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When performing isolation exercises for the shoulder such as “lateral flys” for the middle deltoid, front flys for the front deltoid and prone flys for the rear deltoid, you’ll either get some degree of wrist extension (generally around 45 degrees to 90 degrees) or your wrist extensors will contract isometrically to hold your wrist stable throughout the movement. Now before you get too excited and start adding volumes of flys to your routine, there are 2 things to consider.
1) When performing flys, you’ll find that there is more load on the shoulder to raise the load than there is on the wrist extensors to hold the load, there for if your shoulder region is working maximally, your wrist extensors are only working sub maximally.
2) Flys use the long lever principle, which means there is a considerable amount of sheering force on the shoulder joint, this sheering force on the shoulder joint can be a contributing factor when it comes to shoulder injuries.

Weight Training & Tennis Elbow

By Leith Darkin
September 2005


Abstract

In this article we are going to look at how the condition “tennis elbow” can occur through resistance training and how to structure your resistance-training programs to minimise the onset of this condition.



WHAT IS TENNIS ELBOW?

There has been much confusion over the years about the pathological process involved in what has traditionally been termed “tennis elbow”. The primary pathological process is a degeneration of the ECRB tendon in the first 1-2 cm distal to its attachment to the extensor origin at the lateral epicondyte. This area has poor blood supply, which, when combined with excessive use, may lead to degenerative changes in the tendon. (S. Bell 2002) In my previous article “A balanced upper body routine” (Volume 13 issue 2, 2005) we looked at the scapula, the humerus and all the surrounding muscles, with the objective of writing a balanced upper body routine to minimise shoulder injuries and putting the foundations in for a good strong upper back and good upper body posture. One area this article didn’t address was the wrist joint and although elbow injuries, in particular tennis elbow are less common than shoulder injuries, they can be just as debilitating. Over the years I’ve seen many cases of tennis elbow caused through resistance training (mainly body builders) of which some I’ve been involved in the rehabilitation process and although there are a number of contributing factors to the condition tennis elbow in general, as far as resistance training goes, I believe it can be narrowed down to a lack of quality training for the wrist extensor muscle group. Mechanism of injury Inadequate forearm extensor power and endurance to withstand normal, forceful repetitive movements placed against the forearm flexors (Nirschl 1973) If we start off looking at our five push and our five pull exercises (which are the nucleus of all functional upper body movements), then look at isolation exercises for the elbow joint, shoulder joint and the wrist joint, you’ll see where I’m coming from.


1) Chin up or lat pulldown 2) Incline lat pulldown 3) Bench pull 4) BB bent over row 5) Upright row	1) Over head press 2) Incline bench press 3) Bench press 4) Decline bench press 5) Dips

Our five pull exercises will either involve some degree of wrist flexion (generally around 45 degrees to 90 degrees), or our wrist flexors will contract isometrically stabilise the wrist joint through out the movement of the exercise. Our five push exercises involve an isometric contraction of equal proportion for both the wrist flexors and wrist extensors to stabilise the external load through out the exercise. As you can see our wrist flexors are already getting significantly more quality training than our wrist extensors.

ISOLATION FLEXION & EXTENSION OF THE ELBOW

When looking at isolation flexion and extension exercises for the elbow joint, we have several grips to choose from, these grips determine the involvement of our wrist flexors and extensors. 1) Supine (palm facing upwards). 2) Prone (palm facing downwards). 3) Neutral (1/2 way between prone and supine with the thumb facing upwards). 4) ½ way between supine and neutral. 5) ½ way between prone and neutral. The majority of elbow flexion exercises are performed with a grip in the supine position, which will again either involve some degree of wrist flexion (generally around 45 degrees to 90 degrees), or our wrist flexors will contract isometrically stabilise the wrist joint through out the movement. Some exercises are performed with an EZ bar, which brings our grip position to ½ way between supine, and neutral, which again predominantly uses our wrist flexors. Some exercises are performed with our grip in the neutral position, which involves both our wrist flexors and our wrist extensors (in this position there is a greater emphasis on the wrist extensors). Rarely elbow flexion is performed with either a grip in the prone position or a grip ½ way between prone and neutral which brings our wrist extensors fully into the equation. The majority of elbow extension exercises are performed with a neutral grip, which involves our wrist flexors, or a grip in the prone position, which again involves our wrist flexors. Rarely elbow extension exercises are performed with a supinated grip, which brings our wrist extensors fully into the equation.

FLYS

When performing isolation exercises for the shoulder such as “lateral flys” for the middle deltoid, front flys for the front deltoid and prone flys for the rear deltoid, you’ll either get some degree of wrist extension (generally around 45 degrees to 90 degrees) or your wrist extensors will contract isometrically to hold your wrist stable throughout the movement. Now before you get too excited and start adding volumes of flys to your routine, there are 2 things to consider. 1) When performing flys, you’ll find that there is more load on the shoulder to raise the load than there is on the wrist extensors to hold the load, there for if your shoulder region is working maximally, your wrist extensors are only working sub maximally. 2) Flys use the long lever principle, which means there is a considerable amount of sheering force on the shoulder joint, this sheering force on the shoulder joint can be a contributing factor when it comes to shoulder injuries.

ISOLATION FLEXION & EXTENSION OF THE WRIST

Going by my own experience of being around gyms for around 20 years, and being a Strength & Conditioning coach and a Personal Trainer for around 1/2 that time, the only individuals that I’ve seen incorporate wrist flexion and wrist extension into their training are those who are training to increase their muscle mass. The problem being that body builders are concerned with appearance and as the muscle group responsible for wrist flexion is considerably larger than the muscle group responsible for wrist extension, building large forearms often means only training their wrist flexors, or a 2:1 or 3:1 ratio of wrist flexion to wrist extension. As you can see there is a huge discrepancy in training volume (and in some cases intensity) between our wrist flexors and extensors, ideally we need to incorporate some additional quality wrist extension into our training to help even up the tally.

INCORPORORATING WRIST EXTENSION INTO YOUR TRAINING

1) If your training involves only compound exercises then you should consider including some isolation wrist extension into your training. 2) If your training already includes wrist flexion and extension then you should consider a minimum 2:1 ratio of wrist extension to wrist flexion. 3) If your training includes some isolation elbow flexion you can include BB bicep curls with a pronated grip or include an EZ bar bicep curl with a grip that is ½ way between prone and neutral. If your training includes some isolation elbow extension you can include a tricep pushdown with a grip in the supine position

CONCLUSION

The rehabilitation procedure for tennis elbow in the majority of cases is to maintain flexibility and when the client is pain free, incorporate some isolation wrist extension exercises to build up endurance and strength in the injured area. In this article I have attempted to demonstrate the imbalance of wrist extension to wrist flexion in the majority of resistance training programs, there for if 1) There is a muscle imbalance of wrist extension to wrist flexion if in your resistance training programs 2) The rehabilitation procedure for tennis elbow is to introduce some quality wrist extension to build up muscle endurance and muscle strength in the injured area. Why not incorporate some quality wrist extension into you resistance training program in the first place to help even out the muscle imbalance rather than after the onset of an injury.

REFERENCES

S. Bell (2002): Clinical sports medicine 2nd edition. Chapter 15 Elbow and Forearm Pain Mc Graw – Hill book company. ISBN 0 074 71108 3. (Nirschl R P (1973): Tennis elbow. Orthopaedic Clinics of North America 4(3):787 Sports physiotherapy Chapter 24 The Elbow Complex Harcout publishers. ISBN 0 443 04804 5.

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