"Tennis elbow?" you may ask. "What does tennis elbow have to do with me? I'm a weight-trainer!" Well, don't be fooled by the term. Tennis elbow is an all-too common affliction suffered by hardcore bodybuilders / strength athletes.

When Science Editor Lonnie and I talked about presenting this piece to VM readers, its message took on a whole new intensity of importance: Fortress is suffering from what he believes is "tennis elbow". And believe me, it's very annoying and uncomfortable. So do yourself a favor and read on. Every serious weight-trainer - male and female - needs the information presented.

Robert "Fortress" Fortney, Managing Editor

What is lateral epicondylitis (tennis elbow) and what are its symptoms?

Lateral epicondylitis - or "tennis elbow" - is the most common affliction of the elbow, affecting athletes who frequently perform repetitive motions. Dorland's Medical Dictionary (28th edition, pg.564) describes epicondylitis as an inflammation of the epicondyle, or of the tissues adjoining the epicondyle of the humerus.

So, what does all this mean? Simply put, it is an irritation of the small muscles of the forearm at the elbow. There is usually moderate to severe tenderness to touch over the lateral elbow. Pain is usually experienced with resistance to extension of the wrist. There is not a specific incident that initiated the pain although there are daily activities that may increase the pain.

In the early stages there is little to no swelling over the area. In more severe cases there is often pain when picking up small objects or turning a doorknob. Even in these advanced stages the inflammation is rarely visible. Pain may be localized at the elbow and shoot down the forearm and into the hand. There may also be a noticeable decrease in grip strength associated with the pain.

How does epicondylitis develop?

Although it is termed "tennis elbow", epicondylitis affects all types of athletes. Most commonly it affects those who have a repetitive motion involved in their sport or who have heavy objects to grasp. Strength athletes incorporate both of these tasks into their performance and most often they are occurring in conjunction with each other.

The repetitive motions that seem to do the most damage are the motions of supination and pronation as would be required with alternating dumbbell curls. This injury can also be progressed by lifting an object that is too heavy and, therefore, requiring the forearm extensors to overwork. Over a period of time, micro-trauma to the area accumulates and causes inflammation and pain to develop at the elbow.

Poor form may also play a role in placing the forearm in a poor biomechanical position and, therefore, forcing the forearm muscle to work out of the optimal range. Overall, it is usually a combination of all of these factors that contribute to development of the injury. We all do it now and then; you know, you become tired and form goes right out the window.

How can I treat and relieve my pain?

First and foremost, see your primary care physician and / or your physical therapist if you are experiencing elbow pain so that an accurate diagnosis of the problem can be made. This is an injury that can become chronic and debilitating unless proper treatment is sought - and sought early. In the meantimeā€¦ice, ice, and then more ice! That's right, ladies and gentlemen, when in doubt, ice it. Use of ice immediately after your workouts and 2-3 more times throughout the day can help to decrease the inflammation. Also, use of your anti-inflammatory medication of choice may help with the pain and keep you lifting.

Stretches for the wrist extensors should be performed 4-5 times daily and should be held at the point of stretch but not to the point of pain. Completely stopping the activity causing the pain is only necessary if the conservative treatment described above is not improving the condition. Interestingly, Immobilization is only appropriate for a short period of time and may actually worsen the condition.

Exercises should be initiated to begin to build-up the wrist extensors to allow them to handle the demands being placed on them by heavy lifting. Yes, sometimes the only thing that will allow an injury to heal is proper rest. This means taking a week off from lifting completely (which is not always a bad thing, anyway). You may also need to decrease the weight used on your lifts. It is important to be aware if you are sacrificing form to increase the poundage used in a lift. Pay attention to your form! You may be doing harm by simply using poor technique.

Progression of your exercise program is also another important consideration. I understand the desire for quick gains, but gains come with hard work, dedication and lots of time. Progress slowly and with perfect form as you increase the weight of your lift. In most situations, for a beginner, a good rule of thumb is, if you cannot perform at least six repetitions of any specific movement with good form, then the weight is probably too heavy.

Lastly, you may want to consider assistant / supportive devices, such as forearm straps and wrist wraps, to take some of the stress off your extensor tendons of the forearm. In rare and very severe cases, corticosteroid injections and surgery may need to be utilized to give some relief of symptoms. These should only be options after all other treatments have failed.

How do I keep this from being a chronic problem?

As mentioned previously, don't sacrifice form for any weight. Be disciplined with form and it will pay off in the long run. Secondly, don't forget to train the small muscle groups of the upper extremity such as the rotator cuff and the scapular muscles. These muscle groups are often neglected and lead to misuse and overuse of the extensor tendons of the forearm to counteract early fatigue of the rotator cuff and the small scapular muscles during heavy lifting.

Make sure that you set aside some time weekly to train the "non-beach muscles", like the small muscles of the forearm. It is important to maintain a good rehabilitation program of stretching and strengthening for an extended period of time once symptoms have dissipated. Also, use appropriate supportive wraps such as wrist and forearm straps to provide protection during heavy lifts. And last, don't forget to ice an injury at the first signs of irritation. This may keep a minor injury from developing into something more severe.

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