Hi, this is Dr. Gangemi and welcome to our newest Sock-Doc video. Today we're
moving to the upper extremities, and going to talk about the elbow and the
muscles surrounding the elbow and common elbow injuries, elbow type of
pain, lack of range of motion in the elbow, and pretty much any elbow
discomfort. Helping out today is a great runner in the area, Ian McPherson.
Thanks for helping out. And let's get right to it.
So one common injury that many people are plagued with is something called
tennis elbow, which is also known as a lateral epicondylitis. And you
might not even be playing tennis to have this type of elbow diagnosis.
It's pretty much an extension type, or if you think about tennis, like,
backhand especially, type of injury, where the back of your elbow is
exhibiting some type of pain with extension, you're going to think more
about the triceps. Your triceps are those powerful muscles in the back of
your arm. But also, your triceps have to do with, or the long head of your
triceps, which is one of the three heads of your triceps on the back of
your arm, has to do with extending your elbow and your shoulder back. It's
sort of like a retro version movement.
So with the triceps here, if you have pain, especially close to the top of
the elbow, or even in the mid part of the upper arm here, or the back of
your humerus, the back of your arm, let's turn a little bit here, I want
you to look for trigger points back, on the back side of the arm. Again,
even if the pain is in the elbow. As you know perhaps from some of my
other videos, we try and stay off the area of pain.
So if you have pain in the elbow, especially the outside here, again, that
lateral epicondylitis related to a tricep problem, then don't just go in
there and look for trigger points on that tendon, on that insertion into
the actual elbow bone. But also, or actually just come up here and stay
within the meaty part of the muscle and look for trigger points in here and
work those out as I've described in the trigger points videos on the
websites and in other videos.
That's pretty obvious where you can look for with the triceps, but one
place a lot of people don't know to look for a tricep problem is way up in
the back of the shoulder blade, which I wanted to show. Just going to
stand up here and move your tank top for a second, because the long head
of the tricep that does this type of motion here, the origin of that is on
the back of your scapula. So you actually have to get up here in sort of
underneath the armpit almost. Not way in there, but on the back here, right
up in that crease, and you're going to look for a tender point as you push
up and in there. It's pretty deep in there.
So you're going to have trouble getting that yourself. This is kind of
where you might need a partner if you can't reach or you can't feel it, but
the short head, or the medial and the lateral head as they're commonly
called, of the triceps, start more in here and come down. Where this long
head comes up and goes up in there in the back of your actual shoulder
blade.
So it's a very common injury even if you're not feeling pain in the
shoulder. You can still have pain in the elbow from that long head of the
tricep causing a problem. Think about this with a running type of injury
even. If someone is doing a normal gait motion where they're like this,
not that you're hopefully running like that all the time, but this is a
normal motion where you're extending that opposite arm as the length that
I'm standing on is pushing off, so this right leg is flexing forward as the
normal gait mechanics. I can have a problem with this elbow from, say,
perhaps, an extension problem on the opposite limb every time I go
forward.
Extensors are firing on the upper right side. Extensors are firing on my
lower left side, on my glutes, even to the point of some of my calf muscles
propelling me forward. So I could have an old hip injury, or a new
hip injury, on my left side, creating an elbow problem on my right, or vice
versa. So we're going to look at those gait imbalances.
Again, I've talked about this in some of the lower extremity videos on how
you need to look at a gait pattern for a possible injury connection. Okay?
So that's a big thing with tennis elbow.
The other common diagnosis which is what is called golfer's elbow, even if
you're not a golfer. But it's also a throwing type of injury, where it's
called medial epicondylitis, which is more of the front of the elbow on the
inside, has to do more with your bicep, and you can even think of bowling
if you're a bowler, or a throwing type of motion, especially with baseball,
where someone might injure their bicep.
The thing is, people think about their bicep as flexion mostly, but
actually what your bicep does, two primary actions of your bicep really
more than flexion, and people who really think about their biceps as
getting big, big in terms of, like, weightlifting, is elevation of the arm,
and let's do what I showed you a little bit earlier, is contract your bicep
naturally, and whenever you naturally contract your bicep, notice what
happens to your hand, it turns out. That's a natural motion. He's not
trying to turn his hand up, but when he contracts his bicep his hand
naturally supinates. And we're going to talk about why that is in a minute
with the supinator, but it has to do with your bicep too.
So any motion, if you have trouble lifting your arm up, the shoulder is
going to be another type of Sock-Doc video, but right now, if you have pain
in the elbow with lifting or throwing, I want you to think about the bicep,
and you might have a trigger point up here, which is the insertion of the
long head in this little groove in the front of your shoulder. You can
lightly palpate, lightly touch in there, and if it's tender it helps
relieve your elbow pain, you could treat that a little bit. In other
words, he could hold right here and lift his arm. "Hey, my elbow feels
better. There might be something to that."
Or the short head is actually in this little groove right underneath your
collarbone on the outside where it attaches to your shoulder, and then he
could do the same thing there. Put your hand there. If you raise your arm
or contract your arm, flex your bicep, it helps there - again it might be
something to look for for an elbow issue.
Very rarely do I ever treat a bicep trigger point in the actual muscle
itself. The most common place for a trigger point for a bicep is in the
front of the forearm, where these muscles, the biceps, two heads come
together and join into a thick matrix of fascia, connective tissue in front
of the forearm here. So the common area for the bicep trigger points,
again, with flexion, are actually about an inch below where the crease
of the elbow is, okay?
So it would be in here and more towards the inside, meaning the inside when
you hand is flexed palm forward. The trigger points are here. So you could
rub those a little bit. See how that feels. If it helps, that's where
you're going to treat those trigger points, for front of elbow pain,
perhaps something that's been diagnosed as a bicipital tendonitis or as a
golfer's elbow.
Now let's get into the supinator, which, again, has to do with a little bit
of bicep control, but also, your supinator basically does this with your
hand. It's a common type of motion. People use it for opening doors,
opening jars, that sort of thing. Turning the hand out, palm up, that
muscle is going to come from about the outside, about a half inch above the
outside of where that bone is in your elbow and wraps around like this, to
the front, okay? So it's like that.
I can show you on my arm. It's from here to here. Think about that part
of your arm, so when you turn, it's right there. So the place to look for
the trigger points are here and right here, on the front of the forearm,
again, about an inch below, but now on the outside of the forearm, turning
the hand over. So that's the supinator. That does this. If
you have pain in your elbow while I'm doing that, or even in your wrist,
look for that muscle right there.
On the inside is your pronator. The pronator is going to turn your hand
in. Either one of these motions, you could have pain while you're
throwing, again, opening a jar. Pronation, a lot of people have pain when
they're shaking someone else's hand. I've seen that a lot. Cyclists,
hanging onto a bike, depending on what your handlebar position is, and the
drops on your bike. If you're on a mountain bike you could be more
pronated or supinated. And I've seen supination problems and pronation
problems in swimmers, especially, with, like a motion, like the back stroke
as your hand is pronating and supinating through the stroke. Okay?
Again, you might have wrist pain or shoulder pain, could be coming from
your elbow, so don't disregard that. So the pronator is coming from the
opposite side, from the back here, and wraps around the front, allowing him
to turn his hand over like that. So, it's like supinator here, again, on
the outside, and then pronator on the inside. I'm about an inch above and
an inch below my elbow crease, but now inside to the front of my forearm on
this side, and for supinator, here. Okay?
So pronator problems here, supinator problems on the outside. But the
pronator actually has another important muscle, more for your wrist down
here. This is called your pronator teres. Down here is a muscle called
your pronator quadratus, and it actually helps turn more of your wrist out.
I'm sorry, in, turn your wrist in, pronation. And that muscle pretty much
comes like this. Let's have you raise your arm just a little bit. All
right, hold still like that. There we go. So the muscle's going to extend
from here to here, right across your distal, the end of your ulna, and your
radius, into your forearm bones, and it does this, turns it in.
So he might have a trigger point here, right at the end part of your wrist,
right before the wrist flexes. That could cause wrist pain. It could also
cause elbow pain as he tries to pronate each time. Okay?
So pronation, supination. Pronation, you're looking here. You're looking
on the inside of the elbow. Supination, you're looking on the outside of
the elbow, and also with the bicep.
The last muscle we're going to talk about for the elbow is this one, called
your brachioradialis. People think of it as hammer curls, that type
of muscle, or hammering, it's a very powerful muscle, and it basically
starts at the very end part of your forearm here on top of your radius and
comes right up like this and allows you to do that. So you could have pain
in your elbow and it could be anywhere in here. Typically it's more in the
meaty part of this muscle. They're kind of sore anyway.
A lot of people they're just sore. You use them a lot. That's a good
running position, too. Your hand's like that. Hopefully you're not
stressed when you're running. Your hands are relaxed so you're not
stressing out your brachioradialis. But you can get forearm, or elbow
pain, from that. Remember to cross the joint a little bit. That inserts
right here above the elbow joint, and you can have a lot of fascia
connections in there that needs to be corrected.
The last thing I wanted to mention for your elbow, as you might know from
some of my other videos, we always talk about nutrition and blood sugar
handling problems and what's known as dysglycemia or imbalance of blood
sugars. This is what also some people call carbohydrate intolerance or
insulin resistance, and they get elbow pain because of an imbalance of your
biceps and your triceps as those muscles are very uniquely controlled by
blood sugar and by your blood sugar, and spikes and dips all day long in
your blood sugar from eating too many refined carbohydrates or training to
anaerobically, or not eating enough protein or good fats so your blood
sugar's constantly going up and down all day, can and will definitely cause
elbow pain.
One thing that endurance athletes can note, and I've gotten this in IronMan
races and in doing long runs even, is if your blood sugar drops too low and
you're running along like this and you drop your arms like that and you
kind of extend your triceps, you might get a shock in your hands, like a
little electric shock going down to your fingertips, almost like pins and
needles. That's a good indication that the balance between your
triceps and your biceps has occurred based off dysglycemia, meaning you've
gone too long without eating or you're starting to hit the wall or bonk.
I've done that plenty of times to know, and I know when I'm in a race, if I
do that with my hands and I feel that shock I probably missed my perfect
opportunity to already consume some carbohydrates, but I know I'd better
start before it gets any worse. And the same thing, people who wake up with
numb hands when they sleep, that's a common, common problem too, from
dysglycemia, in that case, nocturnally, night dysglycemia, and there is
some stuff on the website about that, sleep problems.
So again, elbows, think about the triceps, think about the biceps, think
about the different motions that we talked about, pronation, supination,
and even wrist flexion and extension, sometimes with elbows, but that's
going to be more wrist problems; we're not going to talk about that
today.
That should do it. Thanks for helping out. That's a pronation move. This
is a supination move. And thanks for watching.