Previously we have talked about tennis elbow, which a lot of people suffer from, but there is a synonymous injury on the opposite side of the forearm which elicits pain on the medial side. This is referred to as medial epicondylitis, golfer’s elbow, or baseball elbow. Many of the same mechanisms, or same type of mechanisms can cause medial epicondylitis such as excessive gripping, carrying heavy objects often, playing racquet sports with a lot of forehand motions, excessive wrist flexion or excessive throwing motions. The pain will mostly be localized around the common attachment point of the forearm flexors at the medial epicondyle of the humerus and you will experience pain on the inside of your elbow. Just like with tennis elbow, this pain begins because of the increased use of these tendons and they become inflamed overtime. If you feel around the inside of your elbow and locate the large bony prominence there, you are on the correct landmark. If you feel just below that and press down you may even feel some tingling, that is your ulnar nerve or “funny bone” just to give you a little better idea of the area you should be feeling around. If you supinate your hand and flex your forearm by bringing your hand up towards you, you will feel your forearm flexors contracting and if you follow them all the way up to your elbow, you will eventually find that same landmark.
The pain will commonly radiate down the anterior forearm along the distribution of the forearm tendons, so it is not uncommon to have pain in that entire area all the way between the wrist and elbow. People who have this condition will commonly complain of activities that involve gripping and force the elbow to go into a valgus position, or when the elbow moves toward the body while the hand and wrist is outside of that (think of throwing a javelin). The severity and frequency of the pain will depend on the individual person and their daily activities. If these activities are not modified and that tissue continually is stressed the issue will only get worse. If you think you may be suffering from this, think about when it hurts the worst, and what activities you do that aggravate it commonly.
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 flexors 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 Flexor Strengthening (Eccentric or lowering portion should be 3-5 seconds minimum)
Isometric Holds (With a very light DB, 2-5 lbs):
Self-Resisted Forearm Flexion 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 flexion portion causes pain.
If no pain, you can perform the entire exercise, still focusing on the eccentric portion.
Supinated 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 medial 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.