Anatomy of an Injury – Wrist & Elbow

Over the last four articles, we have discussed the types of injuries: Mechanical, Chemical, and Mental; we then looked at injuries associated with the Back, Ankles & Knees, and Shoulders.  If you haven’t read these articles, please click here so that you have a full understanding of how injuries occur and how these strength & flexibility exercises will help keep you healthy and performing at an optimum level.  This week we will look at the injuries associated with the Elbow & Wrist and how to offset with strength training & flexibility.

Injury Reduction NOT Elimination
As previously mentioned, the reality of exercise & racing is that athletes will become injured from time to time.  The key is to minimize the athlete’s exposure to injuries through nutrition, hydration, strength training & flexibility.  However, a typical stumbling block for athletes is that they are willing to sacrifice correct form for the sake of exercising (lifting weights, implementing plyometrics, stretching, sport specific skills & drills) which will lead to technical mistakes & biomechanical compensations – causing to excessive stress on muscles, tendons, & ligaments.

Train & Race without Pain
As a reminder, when you are executing any form of exercise (strength or cardiovascular) ask yourself this question: “Does it hurt?”  Your answer should always be NO – without exception!  I have received the responses, “it doesn’t hurt after a long warm up” – I let them know that they are injured.  I can give you multiple examples of this rationalization of pain.  Remember, the pain we are speaking about is the pain associated with movement. This is not the same residual pain associated with the delayed onset muscle soreness (DOMS) – this discomfort is associated with the intended breaking down of muscle tissue, NOT within the joints, tendons and ligaments.

Pain Site vs. Pain Source
I have received a lot of feedback about the difference between a pain site and a pain source.  As I mentioned in my last article, to help you alleviate your pain, you need to differentiate between your pain site & your pain source. Think about this statement, if your lower back is in chronic pain, you need to understand it is because your back is doing the majority of work associated with movement that other synergistic muscles should be helping the back to complete.  Another example is knee pain on the outside of your knee.  You “feel” the pain at your knee; however, the source of your pain is in your hips which pull on your ITB inserts on the side of your knee where you are feeling the pain.  Today’s medical treatments are about covering up the problem with prescription drugs rather than looking deeper into the source of the pain. With this being said, before we look at the various injuries associated with the elbow & wrist, let’s review some basic anatomy & physiology.

Arm Function
As declared by Dr. Sovndals, your arms significantly contribute to your ability to handling the bike along with providing a foundation and platform to stabilize your body when you are riding.  These muscles offset the pushing and pulling of the bars (forward, backward, side to side) along with providing the shoulders, chest, back, and truck an anchor to synergistically work together and perform optimally.

Arm Skeletal Anatomy
The bone above your upper arm (above your elbow) is called the humerus.  Your forearm is made up of two bones: the radius & ulna.  The elbow is a hinge joint that allows your arm to flex and extend to create movement. The forearm rotates to turn the palm up and down.

Muscles of the Upper Arm: Biceps & Triceps
The muscles on the top of the arm consist of the biceps (front of the arm) and the triceps (back of the arm).  These two muscle groups work together to bend and extend your elbow.  The bicep is composed of two heads and it is important you understand where these muscles attach. The long head of the bicep originates in the shoulder joint; the short head originates at the coracoid process.  The bicep tendon inserts just below the elbow joint on the medial (inside) tuberosity (that little ball that protrudes from the inside of your elbow).  This medial attachment serves two purposes: flexion of the elbow (brings your palm towards your head) and supination of your palm (rotating your palm upward).

There are two other flexors of the elbow: brachialis & brachioradialis.  The brachialis muscle originates along the front lower half of the humerus, crossing the elbow joint to insert at the proximal (close) end of the ulna bone.  Flexion is a combination of biceps muscle pulling up on the radius, the brachialis pulling up on the ulna and the synergistic relationship of all these muscles to flex the elbow.  The brachioradialis muscle arises from the lower lateral (outside) portion of the humerus, courses down the entire forearm and inserts at the radius just above the wrist joint according to Dr. Sovndal.

The long head of the triceps on the back of the arm originates just under the glenoid cavity of the scapula.  The medial head’s origin runs all along the medial (inside) and posterior (backside) aspect of the humerus.  The lateral head originates along the upper backside of the humerus.  All three of these muscle heads fuse together to form the triceps tendon that attaches to the olecranon process of the ulna.  The triceps offset the flexion of the elbow with extension (straightening the arm).  If a facture occurs that displaces the olecranon process, the triceps will cease to have a lever point to straighten the elbow.  This bone is broken frequently because it is the first point of contact when we fall on our elbow.

Muscles of the Lower Arm: Flexors & Extensors
According to Dr. Sovndal, because there are so many movements of the wrist, hand and fingers, causing a complicated array of muscles to be crammed into this small location of the arm. To keep this anatomy simple, the lower arm muscles can be broken down into flexors & extensors.

Wrist flexors: Flexor carpi radialis, palmaris longus, flexor carpi ulnaris
Finger flexors: Flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus
Wrist extensors: Extensor carpi radialis longus, extensor carpi radialis brevis, extensor carp ulnaris
Finger extensors: Extensor digitorum, extensor digitorum minimi, extensor indicis, extensor pollicis longus, extensor pollicis brevis

A person should refrain from getting caught up in the anatomical terminology; instead recognize the abundance of muscles you are strengthening and stretching when you work your arms.

Warm up Exercises for your Arms
The whole principle behind a warm up is to get the muscles warm and the blood vessels dilated to bring oxygenated blood into the working muscles.  Here are a few simple things you can do prior to working out or riding.  Complete one or all of the following for 1-2 minutes per arm for optimum results:

1. Simple rub your arms with your hands.  Friction will create heat and dilation of the blood vessels.  Rub gently for 1-2 minutes from your wrist towards your heart with a flat palm both on top and bottom of your arm.
2. Squeeze & release.  Starting at your wrist, gently grip and squeeze the muscle tissue on the front and back of your arm.  Work your way from your wrist up to your arm pit.
3. Tennis ball press.  Take a tennis ball and gently press the tennis ball into the muscle tissue.  Run the ball from the wrist up to the elbow and then go back down to your wrist and rub the tennis ball back and forth across the muscles of your arm.

Strength Exercises for your Arms
Bicep Curls
Bicep 14’s – click here for instructional video
Bicep curl up to 90 degrees – click here for instructional video       

Triceps
Triceps dips off of bench or fit ball – click here for instructional video
Triceps kick-backs – click here for instructional video
Lat pull over/triceps extension – click here for instructional video
Fit Ball Roll up & Push Up Combo – click here for instructional video
Pike – Push Up – Pike on Indo Board – click here for instructional video
Medicine Ball Slam – click here for instructional video

Stretch Cords without handles: click here to watch a series of videos that require you to “grip” the stretch cord versus holding a handle.  This will engage and strengthen the muscles of your arm in addition to the specific muscle groups.

Flexibility & Soft Tissue Maintenance for Arms
See Warm Up Exercises for your arms listed above.  Doing this one to two times a day will reduce muscle tightness within your arm muscles.

Setting the Shoulder Blades
Ian McLeod, a certified massage therapist to the athletes in the 2008 Summer Olympic Games in Beijing, states that when performing upper-extremity exercises, particularly those that target the shoulder joint, you should set the shoulder blades into a stable position.  The setting movement involves pinching the shoulder blades backward and downward as if you were trying to put your shoulder blades in your back pockets.  When setting the shoulder blades, avoid shrugging the shoulders upward because this action shifts the focus of the exercise from the lower fibers of the trapezius muscle to the upper fibers which are typically already overdeveloped in most athletes.

Nutritional Support
Adequate protein intake provides the muscles that you are strengthening the amino acids needed to rebuild torn down muscles associated with load bearing exercise.  For more information about protein, please click here & read this article.

Next week we will discuss how to get rid of and keep off those unwanted pounds that sneak up on us during the holidays.

Until next time, Train Smart-Not Hard!

-Coach Robb