Athletes Treating Athletes

This is part fifteen in the Self Muscle Massage Series. In the introduction post to this series we introduced and demonstrated the three muscle release techniques that will be used in this post. If you would like to review them, click here. If you would like to see any other parts of the series, click here.

In this installment of the series we’re going to be moving from the shoulder down to the elbow. Typically, as you move further away from the core of the body, the muscles get smaller and become more prone to injury through repetitive overuse situations. It is also why bony injuries such as fractures and joint dislocations become more common where the muscles are unable to counteract the full load of the body in a fall situation onto the arm.

Anatomy

Bony Landmarks

There are four basic ways that the elbow joint can move: 1) flexion (bending the elbow), 2) extension (straightening), 3) pronation (rotating your forearm so that the palm of your hand is facing down towards the floor), and 4) supination (rotating your forearm so that the palm of your hand is facing up towards the ceiling).

With those motions in mind, an easy way to visualize the elbow joint is to think of it as one bone coming down from the shoulder (this is the humerus). As it’s dangling there, two bones that are already connected to each other (this is the radius and ulna) then literally hook on to that bone. This forms the actual elbow joint and allows you to bend and straighten your arm. The other two motions at the elbow actually occur because of the two lower bones and how they are  connected to each other. The rotation of the forearm occurs because the radius and ulna are able to rotate over each other.

#1 Humerus. The humerus is the long bone of the arm that moves down from the shoulder to the elbow. As it moves down the arm, the narrow bone becomes wider at the elbow. If you cup your hand under your elbow you will feel the two “knobs” on either side. These are called the epicondyles (the medial is on the inside closest to the body, and the lateral is on the outside away from the body).

#2 Forearm bones- Ulna and Radius. These two bones connect in two spots (up near the elbow and then again down at the wrist). The ulna actually hooks onto the humerus at the back of the elbow. This part of the ulna is known as the olecranon. The second forearm bone, the radius, then connects to the ulna. Together, these two bones rotate to produce supination and pronation of the arm. Without these you would be unable to turn keys, door knobs etc. An easy way to differentiate which bone is which is to look at your hand. The bone on the side of your thumb is the radius, while the bone on the side of your pink is the ulna. As you rotate your arm back and forth you can see how the radius rotates over the ulna which is connected to the humerus.

Muscles

#1 Biceps. This is the most superficial muscle in upper arm. One of the important parts of this muscle is that it helps move two joints because it has two different origins. These tendon origins are referred to as heads (and are named by length). The “long head” starts on the front of the scapula while the “short head” starts at the top of the humerus. Both heads then join together to form the muscle, cross the elbow joint and insert onto the radius. Primarily, this muscle bends the elbow, however, it is also able to flex the shoulder (aka lift the arm out straight in front of you) and pull the arm in towards the body (shoulder adduction). To feel this muscle, place your hand over the front of your upper arm. With your palm facing up towards the ceiling (supination), bend and straighten your elbow. You will feel the muscle move as you do so.

#2 Brachialis. This muscle sits underneath the larger bicep muscle. It starts on the humerus about halfway down the arm and then inserts onto the ulna. It’s sole function is to bend the elbow. To feel this muscle, place your hand over the front of your upper arm. With your palm pacing down towards the floor (pronation), bend and straighten your elbow. You will feel the muscle move as you do so.

#3 Brachioradialis. This muscle is also deep to the bicep muscle and starts furthest down the humerus (bottom 1/3). Front here, it runs along the radius before inserting down near the wrist. It also works to bend the elbow. To feel this muscle, place your hand over the front of your upper arm. With your thumb facing up towards the ceiling (like your holding a glass), bend and straighten your elbow. You will feel the muscle move as you do so.

#4 Pronator Teres. This muscle starts on the inside of the end of the humerus and wraps over to the radius. These attachments allow it to pronate the forearm (aka twist it so that your palm is facing down towards the ceiling). To feel this muscle, with your arm bent, place your thumb over the crease of the elbow (the line where it bends). Then slide down approx 1 inch. Now try rotating your forearm back and forth. You will feel the muscle move as you do so.

#5 Supinator. This muscle is on the back of the arm on the outside and is deep to the more superficial muscles. To find this muscle start with your elbow bent and your fingers on the lateral epicondyle and move down just below the bone. From here, rotate your forearm back and forth. You will feel the muscle move as you do so.

#6 Triceps. This muscle is the major muscle on the back of the upper arm. It is broken up into three parts, much like the bicep is- the long head, lateral head and medial head. The long inserts onto the scapula, allowing the muscle to help move the shoulder back into extension. The lateral and medial heads insert onto the back of the humerus accordingly. All three then merge to make up the muscle itself and travel down the back of the upper arm to insert on the olecranon of the ulna. The major function of this muscle is to straighten the elbow. To feel this muscle, place your hand on the back of your arm and bend/straighten. You will feel the muscle move as you do so.

Soft Tissue Release

What you’ll need: stick/foam roller and tennis ball

The techniques: click here for an introduction to the techniques and a video demonstration

1) Lengthening/elongation with the foam roller or stick.
2) Cross friction with your hand or tennis ball.
3) Sustained pressure or trigger point release with the tennis ball.

Key Areas to Work On

#1 Foam Roller. When working on the upper arm, start by loosening up the larger and more superficial muscles. To start with the front of the arm, lay on the roller with your arm out at shoulder height. Position the roller vertically at the front of your shoulder. From here you will be able to roll from the shoulder to the elbow. Then roll over onto your back and repeat for the triceps muscle. You may find that this area is very tender. If so, try using a raised surface versus actually laying on the roller itself. A bed or table works best. This way you can directly control the pressure you are using and can work your way up to laying on the roller. Shoot for 3-5 minutes before moving to the deeper techniques.

#2 Tennis Ball- Cross friction.

The key with cross friction is to remember that you are working perpendicular to the muscle fibers. This means that you will be working in a side to side (horizontal) direction when working on the upper arm. The movement itself is very small (maybe 1-2 inches). Sink the tennis ball in deep, relax and then maintain that depth as you work. If you feel like the ball is rolling or sliding, you’re moving too much. When working on the upper arm, the primary location for friction work will be on the tendons of the tricep/bicep muscles where they insert at the elbow. Sitting or standing with the tennis ball will work best for the tricep. The bicep is easiest using your fingers/thumb versus the tennis ball. See the video for further details. If you’re still unsure of the cross friction technique and how to properly do it, click here for a review.

Key Areas:

1) Intersection areas are prime spots for cross friction. At the front of the elbow you have the large biceps tendon criss-cross the brachialis tendon and then the pronator teres is in the mix as well. Start at the medial epicondyle (place your thumb here and then move down approx 1 inch or thumb width onto the pronator; you can rotate the arm to make sure you’re on it). Use your thumb for the friction. remember- sink your thumb in and then work horizontally. From this start spot, work your way across the crease of the elbow. this will allow you to get everything in the front. Once you work across the crease, move down approx 1 thumb width and work from end to end again.

2) Another big spot for cross friction at the elbow is on the large tricep tendon. For this one, you can stand up against the wall and use the tennis ball. See video for further details.

#3 Tennis ball- Trigger Point. When moving onto trigger point areas, remember, let the tennis ball sink in nice and deep and just sit on it. If after 2-3 minutes it hasn’t released, move onto the next spot!

Key Areas:

1) Muscle belly of bicep and tricep.  For the bicep, use your thumb and sink right into the thickest part of the muscle. HOLD it there. For the tricep, you can do the same using a tennis ball and standing against the wall. See video for further details.

Video

Below is a video demonstration for the elbow/upper arm techniques.

References

1) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

2) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

3) Moore, Keith and Dalley, Arthur. (1999). Clinically Oriented Anatomy, 4th edition. Lippincott Williams and Wilkins, Baltimore, MD.

4) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.