. Eat the Right Food: As the saying goes, “food is fuel for your body” and you want to be giving yourself some jet fuel to optimize your CrossFit Open performance. What this means is you need to be eating the right foods in the right proportions to restore your body’s energy levels and to give it the needed energy it needs to repair and recover. You can find more info on how to do that by checking out out previous blog, "Which Diet is Right For Me."
4. Staying Hydrated: You should be drinking water constantly to maintain good muscle and vascular health. The general recommendations say to drink 8 eight ounce glasses of water a day. However there are plenty more variables that go into determining the appropriate amount of water for you to drink. Click here to go to a calculator that will give you a better idea of how much water you need to stay appropriately hydrated throughout the Open.
So, if you want to get your best possible score in this year’s Open AND decrease your risk of injury then you need to make recovery a priority. A lot of things factor into recovery periods that are outside of your control (age, genetics, training experience, etc.), but by doing what we covered in this article you will be setting yourself up for success by recovering like a pro and getting the most out of your workouts.
Thanks for reading,
Sprinting, rapid change in directions, lateral agility, precision footwork, and even the low profile cleats, soccer is a sport that requires an incredible about of ankle strength and stability. It’s no wonder the injury rate in soccer is so high. In fact, studies have shown that more injuries have been recorded in soccer than in volleyball, basketball, rugby, boxing, and swimming, and to no surprise, the majority of soccer injuries at at the lower extremity. In order to prevent injury and boost performance, it’s crucial that you focus on improving your ankle strength and stability.
Before we dive too deep into improving performance and recovering from injury, let's quickly take a look at the anatomy of the ankle.
The outside (lateral) component of your ankle is comprised of both dynamic (muscles) and static (ligaments) stabilizers, which are designed to keep your ankle from rolling.
Now these names and long and technical and it’s not really all the important to know what there names are, but what is important is knowing that these structures all work synergistically to keep your ankle from rolling. That means that if you’re not targeting both systems (dynamic and static stabilizers) in your programming, you are setting yourself up for increased risk of injury.
In order to best set yourself up to prevent ankle injuries, you need to focus on not just ankle strengthening exercises, but proprioception as well. Proprioception simply means your joints awareness of where it’s at in space and this predominately comes from mechanoreceptors found in the three ligaments we mentioned earlier. Below are three drills that are fantastic at improving ankle proprioception.
Half Kneeling Balance Drill: Must be able to maintain balance for 60 seconds. Progress by adding weight to one side, being on foam surface, or by closing your eyes.
Clock Balance Drill: Complete three full rotations, both clockwise and counterclockwise.
Single Leg Med Ball Toss: To improve lateral stability. Complete 30 seconds of tosses with focus on high velocity.
Now as we mentioned earlier, your static stabilizers work synergistically with with your dynamic stabilizers and are equally important to focus . This is where ankle strengthening comes into the picture. Below are three great drills to strengthen your ankles.
Banded Side Step Up: Complete 3-4 rounds of 30 seconds in each direction. The key is to keep the band at the bell of your feet.
Single Leg Jump Rope: Should be able to perform for 60 seconds and without a significant difference in difficulty side-to-side.
Single Leg Volleys
Thanks for reading,
Pain on the outside of the elbow is classically called “tennis elbow” or tendinitis. Although, people who don’t play tennis can also have this pain from grip-heavy or repetitive activity. There are also many structures that can cause this same pain, outside of the usual tendinitis.
Tendinitis is thought to be caused by increased inflammation due repetitive stress in the area and micro-tears to the muscle. It is acute, meaning it just happened. However, many folks that we see have had symptoms for months (sometimes years!!) and so the process is different and chronic. We call this tendinosis. There is no longer acute inflammation or swelling, rather long term changes to the tissues in that area from improper healing and continuous repetitive trauma.
The area that is irritated to cause the pain at the outside of the elbow is called the extensor tendon. That is, the common tendon where all of the smaller forearm muscles that extend the wrist, join at the elbow.
Often times, players who are playing frequently throughout the week without proper mobility and recovery plans will present with this issue. Over-gripping the racket is also another major cause.
If the muscles and therefore the tendon or irritated, a great place to start for self-care would be to perform the forearm release (seen below).
Doing this for two minutes, 1-2x/day, can have a positive impact on the pain you feel.
So while many tennis players have pain at their elbow, only a fraction will actually have “tendinitis”.
Another tissue that is often the culprit is the nervous tissue. Nerves course throughout our entire body for muscle function, sensation, etc. Irritation of the nerve, from repetitive activities or rubbing against another structure can send pain signals to the same area. However, treating the muscle in this case will not clear up the symptoms.
The major nerve that runs by the outside of the elbow is called the radial nerve. Muscles nearby are commonly overused in tennis and can be the cause of the symptoms. Irritation of this nerve can also begin at the neck, but that is a discussion for another time!
I often see players who are changing their grip or adding more top spin to their balls tend to have more issues with nerve irritation.
The best way to address the radial nerve irritation is a radial nerve glide (see video below). Try 15 of these before a lesson or match to improve the mobility of the nerve and decrease the pain. With nerve glides, keep the tension that you create 5/10 tension/pulling or less to avoid extra irritation!
Try 15 of these before a lesson or match to improve the mobility of the nerve and decrease the pain. With nerve glides, keep the tension that you create 5/10 tension/pulling or less to avoid extra irritation!
While both of these strategies above are a great way to decrease your pain, the best way to keep it from happening again is to address the shoulder. Shoulder weakness changes how your arm (elbow and wrist) move through space. With tennis players, overhead strokes and serving can be particularly irritating if proper shoulder position, strength and control are not achieved.
Does your back look like this? Notice how the inside edges of her shoulder blade are prominent? Not ideal. That demonstrates weakness in muscles that are essential for overhead movement.
You can begin to address this weakness and shoulder position with a simple and effective exercise called the single arm punch out. It strengthens a muscle called the serratus anterior to help normalize scapular position. Try 2 sets of 15 reps per side, 3x/week. This is a great warm up on the court or at the gym!
Thanks for reading,
Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.