Posted by Stephen Messineo on Mon, Apr 05, 2010 @ 07:33 AM
The successful treatment of any injury depends not only on resolving the presenting problem but also addressing the factors which contributed to the cause of the problem. In order to do this the clinician must look towards the kinetic chain to understand where the problem might have come from.
What is the kinetic chain?
The kinetic chain referrers to a biomechanical model of movement; segments or joint of the body work as a whole to achieve motion. This chain of movement transfers forces from proximal (near to the body) to distal (away from the body). For example when kicking a football the kinetic chain of movement passes from the trunk through the hip, to the knee, onto the ankle and then is transmitted through the ball as it is struck by the foot. They say that a chain is only as strong as the weakest link, this is certainly true here. Any disruption to the kinetic chain, i.e. if one body part is not functioning normally, will mean that it places stress/strain on the other segments which will ultimately result in injury.
Consider the example of a tennis serve; an activity which uses the upper limb. The kinetic chain of the upper limb is as follows:
How can the trunk and shoulder cause problems at the elbow?
If the shoulder is not able to fully rotate inwards, then the wrist will have to compensate in order to get the racquet face to the ball at the correct moment (1), this places undue stress on the tendon which is likely to develop into injury if this pattern is repeated.
The Kinetic Chain and Tennis Elbow
The pain around the outside of the elbow joint that is associated with lateral epicondylitis (tennis elbow) develops when there is an abnormal level of stress on the tendon of the wrist extensors which attach the forearm muscles to the lateral epicondyle of the elbow. Issues surrounding the trunk and shoulder can be the cause of this undue stress to the tendon.
Rotator Cuff and Mid Thoracic Strengthening in the Treatment of Tennis Elbow
The rotator cuff consists of the tendons of 4 different muscles: Infraspinatus, Teres minor, Supraspinatus and Subscapularis. These muscles are responsible for providing stability at the shoulder by drawing the head of the humerus (arm bone) towards the glenoid fossa (socket of the shoulder joint). They also produce rotational movements around the shoulder. When strengthening around the shoulder the articulation between the scapula, ribs and thoracic spine (middle back) cannot be forgotten. The muscles around the middle back and shoulder blade work to extend the thoracic spine, and tuck the shoulder blade in towards the rib cage. This serves to place the glenoid fossa into its optimum position for movement of the shoulder.
By stabilizing and generating force within the first two links; it is possible to improve the efficiency of the kinetic chain, thus, helping to not only remove the stressful stimulus that may have caused the elbow injury, but also to prevent further problems in the future.
References
1. Occult periarthrosis of the shoulder - A possible progenitor of tennis elbow. LaBan, MM, Iyer, R and Tamler, MS. 11, 2005, American journal of physical medicine and rehabilitation, pp. 895-898.
Posted by Stephen Messineo on Tue, May 05, 2009 @ 08:58 AM
With the arrival of spring there are many outdoor activities that we prepare to participate in throughout the spring and summer. These include but are not limited to baseball, softball, golf, tennis, gardening, horseshoes, bocce, bags (or whatever backyard lawn sport you enjoy), and fishing. All of these activities require use of our shoulders and elbows. So, around this time of year, we start to notice an increased incidence of shoulder and elbow tendonitis injuries (along with a variety of other injuries stemming from these activities which I will discuss at another time.) Tendonitis is an irritation of the muscle tendon where it attaches to a particular bone. The irritation, swelling, and pain are due to added stress to the tendon due to a particular activity or several activities.
Tendonitis injuries to the shoulder and elbow stemming from the activities mentioned above can be avoided by performing some simple stretching and strengthening exercises using thera-band (which you can always purchase from us if you can’t find it in the stores) or hand weights. I have included pictures below of 4 stretching and 2 strengthening exercises for the shoulder and elbow that will help you avoid tendonitis onset as you get involved with your spring and summer activities. These 6 exercises should take you no longer than 15-20 minutes at a time to do. For the two theraband exercises, you should try 2 sets of 10 reps each. For the 4 stretch exercises, you should hold each stretch gently (no pain) for 20-30 seconds each and repeat 2 -3 times.
Of course, if you do develop a tendonitis injury of the shoulder or elbow, please give us a call. You will want to address this type of injury sooner than later when it occurs, even if you only view it as a nuisance when you first develop it. As tendonitis injuries get worse, they become more debilitating. Furthermore, if you let the injury go to long, it becomes that much harder to rehabilitate and can occasionally lead to a tendon tear that requires surgery to repair. So if you or someone you know has developed tendonitis in their elbow or shoulder, please call or have them call for an appointment with us sooner than later.
Finally, if you would like more information on exercises that will help you prevent tendonitis injury onset, call our new All-Access Fitness Academy (508-845-6738) and schedule an assessment session with one of our Strength and Conditioning Specialists. You do not have to be a member to schedule an assessment, and you will walk away with an increased understanding of the types of exercises you should be doing to avoid tendonitis injuries. This will allow you to stay active this spring and summer without worry.