elbow instability

[dub101]

I hope I can get some advice from someone here...

I've been doing the Warrior Wellness moves (almost) daily for several months now. My joints feel great--except my left elbow. There seems to be excessive movement going on in the joint--I can sometimes feel "stuff" moving around as I go through the various ROMs. Push-ups have caused slight pain but not if I warm up with a few elbow circles first.

Yesterday I was set to do some Hindu pushups, and on the beginning downward movement of rep#1 I felt something pop in my left elbow. It felt like something "popped" into position, after which my elbow felt very sore. I ended the workout and implemented RICE.

This morning it feels much better but is still a little sore. ROM is not hindered. Weird. :?

I would really appreciate any suggestions.


Werner

[rbibbs]

Howdy Werner. What's the history of that L elbow? Broke it when you were a kid? Right-handed and inactive over a period of time? Left-handed blacksmith/tennis pro? If you went to a doctor with it, after getting your history, he'd ask "where does it hurt" and you'd point to it. Then he'd move your lower arm and wrist and see what articulation piques the discomfort. That's not possible online, so a pinpoint diagnosis is not possible either.

Having a minor musculoskeletal dysfunction is a great learning opportunity though. Google "anatomy", narrow it down to the MS system, find the arm, and explore the structure. The forearm is not just a short shin, you can't turn your feet palms up, how does that work? Now you can name the bone where the pain seems to be coming from, and describe what motion makes it come and go. With that information, our trainers here can better tell you what to do for it, what not to do until it gets better, etc.

Meanwhile keep doing WW. When you have a transitory dysfunction, do WW several times a day, not just the maintenance level of 5 reps/direction. Use relaxed, exploratory motions and do not force any motions that cause deep pain.

The articulating surfaces of joints are lined with kinesthetic sensors that measure the compression/distention the joint is under. A sloppy ligament (previously injured, congenitally weak, overused) can allow an amount of displacement/distention that overloads these sensors, and your reaction is likely to be more than just a wince. You'd likely hear a pop too, from the sudden unauthorized movement, and perhaps cavitation from the sudden change in pressure. If you really have such a structural deficiency in your L elbow, you can have it surgically corrected, or learn where the weakness affects your articulation and avoid extreme loads in that position.

To my knowledge, ligaments can't be appreciably "strengthened" with use. Their only source of nutrients is contact with surrounding tissue, enough to remineralize and maintain them, but once you're 20 or so, they don't ever get "bigger". And if they're under no strain to speak of, as in "inactivity", like most unused body systems they gradually deteriorate in strength and flexibility.

Don't take mine as "the final word" on any of this. I have only layman's knowledge based on my own curiosity and exploration. (Coach, Dr. Cobb, Dr. Bob, please correct my misconceptions.)

Rick

[dub101]

Hi Rick.

>> Right-handed and inactive over a period of time?

That's it. :(

I've also played guitar for about 25 years (left hand is my fretting hand) and have occasionally had pain in my elbow that has been exacerbated by playing.

The last few mornings I've done Pete Egoscues "menu" of exercises for elbow pain as outlined in his book (Pain Free...). Seems to help.

>> Meanwhile keep doing WW. When you have a transitory dysfunction, do WW several times a day, not just the maintenance level of 5
>> reps/direction.

I try to sneak in some WW moves during the day and then do the full routine in the evening.

>> Use relaxed, exploratory motions and do not force any motions that cause deep pain.

Good advice. I'll heed it.

I have only a trace of pain in the joint right now, and I feel it in different places throughout the day. If the pain remains minor and transitory I'll just keep exploring this on my own (and with the help of this forum, thank goodness!)

I really appreciate your response -- you got me thinking about my overall approach. Looking back I can see that I've dabbled and experimented quite a bit but have not been very consistent. I'm going to pull back a bit and focus on recovering my range of motion first (WW tape 1). Meanwhile I'll work on clarifying my goals.

Thanks again for your help.

Werner

[rbibbs]

Most welcome Werner. When my joints are acting up, I'll do circles in the supermarket, in line at the bank, even the airport and the devil with who sees me or what they think.

Guitar eh? Not a musician myself... drummer. British invasion stuff from 1965. Yeah, yeah, yeah. Fretting is done near the CCW limit of wrist motion for extended periods, I can see how that might predispose the elbow to asymmetrical tension. And your pushups, when this happened, which limit of wrist motion are those?

Work back into strength stuff gradually if you've been inactive. I went "pretty gradually" myself but still managed to irritate a BUNCH of tendons in shoulders, elbows, knees. If you get such an irritation, back up to unloaded motion until it abates. Smooth coordinated motion before power.

I'd suggest once you're pretty much pain-free, graduating to light hand weights (depending how husky you are, 5-25#, no more than 1/3 of what you can do sets of isolated curls with) and doing smooth coordinated WW motions with moderate load. Hold the weights at the "awkward" end of the handle instead of the center. This "simulates" Circular Strength Training, nowhere near as much range of challenge as Clubbells, but it's a step in between ROM recovery and extreme strength training, that us "formerly inactive" guys can't really skip. Don't rush or "macho" this step either or you can just about guarantee a rotator cuff problem. Conservative as I thought I was being, I managed to pinch a nerve in the C-4/C-6 area that rendered my R shoulder pretty useless for a month.

I'd also suggest that these circular motions, with weights you can handle at non-reciprocal angles, are MUCH more productive than reciprocal loading with "as much as you can lift".

Be patient and confident mate. We're both paying-off those years of "relaxation" we "enjoyed", to get strong and mobile again.

Rick

[dub101]

Once again, thanks for the thoughtful response.

Let me make sure I understand what you wrote:

>> Fretting is done near the CCW limit of wrist motion for extended
>> periods, I can see how that might predispose the elbow to
>> asymmetrical tension. And your pushups, when this happened, which
>> limit of wrist motion are those?

Are you saying that cranking the wrist counter clockwise for extended periods could create an "imbalance" of some kind in the elbow joint ? And that this imbalance could cause problems when the wrist is turned clockwise and the elbow is under load ?

I like the idead of using light hand weights an an intermediate step to clubbells. I look forward to trying that.

After following a consistent routine all week ( Morning: e-cises, During workday: sporadic WW, Evening: Full WW ), the instability is no longer there. I do feel a dull, near-constant pain around the joint. None of the WW ROMs seem to make it worse. There's no tingling and my grip strength feels normal. The pain seems to "move around" and sometimes radiates a few inches into either my upper or lower arm, but not all at once.

I'll keep at it, but I'm going to back off to fewer, slower, and more careful movements with the elbow in question.


Werner

[bob_stra]

Once again, thanks for the thoughtful response.

Are you saying that cranking the wrist counter clockwise for extended periods could create an "imbalance" of some kind in the elbow joint ? And that this imbalance could cause problems when the wrist is turned clockwise and the elbow is under load ?



Wolff's law

Changes in function are followed by changes in structure.

Make of that what you will and train smart ;-)

PS: Maybe. My old biomechanics professor had something similar happen to one of the swimmers he was training for the Australian institute of sport. I'm not sure if he was implying that it was common, but this guy had troubles until they created a more balance routine for him.

[bob_stra]

>To my knowledge, ligaments can't be appreciably "strengthened" with
>use.

In my darker moments, I tend to agree with you.

Dammit - someone put out a paper already. It's gotta be happening.

Sh-eeet... you want something done right, you have to do it yourself ;)

> (Coach, Dr. Cobb, Dr. Bob, please correct my misconceptions.)

It won't be Dr Bob for quite a few years Rick.

Unless there's another Dr Bob on here... which would be cool...freaky but cool ;-)

Werner

I have no idea. You havn't given us enough info to be honest. Unfortunately, I barely know what the questions are.

The causes of hypermobility are many and varied. Far too many to mention here. Injury, disease, pregnancy....etc etc....

The guys on http://www.rehabedge.com/ might have some leads.

[rbibbs]

"Dr Bob" is a more tidy construction than "almost Dr Bob", if only a little futuristic. :wink: The official title is just a matter of "when".

I only got as far as anatomy 201, a long time ago, and only passed that because it was multiple choice. And I agree, "ligaments can't be strengthened..." is a dark prognosis, when in fact they can become less-subject to failure than they would have been in their disused or misused state, one definition of "stronger".

Werner, being strongly accustomed to using your lower arm in one position gives it preferential integrity in that position. And L wrist CCW is inherently the stronger loadbearing position, try a few palm-down curls (with your good arm) to demonstrate this. When you go to the opposite ROM of the radius/ulna, the elbow may be "expecting" the same degree of integrity which in fact may not be there.

That is all hypothetical, as a possible explanation of what's happening. A pushup is not the same load as a curl, etc. Doesn't alter our methodology though, as Bob says, "train smart". You're in good company, a great many extreme-performance athletes found out where their structure was weak the hard way. And it's not just an "age thing" either, structure can be misapplied-to-failure at any age.

Maybe think of training as a road trip, one from which we don't ever have to go "home" to the way we were before in terms of physiological state or knowledge, an endless vacation from our "job" of slowly dismantling ourselves by disuse. You just got a warning ticket, no biggy.

Rick