Todd Sabol MS, AT
Have you ever had that nagging pain on the top of your forearm, that seems to just never go away? Every time you are gripping something or lifting things at work over and over again, you feel this pain? If your daily activities at work, in the gym or around the house include excessive gripping or repetitive motion using your arms and hands, and you seem to having pain on the “top of your forearm” you may be suffering from a chronic overuse injury called lateral epicondylitis. The reason I have top of the forearm in quotes is because I most of us live our lives in a pronated wrist position which means the palm of our hands are down, so the pain will present on the top, but if we are in anatomical position (arms at sides and palms up, the pain will be lateral and posterior, or on the back of your forearm. Lateral epicondylitis, or tennis elbow, as you may have heard it referred to before, is an overuse condition where the extensor muscles of the forearm are becoming inflamed, and in turn can cause pain. The pain usually stems from the lateral epicondyle of the of humerus, which is the small bony eminence of the most lateral part of your elbow, this is the common attachment point of the extensor muscles of the forearm. (If you put your arm at your side with your hand palm up, and feel for the little bony prominence on the outside, and then extend your forearm, you can feel the extensor tendons firing right at that origin point). The pain will commonly radiate down the posterior forearm along the distribution of the extensor tendons down into the wrist. People who have this condition will commonly complain of opening doors or jars, or lifting things with a neutral hand, like if you’d be lifting up a glass to drink something. I have had this condition from time to time and if I don’t stay on top of it, it can really be aggravated with low bar squatting, so this may sound familiar to a lot of you powerlifters. I have had experiences of this radiating up my elbow into my shoulder as well, so your pain will depend on the severity and the duration of the condition too! So keep this in mind if you are doing things that produce forceful flexion of the wrist, where those tendons have a traumatic eccentric load on them, or if you are doing things with repetitive wrist extension.
So the big question is how can I alleviate the pain, what rehab exercises can I do to make me feel better and operate pain free? I have found through my own experience with this, and with numerous clients and athletes that I have worked with that it is a multifaceted approach. First, off you may need to modify your activity a little bit to reduce that repetitive stress on those tendons, but then slowly learning to load that tissue in an eccentric fashion and working on developing more adequate grip strength are the two big factors that I have seen make a huge difference in my clients and myself.
Here is a sample of a rehabilitation program to help target the source of your pain and get forearm extensors stronger and less prone to injury. Add these eccentric focused lifts in your regimen beginning with 2-3 days per week The focus on eccentric contraction will help recruit more muscle fibers and allow more blood into the tissue and can promote healing without you having to just completely rest.
Forearm Strengthening (Eccentric or lowering portion should be 3-5 seconds minimum)
Isometric Holds (With a very light DB, 2-5 lbs):
Full Wrist Flexion
Wrist Fully Extended - 3x5, 5 sec hold
Self-Resisted Forearm Extension Eccentrics - 3x5, 5 second eccentric portion
*You can progress to a DB for the eccentric portion, but can use your other hand to raise the DB back up, if the extension portion causes pain.
If no pain, you can perform the entire exercise, still focusing on the eccentric portion.
Pronated Forearm DB Curl - 3x5, 5 second eccentric portion
Hammer DB Curl - 3x5, 5 second eccentric portion
DB Grip Walks – 3x30 steps, holding DB at the top with your finger tips
*This can be progressed into heavier DB Farmer carries and Overhead carries, this is the beginner movement.
This is not an all-encompassing rehab program, it is mainly for the beginning aspect of lateral epicondylitis rehab, but will give you a great start in correcting your forearm pain by increasing the overall tissue strength around your injury. Let me know if you have any questions about this article or other progressions, and always remember to #HealByMoving.