Fixing Elbow Pain Prevention

Fixing Elbow Pain Medial and Lateral Elbow Pain Fix For Athletes and Lifters

Preventive Methods Copyright © 2013, The Diesel Crew, LLC All Rights Reserved. Published in the United States by: The Diesel Crew, LLC P.O. Box 806, Wyalusing, PA 18853 Tel: 607.857.8997 Email: [email protected] Websites: http://www.DieselCrew.com http://www.TheGripAuthority.com Author: Jedd Johnson, CSCS, RKC Manufactured in the United States Second Edition: June, 2013

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DISCLAIMER Strength training involves a potential risk for serious injury. The techniques discussed and utilized in this manual are being demonstrated by highly trained professionals. No one should attempt any of these techniques without proper personal instruction from trained instructors. Anyone who attempts any of these techniques, under supervision or not, assumes all risks. The Diesel Crew, LLC, DieselCrew.com, or any partners of The Diesel Crew, LLC shall not be liable to anyone for use of any of these exercises, drills or instructions. This product is informational only. The data and information contained herein are based upon information from various published as well as unpublished sources and merely represents training, strength and power development literature and practice as summarized by the authors and editors. The publisher of this manual makes no warranties, expressed or implied, regarding the currency, completeness or scientific accuracy of this information, nor does it warrant the fitness of the information for any particular purpose. This summary of information from unpublished sources, books, research journals and articles is not intended to replace the advice or attention of health care professionals. It is not intended to direct their behavior or replace their independent professional judgment. If you have a problem with your health, or before you embark on any health, fitness or sports training programs, seek clearance from a qualified health care professional.

COPYRIGHT © Copyright © 2011 - 2013 The Diesel Crew, LLC. All Rights Reserved. No part of this information may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, distributing, or by any information storage or retrieval system, without permission in writing from the author. The authors and publisher disclaim any responsibility for any adverse effects or consequences from the misapplication or injudicious use of the information presented in this text. Inquiries should be addressed to The Diesel Crew, LLC, Webmaster, PO Box 806, Wyalusing, PA 18853, USA. For complete information on all of the Diesel Crew’s products and more valuable information available to help you get incredible results in your training, visit www.DieselCrew.com and www.TheGripAuthority.com.

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TERMS & CONDITIONS 1. I am aware that The Diesel Crew, LLC, and its members Jim Smith and Jedd Johnson, are not medical doctors and are not qualified to determine a participant's physical capability to engage in strenuous exercise. 2. Medical clearance from my physician may be required prior to participation in any exercise program and/or engaging in any of the exercises contained within this eBook.

WAIVER AND RELEASE OF LIABILITY: (READ CAREFULLY BEFORE PERFORMING ANY EXERCISES IN THIS MANUAL) I UNDERSTAND AND ACKNOWLEDGE THAT THERE ARE RISKS INVOLVED IN PARTICIPATING IN ANY EXERCISE PROGRAM AND / OR ANY EXERCISES CONTAINED WITHIN THIS EBOOK IN CONSIDERATION FOR BEING ALLOWED TO UTILIZE THE INFORMATION IN THIS EBOOK, I AGREE THAT I WILL ASSUME THE RISK AND FULL RESPONSIBILITY FOR DETERMINING THE NEED FOR MEDICAL CLEARANCE FROM MY PHYSICIAN AND OBTAINING SUCH CLEARANCE, THE SAFETY AND/OR EFFICACY OF ANY EXERCISE PROGRAM RECOMMENDED TO ME, AND ANY AND ALL INJURIES, LOSSES, OR DAMAGES, WHICH MIGHT OCCUR TO ME AND / OR TO MY FAMILY WHILE UTILIZING THE INFORMATION IN THIS EBOOK AND TO THE MAXIMUM EXTENT ALLOWED BY LAW I AGREE TO WAIVE AND RELEASE ANY AND ALL CLAIMS, SUITS, OR RELATED CAUSES OF ACTION AGAINST THE DIESEL CREW, LLC, JIM SMITH AND JEDD JOHNSON, THEIR EMPLOYEES, OR AFFILIATES (COLLECTIVELY THE DIESEL CREW, LLC), FOR INJURY, LOSS, DEATH, COSTS OR OTHER DAMAGES TO ME, MY HEIRS OR ASSIGNS, WHILE UTILIZING ALL THE INFORMATION OR PARTAKING IN THE EXERCISES CONTAINED WITHIN THIS EBOOK. I FURTHER AGREE TO RELEASE, INDEMNIFY AND HOLD THE DIESEL CREW, LLC FROM ANY LIABILITY WHATSOEVER FOR FUTURE CLAIMS PRESENTED BY MY CHILDREN FOR ANY INJURIES, LOSSES OR DAMAGES.

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Fixing Elbow Pain: Prevention Table of Contents

Table of Contents

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Introduction

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Pre-Activity Prevention Measures

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Mental Approach

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Warm-up

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General Warm-up Methods

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Specific Warm-up Methods

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Worthwhile Lower Arm Warm-up Equipment

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When Warm-ups Are Not Possible

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During Activity Prevention Measures

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Avoiding Injury During Activity

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Avoiding Excessive Force & Repetition

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Post-Activity Prevention Measures

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Taking care of the Body After Activity

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At-Home Therapeutic Measures

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Professional Therapeutic Measures

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Pre-habilitation Preventive Measures

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Pre-habilitation Exercises

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Maintaining Antagonistic Balance

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Forearm Rotation Training

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Circumduction Training

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Increasing Blood Flow and Recuperative Elements

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Quick Reference Guide for Pre-hab Movements

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About the Author

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Additional Products

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Fixing Elbow Pain: Prevention Introduction Medial and Lateral Epicondylitis, or Golfer's Elbow and Tennis Elbow, respectively, are common conditions many people face these days. And despite the fact that many of us don't even play that much tennis or golf, we still suffer the nagging pain.

I too have had both of these conditions at many points in my career, and I have been lucky enough to get rid of them using a combination of conventional and non-conventional means. But before we get into all that, let me tell you a bit about myself and how I have developed these conditions.

My name is Jedd Johnson, and I am a certified strength coach through the National Strength and Conditioning Association, which means I have passed the NSCA's testing requirements (2001) and continue to study and gain continued education units.

Part of my continued education has been the learning, practicing, and teaching of non-conventional forms of strength training. I have competed in numerous Strongman and Grip Strength competitions, as well as mastered the proper techniques of Kettlebell Training, Powerlifting, and many other forms of training. The good thing about this is that I have a very broad background of training and I can help a wide range of athletes develop their own strength and power to high levels.

The bad side to all of this is that through my years of training and experimenting with new methods and trying new sports, I have had to endure a great deal of pain and injuries in the trial and error process. Let me tell you the story of my first serious bout of forearm pain and how I came to develop the Preventive side of the Fixing Elbow Pain Program.

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In 2003, I had just begun a new form of strength competition, called Grip Sport. This brand new sport involved all kinds of ways to test hand and forearm strength, like squeezing heavy-duty hand grippers until the handles touched together, lifting very heavy thick-handled dumbbells, and my favorite part of all - bending nails and steel bars! Once I found out about this new sport, I went at it with 100% effort. Because I loved it so much, I began bending nails almost every single day of the week. It just felt awesome to twist a 6-inch nail into a U-shape. Then, one day at work, I was pushing open the door to the cafeteria break room and got an intense pain in my arm that felt like someone was poking me with a red hot fireplace poker. WHAT JUST HAPPENED TO MY FOREARM???? Here I am, a person with a desk job, and I found myself in the nurse's station reporting an injury from opening a door - I couldn't have been any more embarrassed...it felt like every single person walking by the door was staring at me in shame! I soon learned that I had developed two conditions, commonly referred to as Tennis Elbow and Golfer's Elbow. Both are very common injuries that thousands of people suffer from each year - the only difference was most people only get one or the other. Both sides of my elbow were sensitive to the touch and they hurt so bad, I couldn't even drink coffee using that arm for a week due to the pain. I soon began going to a therapist and after spending hundreds of dollars and missing countless half-days of work in order to attend appointments, the pain was gone and I was back to my old self again. I decided to take it a little easier on the Nail Bending after that.

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Over the next couple of years, I experienced other bouts of Tennis Elbow, but thankfully, it was never as severe as that first time, and I think that is because I have figured out how to prevent it from setting in again.

I have identified a handful of simple and easy-to-perform drills that I do on a regular basis that plug right into my current training and lifestyle. Since adding these in, I have been able to prevent that terrible forearm pain from coming back.

I have even passed on this information to many friends and coaching clients and they remain free of nagging forearm pain…

Unfortunately, because I am recognized as an expert on grip and forearm strength development, I am contacted by people just like yourself from all over the world every single week about pain they are experiencing in their forearms and elbows.

Preventing forearm pain is my strong point, but what about those who already have forearm pain and so desperately need relief?

For over a year, I kept on reading about this injury expert, Rick Kaselj. I would see his name here, or see him in a video there, and I came to realize that Rick Kaselj is an expert at helping people solve even their most frustrating injuries! What a list of accolades he has amounted...

I knew that I was on to something as far as preventing elbow injuries from occurring, but I needed to get information out to the people who were suffering from the same kind of pain that I battled years before.

That is when I reached out to Rick Kaselj about developing the Fixing Elbow Pain Program, and that is what we bring to you today.

What I plan on doing in this manual is showing you the many techniques I do on a daily, weekly, and sometimes even monthly basis in order to keep these conditions away and if they do set in,

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to get rid of them as soon as possible. Some of these methods are listed as "Prevention" while others are listed as "Recovery." Take note that some of them are good for both, but also understand that ALL of them are effective and they will help you continue to perform at a high level.

Before we get into the meat and potatoes, the main course, of this manual, don't think that if you are not a Strongman or Grip Sport competitor these practices will not help you. The truth is, these movements have and will help anyone who uses their hands and forearms with a high frequency whether you play tennis, golf, or other bat, stick, or racket sports, or if you spend a great deal of time using hand tools at your job or even if you play a musical instrument - I've got stuff that is going to help you out.

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Fixing Elbow Pain: Prevention Pre-Activity Preventive Measures Mental Approach A major part of preventing injuries and conditions like epicondylitis is having the right mindset. This is also something that most people do not take into account. You have to understand that because you push your body to limits that others do not, you run the risk of developing these types of issues to a higher degree than someone who does not use their hands heavily in their job, does not readily play sports that involve lower arm activity such as tennis and golf, and does not do other forms of resistance training, such as weight lifting, climbing, or other pastimes.

Starting now, you need to always have in the back of your mind the idea that because you take your activity seriously, you will have to invest just a few minutes each time you are going to be active toward the proper warm-up. Warm-up is covered in detail in the next section. Make sure to read through it in detail and go through it for a refresher from time to time so that it stays fresh in your head. Also, going forward, it has to be part of your mental approach that you will take preventive measures while you work, play, or train to ensure you stay in top form. For instance, if there is a long lay-over between matches at a tennis tournament or any other sport you might play, before returning to play you're going to have to warm up again.

You will need to constantly assess the conditions that you are experiencing. If it is cold out, it may mean wearing layers in order to keep your body warm during the short bouts of inactivity during a game or round of golf. If you know that you are doing something which in the past has caused problems for you, then it may be necessary to use an analgesic cream, carry elbow sleeves with you, or bring portable instant heat packs in order to warm the areas up better and keep these conditions from coming back again.

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Still another example of how your mind needs to be different from those of others is that you are going to have to take care of your body following your bouts of activity, especially in the form of stretching. Later on, you will see many examples of stretches that you should be doing after each workout or after each session of activity that has been known or is suspect to causing medial or lateral epicondylitis. You will see that the time you need to invest in these stretches is quite short, but the rewards are immense. Again, view stretching as a means of investing time in helping your worked muscles relax and not as something that takes away from your time with your friends or makes you board. The more serious you begin taking your stretching and the other preventive measures discussed in this manual, the more benefit you will see and the better you will continue to perform at work and at play.

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Fixing Elbow Pain: Prevention Pre-Activity Preventive Measures Warm-up One thing is certain – if your hands and lower arms are sore, you can not perform to the best of your potential. It is extremely important to make sure you take care of your body and prevent injuries. If you develop an overuse injury of some sort, your performance will no doubt suffer.

At this point, most people should be aware that consistent high performance on the field and the ability to stay healthy when performing sporting endeavors, pastimes, and manual labor depend upon being properly warmed up for the respective endeavor.

Unfortunately, just as they say, "Common sense ain't so common," sometimes neither is the awareness and recognition of the need for a proper warm-up. Whether we skip it because we think we are immune to injury, or if we forget to get a good warm-up going, or maybe some just don't know how to properly warm-up correctly. They might indeed be doing something, but it just isn't working. Following is how a Warm-up should be done.

For any physical endeavor, an effective warm-up begins with a general warm-up, targeting the entire body, followed by a specific warm-up, targeting the main musculature that will be worked during the session.

Without a doubt, the biggest mistake people make regarding their warm-up process is skipping it or not doing enough for it to be effective. The next biggest mistake is by doing the wrong things during the warm-up preparation.

Unfortunately, there is still an overwhelming number of people that believe static stretching is the best way to warm-up. Unfortunately, these people could not be more wrong. Static stretching should be done following a workout in order to lengthen and relax muscles. That's

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right - static stretches relax the muscles, in effect putting them to sleep. Do you really expect your muscles to perform at a high level and stay injury free if they are asleep?

Instead, your warm-up should include movement, and it should begin by involving the entire body in this movement, or very large portions of it. By targeting large areas of the body first, we can more effectively begin pumping blood through the muscles, through the core, and out into the joints and extremities, lubricating them for the work we are about to ask them to do. On top of this improved circulation to the muscles, joints, and connective tissues, we can also begin to prime the nervous system for the activities we're about to embark upon.

For your general warm-up, squats, lunges, deadlifts, pushups, leg lifts, good mornings, plate or dumbbell raises to all angles, light presses, back extensions, rows and other exercises that involve large groups of muscles are perfect. These exercises will increase circulation throughout your body for the general warm-up you need, even if being done with just bodyweight or a light exercise band for the resistance.

After the general warm-up, it is important to move into a specific warm-up. The specific warmup is where you will make sure that the muscles that will be used are ready to perform work.

The bottom line is that warm-up is important. If you give it an honest effort and properly warmup each time you train, you will see results and progress faster than others who do not perform a warm-up.

Years ago, Louie Simmons, the great powerlifting guru, suggested at a seminar I attended that prior to performing any work sets, an athlete should always warm up to the point that the core gets to 103 degrees Fahrenheit. Since this is a difficult thing to measure, the guideline I use is to make sure I have a good head sweat going before doing my work sets, and especially when training grip. Once I get to that point, I know I am on my way to an effective warm-up.

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General Warm-up Methods The following exercises can be done with bodyweight only in order to get the blood going throughout the body, by first starting with the legs and then working upwards to the arms. Then it will be time to begin the specific warm-up.

Bodyweight Squats

You will begin with a stance around shoulder width and then lower down into a squat. How you hold your hands is not important, so do what is comfortable. The most important thing is to get the quads and glutes going. Two or three sets of 10 should be fine.

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Lunges

This is a similar lift to the squat, except instead of dropping down into a squat, you take a healthy stride forward and then drop down until the knee lightly touches the ground, then return to the starting position. Alternate legs for two to three sets of 6 to 8 reps with each leg will be good.

Leg Swings

This movement is a dynamic warm-up for the hip flexors and extensors. Grip something to keep your balance and then swing one leg forward and back 10 to 12 times. The quads and hip flexors will bring the leg forward and give a stretch to the extensors and glutes, and then vice versa on the swing back. One set of 20 per leg should work well 18

Cossack Squats

The Cossack Squat is a bit more intense, so the rep count will be lower. You will begin with a very wide stance and then shift your weight to one leg while bending the knee. You will come up onto the ball of the foot on the side of the bent knee, and you will come up onto the heel of the of the opposite foot. Transfer to the other side, while trying to avoid moving the torso up more than a few inches. An intense drill for the entire leg and hip complex, one set of 6 total reps should do well.

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Woodchoppers

The next two movements will serve as a transition from the lower body to the upper body warmup drills. Woodchoppers are performed by swinging the Medball from up above the head, and then down outside one knee. From there, the Medball returns overhead, and then down outside the opposite knee. A Medball, or any resistance, is not necessary for this drill to work, so don't worry about taking your Medball to work with you. Just moving the hands down and up can get the job done. Also,1 or 2 sets of 5 to 10 reps will work well.

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Halos

Now, you can transition directly into Medball Halos. Remember, a Medball is not necessary, nor is any form of resistance. The warm-up can be accomplished by simply moving the arms in the motion shown. As in a halo shape, move the hands around the head in a circle, 5 to 10 times in each direction.

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Overhead Press

If you have a bar, dumbbells, or light weights available, great. If not, just grab a shirt with both hands about a foot or so apart and apply tension to it slightly as you move it up and down from the torso to the fully overhead position. One or two sets of 8 to 10 reps will work well to start directing the circulation into the arms. (Can be done with an exercise band or unloaded as well)

Push-ups

Just a few Push-ups will get so much muscle in the torso involved that the warm-up will be felt from the legs and glutes all the way up to the torso and lower arms. This is great to get the Specific Warm-up going into the lower arms next. Just a set of 3 to 5 Push-ups should work well to direct the circulation properly. If the Push-ups are done on the knees, it will be a good idea to double the reps. 22

Egyptian

Before moving to the lower arms specifically, perform Egyptians. Extend the arms out to your side. Pronate one arm as far as possible while supinating the other hand, then switch back and forth. Perform the movement slowly in order to keep tension on the connective tissues and eliminate momentum. One or two sets of 10 reps will be enough.

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Specific Warm-up Methods With so much activity in a short period of time, the blood should be flowing throughout the body in a healthy warm-up state. Now, it is time to transition into the Specific Warm-up for the lower arms by isolating them in the next few movement patterns.

Elbow Circumduction

For this exercise, the upper arm will remain at the sides and then the hands will travel in large circles, pivoting at the elbow. It is a good idea to do these slow to keep tension on the muscles and connective tissues and to eliminate momentum.

Loaded N-Planar Elbow Warm-up If you have some kind of light resistance item around, you can also further warm-up the lower arm by moving the item (here, an empty loadable dumbbell is used, but even a soup can would do the trick). Just 30 seconds per arm is great for these drills.

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Manual Resistance (Wrists)

Now it is time to direct the new, fresh, and healthy blood into the lower arms with some manual resistance. Perform 5 repetitions in extension and then flexion on the left hand, then 5 reps in extension and flexion on the right hand.

Manual Resistance (Fingers)

The warm-up will be complete with some manual resistance to the fingers. Perform the same workload on the fingers as you did on the wrists - 5 reps of extension and flexion on the left hand followed by 5 and 5 on the right hand.

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Worthwhile Lower Arm Warm-up Equipment I have tried countless hand and forearm tools, gear, and gadgets since I started training for ultimate grip strength. Unfortunately, much of what is available on the market is pretty much garbage, but not all of it. One of the items worth investing in is a DynaFlex Power Ball, or one of the other similar items on the market.

DynaFlex Power Ball

The DynaFlex Power Ball is a gyroscopic ball. The yellow internal ball spins independently of the outer shell. The yellow ball is set into motion with a red string that comes with it and from there, the athlete circumducts the hand to keep the yellow ball moving.

As the speed of the internal ball increases, the difficulty of the device increases as well. As you can see in the image below and to the left, the fingers must work hard in order to keep the ball under control.

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The PowerBall is great for a warm-up because it requires the entire lower arm, the wrist, fingers and thumb to work together to keep the ball spinning. Aside from turning the PowerBall in a circular fashion, wrist flexion and extension can be emphasized as well as deviations.

I have also found that by playing with the angle of the arm and wrist, as well as the degree of bend at the elbow, you are able to target the upper forearm in ways that will emphasize the areas that are susceptible to developing Golfer's and Tennis elbow.

I like to use the PowerBall in my warm-ups if I am not performing a full body workout prior to doing Grip Training, because it pumps fresh blood into the lower arm very well. So, if you have a history of Tennis or Golfer's elbow, this tool is a good one to add to your equipment bag to warm up the area prior to hitting the court, getting on the links, or before any other activity you do that bothers your elbow.

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Fixing Elbow Pain: Prevention Pre-Activity Preventive Measures When Warm-ups Are Not Possible In a perfect world, we can do our full, proper warm-up, prior to our activity. While this is the best way to do things, time constraints, space, and other factors might keep us from getting the full warm-up we need. In these cases, there are some things that we can do in order to help promote blood flow into the lower arms.

It should be noted that these methods, although somewhat effective, should only be used as a last resort when we know we are unable to properly warm-up. The warm-up style described in the previous section is always the best option.

Heating Pads Heating Pads are great for increasing circulation and promoting relaxation to a localized part of the body. Many types of heating pads are available on the market. The two major types are electric heating pads, and microwaveable heating pads.

Electric heating pads are plugged into an outlet and gradually the pad heats up to 150+ degree Fahrenheit. These pads can get extremely hot, and so a piece of material like a towel or cloth should be placed between the pad and the skin to prevent serious burning. Electric heating pads come in many sizes, even full body length sizes, and sometimes include a vibrating massage function.

Microwavable heating pads work differently. They are filled with beans, rice or other type of material. The heating pad is placed in the microwave for several minutes and the internal contents heat up and retain this heat for quite some time. The soothing moist heat these pads provide can be applied to the lower arms and hands as well as other parts of the body that need

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attention such as the neck, shoulder, or hamstrings. Again, care should be taken to protect the skin from an extremely hot microwavable pack as well, because burning can result.

Using heating pads can be beneficial for both prevention of problems and recovery from bouts of activity. For instance, before traveling to work or to a sporting event, the pack can be microwaved and then applied to the area throughout the car ride as a way to promote blood flow to the area. Also, if the elbow area feels tight, a heating pad can be applied in order to promote blood flow and to help the muscles relax. Combined with some light self massage, this can be a very therapeutic feeling method for taking care of the elbow areas.

Sports Creams / Gels There are many types of creams and gels on the market for athletes and other active people who benefit from improved circulation into the lower arms prior to sporting and working events. Often, these creams contain menthol or some other ingredient that causes increased temperature within the region where they are applied, which can feel amazing and truly help blood flow. However, light activity should still be done for a thorough warm-up.

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Fixing Elbow Pain: Prevention During Activity Preventive Measures Avoiding Injury During Activity As you know, epicondylitis can hinder how you are able to play sports, how you are able to train in your gym or fitness center, and it can even have a negative effect on what you are able to do while working. From complex movements like lifting, carrying, and moving heavy boxes and equipment, to finer motor skills like using hand tools, and even down to seemingly simple tasks like keyboarding and computer use, epicondylitis is truly something to contend with, no matter what our activity or the physical demands we put upon ourselves.

With that in mind, there are steps we can take in order to prevent epicondylits from setting in while we are active.

Tendon Compression Wrapping One of the reasons for tendon pain is inflammation. There are many causes of inflammation, including awkward position, excessive force, and overuse. Because of the incredibly high nature of repetition involved in sports, many jobs, and training, it is easy to see how overuse can lead to this type of problem.

One of the reasons why pain continues to be felt is because a small portion of the tendon continues to be stimulated against bone in the arm. With movement of the lower arm, the tendon must roll over bone in a very concentrated spot. This continued, concentrated contact keeps the tendon inflamed and pain just will not go away.

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One way that has been found to reduce this constant stimulation of the irritated part of the soft tissue is tendon compression wrapping. The purpose behind this is to lengthen the area of contact across the tendon, or to change it altogether.

The compression wrap is placed distally, or further down the arm, from where the pain is. By compressing the tendon in this location, more of the tendon is placed in contact with the bone, spreading out the surface, and sharing the load across more of the tendon. This can sometimes offer immediate relief within the forearm, and over time, as a part of a well-rounded and active recuperative program, can help lead to complete recovery altogether.

This tactic is a simple and affordable method, provided you do it correctly. Make sure to apply the compression wrap away from the point of pain though. Many people place the wrap directly over top of the point of pain, which makes the existing condition even worse.

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Elbow / Arm Sleeves In the Warm-up section, it was covered at length about the importance of promoting circulation throughout your body with an effective warm-up in order to prevent Tennis and Golfer's elbow. Now we are going to look at ways we can maintain this level of warm-up and continue to keep epicondylitis away while we are active.

Elbow sleeves, arm sleeves, and other types of coverings for the lower arms are great for keeping the area they cover warm, and promoting sustained circulation. After a thorough warm-up of the area, placing sleeves over the exposed skin can help keep blood flowing to the area, keeping the muscles and tendons better lubricated and more resistant to injury.

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Wraps and sleeves do not have to be extremely tight, as in a supportive wrap. Shown above, I can easily get a couple of fingers between the sleeve and my arm. The purpose of these sleeves is just to keep the area warm. The sleeves shown above are over 5 years old and thoroughly beaten up, but that is perfectly fine with me because I use them strictly to keep the elbow area warm, in order to prevent the onset of cumulative trauma injuries like epicondylitis.

Sleeves like this can be worn for the duration of a training session or sports play, especially if there is tenderness in the area, or they can be worn during periods of inactivity to keep the specific area warm, while waiting for play to resume.

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Super Hot Hands

Super Hot Hands is a product that is most often marketed to hunters, fishermen, and other outdoorsmen, but they can also be very helpful to those who have or are susceptible to muscle and tendon injuries.

Super Hot Hands come individually packed in foil wrappers and then further sealed in a plastic bag. Once opened to the air and shaken, the chemical compounds inside the package heat up and provide many hours of heat. Normally, these heat packs are then placed inside the outdoorsman’s gloves or pockets until needed to restore warmth to the hands. Hot Hands can also be used for warming the hands prior to a workout, practice, or a game. Also, when used in tandem with other measures they can work great for muscle and tendon injuries.

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Hot Hands can be placed inside a wrap or an elbow sleeve in direct contact with the portion of the body that is feeling pain, as a way to increase circulation to the area, in turn loosening it up and providing more recuperative nutrients to the area and speeding healing.

This can be particularly helpful to those who have a history of epicondyle pain for use during bouts of inactivity. For instance, between holes of golf, between innings of a softball game, or between arm wrestling matches, the Hot Hands pack can be placed near the sore area to keep it warm.

Warning: Hot Hands can get very hot depending on exposure to the air and the chemical makeup of the contents inside, so discretion must be used when applying them in direct contact with the skin. The best option may be to place a layer of clothing between the skin and the Hot Hands packs, or to wrap the hot hands in a piece of old torn clothing material that fits nicely into the elbow sleeve.

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Grip Modification Sometimes we can develop problems in the forearm due to the positions that we take when we work and the planes of motion through which we move in sport and training. While looking at the following exercises, think about similar movement patterns that you perform at work and play. Also, think of opportunities to get out of full pronation or full supination and make your way towards a neutral position.

For instance, when training in the gym, some equipment locks our bodies into positions that are fully pronated or supinated.

Pronated - Military Press

In a pronated position, pressing a barbell overhead can be something that causes a great deal of discomfort for those with lateral epicondylitis, especially with the elbow flexed prior to pressing the weight up.

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Supinated - Barbell Curl

Another example of a common and popular exercise is the barbell curl. Unfortunately with conventional straight bars, the forearm is forced into supination, which can cause discomfort in the tendons connecting to the medial epicondyle, possibly creating problems down the road or re-aggravating the area for those with a history of golfer's elbow.

These are just a couple of common exercises that, while beneficial for strength and fitness, can actually be detrimental to the lower arm for some people. Chances are, you can think of tools and equipment that you use in your sport, pastime, or job that cause similar levels of discomfort in your elbow region.

In these cases, it is extremely important with respect to prevention, that these implements be avoided. Instead we should look for tools that fit more naturally with how our body is naturally supposed to work. Here are some things to try.

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Neutral Grip

Supinated

Neutral Grip

Pronated

The Neutral Grip is that in which the wrist and forearm are neither pronated, nor supinated, but rather perpendicular to the floor when standing. This allows for better tracking of the connective tissue near the elbow and less impingement that can cause issues for us down the road. One object that we can all identify with because practically all of us use one is a computer mouse. Shown below and to the left, the forearm is pronated in order to click the buttons and use the scrolling tool on a standard mouse. Newer, ergonomically designed mouse tools have been designed to promote a more neutral position for the forearm, shown in the image below, on the right.

Image Source: http://www.ergodirect.com/product_info.php?products_id=408

Minor modifications like this can do a lot toward helping you avoid problems like Tennis Elbow and Golfer's Elbow down the road, because it drastically reduces the amount of time you spend out of neutral. Even though some activities, like using a mouse, involve very little force, because

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we spend so much time pronated, that is what leads to issues. This poor positioning at work, combined with time surfing the net or on Facebook, plants the seeds for irritation which eventually shows itself when we are doing something else, like sports or lifting, that aggravates the dormant condition.

Some examples of training tools you can use in the gym that reduce the degree of pronation and supination while increasing the degree of neutrality while working out are the EZ-Curl Bar and the Log or Log Bar.

The EZ-Curl Bar, while not moving fully into neutral, is effective because it does allow us to get out of that 100% pronated and supinated position when we train.

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Strongman Logs never have a handle that puts you into pronation/supination - instead they are inherently neutral and can be very good replacements for normal training. If I aggravate my lateral epicondylitis, I always gravitate to the Log because I am able to work in neutral.

Other Log-style bars on the market contain a variety of angled handles so that you can work more in neutral and less in extreme pronation/supination.

Look for opportunities in your day-to-day activities to do the same thing these strength training tools allow you to do - get into a neutral grip. Even the simple act of gripping the steering wheel can cause problems in the lower arms, something a lot of people do not consider. Holding the wheel at 9 and 3 or even 10 and 2 gets you out of pronation for more natural and neutral grip, and less cumulative strain on the elbow region

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Mobile Grip Mobile Grip is something that is even nicer for your body when training than fixed handles. The reason is because with a mobile grip, you are able to find the exact grip that works best for you, personally. Remember, each of us is different and for some of us, we can even see differences from one limb to the next, so a fixed handle in any angle could potentially cause issues for just one arm or elbow. With a mobile grip, each arm is able to take on whatever angle of pronation/supination that it needs in order to stay comfortable and out of pain.

Perfect Pull-up

The Perfect Pull-up is an example of a mobile grip device, because the hands are not fixed in one position and thus not locking you into one plane.

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Another set-up I use involves giant carabiners with lifting handles attached. These handles do not fully rotate like the Perfect Pull-up system does, but they still provide excellent movement for the lower arms and wrist for Pull-up and Chin-up Training.

When performing pull-ups on these handles, they will turn however I need them to, taking undue stress off the wrists, forearms, and even the shoulders. Above, you can see how my lower arms are able to rotate as they need to during the pull-up and chin-up movements.

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Avoiding Excessive Force and Repetition When it comes to cumulative trauma conditions, like medial and lateral epicondylitis, there are two other factors that are not as easy to track and identify, because we can not see them. They are Excessive Force and Excessive Repetition.

Excessive Force Another factor that causes some serious cumulative damage to the forearms and elbow areas is excessive force. When you consider that we have to expel a certain degree of energy into sporting movements, tasks at work, and exercises in the gym in order to get the results that we need, we can't just say that we are going to cut force out of our daily routine. If we did that, then we'd get very little work done, have very poor in-sport performance, and see a drop in our results in the gym.

The factor of force is why we absolutely must do everything else right before, during and after our activity. Force, speed, and power are all realities of any activity we do, so that is all the more reason to get our warm-up right, take the right precautions during our activities, and treat ourselves right once the work and play are complete.

Excessive Repetition Repetition is another factor of work-life, sports, and training that we do not always identify as a risk factor, but it truly is. Some sports, such as Baseball, involve a tremendous degree of repetition; not only during the game, but also practice sessions involve hitting and throwing balls, dozens if not hundreds of time, all of which adds up to a formula that can cause injuries.

Because repetition is an inherent part of sports and other activities we do, it is important to take care of ourselves however we can before, during, and after activity, but also it is important to identify unnecessary repetition.

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Unnecessary repetition is something we can avoid. For instance, if every swing of a club irritates your medial epicondylitis, is it really necessary to take three practice swings before every time you address the ball?

With respect to working conditions, if removing the knuckle from a cow shoulder causes problems for your lateral epicondylitis, does it make any sense to cut with a damaged blade, which requires you to move your forearm 16 times instead of the normal 8? Sawing, a form of unnecessary repetition in the meat industry, is often a result of having a poorly honed knife edge. Keeping the knife sharp using the maintenance tools provided can cut hundreds of unnecessary repeated movements out of a day's work, reducing the cumulative effects of the job and easing the feeling in the forearms.

Force and repetition are both factors that are sometimes difficult for us to monitor ourselves, although when we do, it can help us out greatly in keeping the risk of developing epicondylitis much lower. Plus, combined with some of the preventive measures we will cover in the next chapter, Post-Activity, we will be able to do even more towards negating the effects of repetition and force, and reducing the chance of an injury even further.

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Fixing Elbow Pain: Prevention Post-Activity Preventive Measures Taking Care of the Body After Activity

Manual Stretching By working hard in the gym, at work, and on the field, the muscles can tighten, possibly leading to inhibited range of motion and mobility. This can lead to reduced performance and injury. As a way to help the body recover from activity, it is a best practice to include a consistent stretching program.

Static stretching where the muscles are lengthened by manipulations from another part of the body or a tool should be done after activity, not before. This is because the muscles are being relaxed. Relaxed muscles do not produce force as efficiently as muscles that have been warmed up and stimulated, so save the static stretching for after activity is done, as a preventive measure, and use dynamic stretching to wake up the muscles and increase blood flow during your general and specific warm-up prior to activity.

Following are some of excellent stretches that can be done after you train, work, or play sports that can aggravate the elbow area. For best results, it is advisable to perform each stretch for 10 to 30 seconds and perform them each at least twice. This will take roughly 5 to 8 minutes at the most.

Remember, time spent stretching is not time lost or taken away from other activities. It is time invested toward the future high performance of the body.

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Straight Extensor Stretch

Pictured above is a basic extensor stretch. This is effective for stretching the majority of the muscles in the back of the forearm, especially those involved in extension of the fingers and wrist.

Angled Extensor Stretch

To emphasize one side or the other on the back of the forearm, you can angle the wrist during the stretch, as shown above.

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Straight Flexor Stretch

Pictured above is the Straight Flexor Stretch. This is great for stretching the flexors of the hand, wrist and forearm. If done correctly, you should be able to feel a stretch from the fingertips all the way to the elbow. If not, the angle of the lower arm can be shifted over the course of the stretch to hit the full length of the flexor side of the lower arm, in much the same way as with the Extensor Stretch.

The Flexor Stretch can also be done by manipulating the wrist angle to put emphasis on areas that might be tighter than others in the forearm.

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Thumb Stretch

The Thumb Stretch stretches the muscles of the thumb pad and the palm. The angle of the thumb can be changed over the course of the stretch to relax the muscles surrounding the joint.

Thumb & First Two Stretch

The Thumb and First Two stretch can be performed to further ease tension in the thumb as well as to help stretch the flexors of the wrist and hand. Begin by hooking the index and ring finger of the right hand over the index, ring finger, and thumb of the left hand. Gradually straighten the elbow. As you straighten the elbow, the stretch will reach up through the elbow toward the medial epicondyle, which is extremely important for warding off golfer's elbow. 48

Deviation Stretches

Wrist Deviation Stretches should also be used. Press the off hand against the thumb and index finger and push the wrist into ulnar deviation in order to stretch the radial deviators. Likewise, press the off hand against the pinky pad and manipulate the wrist into radial deviation to stretch the muscles involved in ulnar deviation.

Depending on your current levels of flexibility and range of motion in deviation, the amount of pressure and angle needed in order to feel this stretch can vary significantly, even between the same athlete’s hands, so ease into this movement to prevent over-stretching.

There you have several basic stretches with some slight variations that you can perform in order to improve or even regain flexibility in your lower arms. Again, stretching should take place immediately following the bouts of activity that cause your issues in order to be most effective. They can also be done throughout the day as needed, but if doing them when cold, use caution so as not to pull or strain a muscle or connective tissue when doing so.

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Torso to Hand Stretch With a wall or other sturdy object, you can perform a stretch that will get everything from your finger tips all the way up to you torso, especially your chest. Also if you turn your head away from the hand being stretched, you will feel it somewhat in the neck muscles as well.

This is an important stretch to perform because routinely when the hands and lower arms are holding tension from day-to-day activities, the biceps, shoulders and chest are too, because the entire system generally works together. Doing this stretch as part of your routine will help keep your performance at a high level, and keep you feeling better.

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At-Home Therapeutic Measures

Contrast Bathing Contrast Bathing is one of the cheapest recovery methods that are available to us. It involves alternating between submerging the hands and forearms in warm water and cold water. Contrast Bathing in the two temperature extremes is great for two reasons.

First, the warm water flushes the submerged area with blood. This is great for delivering new nutrients to the extremity that aid in rebuilding tissue. This portion of contrast bathing is also very effective as a warm-up for the tendons and ligaments that can be done prior to a workout, especially when first waking up in the morning or when heavy manual labor must be done early in the morning to prevent issues from developing.

Next, the cold portion of the Contrast Bathing is great for pulling the blood out of the area, which can get rid of some of the damaged tissues and metabolic waste that is locked in the hands and lower arms. Inflammation will be reduced as well.

Contrast bathing can be done for as short as a couple of minutes or up to 15 minutes or a half hour, depending the time available. The optimal place to perform Contrast Bathing is at a double bay sink, where you can draw the water easily for both extremes. If no double bay sink is available, a shower head can be used, changing the temperature every so often, or the water can be put into large pails and the arms can be submerged from there.

If the double bay sink or pails are used, here is the plan for effective contrast bathing. Fill one bay with water that is very warm – not hot enough to burn you, but fairly warm. If the tap water does not warm up well, then water can be heated with a kettle and then poured into the warm side of the Contrast Bath. (NOTE: Do not put your hands in boiling or scalding hot water)

The other bay should be filled with cold water, even putting ice into the mix. This creates a noticeable difference between the two sections of water.

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There are differing opinions about how long the hands and forearms should be submerged in the water, and which extreme should be started and ended with. What I like to do when Contrast Bathing is to put my hands in the hot side first and end there as well. I find that ending with a cold leaves my hands feeling crampish.

I also like to submerge my hands and forearms in each extreme for as long as I can take it. Remember, the water should not be so hot that it burns, but it should be rather warm. Also, the cold side should not be so cold that it frost bites your hands, but it should be intense. I go until it starts to hit me and then I switch. Each submersion usually lasts about 15 to 30 seconds.

I also like to keep my hands and wrists active while Contrast Bathing. By this, I mean I like to work my hands through circumduction under the water, and stretch out in the various directions. Another great tactic is to rotate a pair of light shots under the water, such as a pair of golf balls or billiard balls. This can be done on both ends of the bath. You’ll be surprised how much more blood is flushed into the area, and how much surface area contact is increased by at least fluttering the fingers and manipulating the wrists while submerged, as opposed to just being passive while under the water.

This is also a great opportunity to do some Self-Myofascial Release work on yourself if you have a specially made tool or you can simply just target the medial and lateral epicondyle with the knuckles and thumb of the opposite hand.

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Band Traction The soft tissues, muscles and bones in the lower arms are the structures that absorb forces when training. Subsequently, the bones and joints can become misaligned and therefore affect the blood flow and nerve impulses to these areas. Traction will allow the joints to realign, improve circulation and speed recovery.

In order to perform band traction, choke a band to a stable object such as a squat cage, door knob, or other non-moving structure. In the picture below, I am using the green bands from Jump Stretch. Other bands can be used of course. The most important detail is using stretch bands of some sort.

Next, make a loop for your hand. Wrap the end of the band over the body of the band and pull the portion of the body through the end loop.

Now you have a loop to hook your hand into.

Pass your hand through the loop so that the end of the band is contacting the base of the back of the hand.

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In the images above, I am using a Stick to show that the direction of the band is pulling straight away from the epicondyles. This way puts emphasis on this area. When the hand is pronated, force will be directed to the lateral epicondyle and when it is supinated, force is directed toward the medial epicondyle.

Now, you can perform rowing type movements with your arm and as you pull the band tighter, your hand and wrist will be tractioned. You can also move your hand through varying degrees of pronation and supination to modify the angle your hand is tractioned.

Generally, wherever the overlap of the band sits on the back of your hand is where the greatest deal of force will be translated into the hand. If you have pain somewhere in the back of the hand/wrist, place the knot in line with it to traction it and correct the alignment.

By playing around with the angle at which you pull on the band, you can also find ways to stimulate the elbow area, easily targeting the lateral and medial epicondyles of the elbow. If you have pain already set in, it may be the best option to use a very, very light band, in order to avoid aggravating the tendons of the elbow.

This technique was first shown to my by Dick Hartsell of Jump Stretch, and it has proven very useful for me over the years. This method can be used daily, if needed, or even on a weekly or bi-weekly basis.

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Self Myofascial Release Techniques Self Myofascial Release (SMR) is a very popular method these days for keeping the body and especially the soft tissues of the body healthy. SMR involves applying pressure to the soft tissues, especially the fascia, a casing that surrounds the musculature in the body.

When the fascia around the muscle becomes irritated, it can cause many issues, including decreased movement quality, restricted blood flow, and even adhesions, which are points along the fascia that have become immobile.

SMR is called Self-Myofascial Release because you are able to perform this type of treatment on yourself using another part of your body or a tool. You can also consult a therapist to have this type of work done.

There are many forms of SMR. Perhaps the most commonly used method is rolling the desired area of the body over a Foam Roller.

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Foam Rollers Foam Rollers work by applying high and prolonged tension on a specific area of the body, causing the release of tension in the fascia.

To use the Foam Roller, rest the forearm on the Foam Roller and apply pressure. This should cause some discomfort. Continue to press against the Foam Roller until discomfort is reduced by about half. This may take several minutes depending on the degree of rigidity within the soft tissues.

Next, continue to go around your body looking for sensitive areas and position yourself on the foam roller accordingly to reduce tension in those spots.

In order to get the desired relaxing result, sustained pressure should be applied. Simply rolling back and forth, as the name applies, will most likely not benefit you that much in a therapeutic sense. However, many have found that rolling back and forth like this on the Foam Roller can be good for promoting circulation and getting the area warmed up, prior to other activity.

Foam rolling can be done as often as everyday or even multiple times per day, or it can be used more sporadically as a part of a maintenance and monitoring part of your routine, as a way to take note of how your body is feeling, thus preventing the onset of epicondyle conditions.

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LaCrosse Ball / Tennis Ball / Baseball Sometimes, Foam Rollers are too large to get to smaller spots that need a more concentrated stimulation. For those times, Lacrosse Balls, Tennis Balls and Baseballs are good options because they can be used to direct the force of SMR in a more localized fashion.

Getting the most out of the SMR technique with these balls is often best accomplished by having the ball on a hard surface so that the ball presses harder into the tissue. Also, working with the ball up off the floor makes it easier and more comfortable on the rest of the body to apply the SMR, so a table or box (as shown below) will help you get more out of the time you put in.

As you can see above, the ball is positioned on top of a box and then I press my forearm down on the ball. I roll until I find someplace that is sensitive and then I wait until it relaxes and move on.

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DynaflexPro Sports SMR Ball

While using a LaCrosse or other ball for your SMR efforts works well, I have found a tool that in my opinion works much better, the Dynaflex Pro.

This tool has a spinning ball mounted on a stationary base. The base is held in one hand and the ball is pressed against the skin and moved around. The pressure of the ball moving up and down the length of the musculature is a great way to improve soft tissue quality. After using it, the skin reddens, flush with blood into the area. This tool feels great and can be used on any part of the body, not just the lower arms.

This ball can be taken anywhere. It can be in the car with you, at your work desk, in your gym or equipment bag - find out the times when you have time to do extra SMR stimulation with your massage ball and make sure it is with you for those times, even if it is in your locker at work and you can only use it for short bouts before shift and during breaks. This tool could be awesome for you.

On top of its natural mobility, the base on this massage ball makes it easier to work with than loose balls, LaCrosse balls or baseballs. You don't have to roll your forearm against a ball on a table or the floor and then chase it if it squirts away from you. With the Dynaflex ball, you just grip the base with the off hand and go to work on the targeted area - PERFECT.

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The Stick

The Stick works on the same concept as foam rollers and ball SMR, but is a bit more focused on movement than the other methods. The body of The Stick is pressed against a sore part of the body in order to loosen it up prior to exercise, or to break up adhesions in the fascia during or after activity.

The Stick is used by therapists in private therapy session, by medical and personal trainers, as well as at the professional strongman level. At a 2010 contest, I saw many of the top pro strongmen in the world getting Stick work on their lats by their assistants prior to the overhead press event. This practice helps loosen and lengthen the lat, which helps makes it easier to lock out the overhead press movement.

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Rolling Pin If The Stick is not in your price range, a regular Rolling Pin used for baking can help you get similar results.

The important trait about either The Stick or a Rolling Pin is that the outside surface rotates freely of the handle. In other words, the person pressing down and moving the Stick back and forth across the other person's body is holding and exerting force on the handles, while the body of the Rolling Pin or Stick continues to move smoothly without hanging up.

Both The Stick and Rolling Pins are generally applied by someone else. One person holds it and massages the other person. However, when using one of these implements to break up adhesions, the partner does not know where the build-ups or the pain is. In that case, the use of the implement is somewhat hit-and-miss.

For this reason, a better method is for the partner to hold on one handle of the tool and you hold another handle of the tool. Especially in the case of rubbing down the forearms, this is a valuable technique.

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The partner takes one handle and applies pressure into the belly of the forearm muscle as you apply force with the other handle while also directing the pressure into the spot of pain or adhesions.

Above, a partner holds one handle while I use the other one to direct the pressure into my forearm.

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Biofreeze Gel with Ball Applicator

Creams such as Ben Gay, Sportscreme, Flexall and other similar products are great for increasing circulation to an area of stiffness or pain. However, Biofreeze is my preferred sports gel for two reasons.

First, Biofreeze can be purchased in a bottle like the one shown above and can be applied and penetrated with the applicator ball. Thus, there is no need to get the gel on your hands and have a greasy residue.

Next, the applicator ball can serve the dual purpose of being used as an SMR massage ball. After applying some gel onto the sore area, the ball can be pressed very hard into the tissue, breaking up adhesions and improving tissue health. This may indeed be the best form of SMR, combining the relaxing feeling and improved circulation from the gel with the near pin-point accuracy of the applicator ball targeting the points in the soft tissue that need attention.

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Icing Ice applied to the body can be outstanding for reducing inflammation in the lower arms. Nowadays there are also Ice Packs and Wraps that are specially designed to be applied to the elbow and forearm, as well as other parts of the body such as the knees and shoulders.

While applying ice to the body can be very effective at reducing inflammation, there is some debate as to how long it should be used. It seems the general consensus is about 20 to 30 minutes of icing, but others do say that longer time periods are okay, while others say only 5 or 10 minutes is necessary.

There is also some debate as to whether ice helps or hurts the ability to recover. Some say that applying ice to an injured area can actually be counter-productive because it constricts the capillaries and essentially shuts down the healing process.

One way to use ice effectively I have found is to apply an ice wrap to my lower arm or elbow while I do other tasks that keep these body parts active and blood flowing to the area. One example is to fold a load of laundry while icing them. The low intensity movements of manipulating the laundry is light enough to not compound any discomfort in the lower arms and elbows and will not disturb an ice pack that is applied to the skin and wrapped to keep it there (ACE bandages work nicely).

It should be noted that ice should not be applied directly to the skin. This can lead to frost bite. Instead, a thin cloth or other piece of material should be wrapped around the ice pack, or placed between the skin and the ice.

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Cryocup

The above image came from the BannerTherapy.com website.

The Cryocup is a plastic tool that water is poured into and then frozen. Later, the athlete can hold the plastic handle of the Cryocup and massage the point of soreness on their body with the ice. This tool has often been used for soothing the pain of shin splints, but can also be used for forearm and hand pain as well. When applying ice to the skin it is important to remember that frostbite is possible, and so only short bouts of ice application should be used.

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Home Made Cryocup While the Cryocup is not extremely expensive, it can be easily replicated with simple household items. This is what you need to make your own Cryocup:

One Paper or Styrofoam cup Tap Water Freezer

Empty Paper Cup

Cup Filled with Ice

Take a paper or Styrofoam cup and fill it up with water. Place inside the freezer until the water is completely frozen.

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From there, begin tearing away the side of the cup, exposing a section of ice. Rub the ice onto the sore or swollen portion of the body. As the ice melts, more of the cup can be torn away.

If you have a history of inflammation-related pain in the lower arms, then this is probably a home remedy you should try. When you consider that the cup and water will cost you roughly 25 cents, it can be a cheap experiment to try. If you see and feel good results, you can then decide whether buying the heavier duty Cryocup is a good option, or if you prefer just sticking with the home made version.

The Cryocup can be used on a daily basis, or whenever it seems necessary. For instance, if you feel like you might have overdone it while working or training or after the first couple sessions of tennis, golf, or other activity following a long lay-off.

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Band Compression Therapy Rubber exercise bands can also be used for compression on musculature to improve soft tissue quality and circulation in the muscle as well.

This is a technique that very few people know about. It was taught to me by Dick Hartsell, the inventor of Flex Bands. For months I had pain in my left thumb that brought my hand strength down significantly and it wasn’t until I learned and began employing this technique that I started to see some relief, nearly 6 months after the original injury.

Take a flat exercise band and wrap it around the sore part of your hand or other part of your body. In this case, I am working on my thumb pad. Wrap it so that the band is tight enough it won’t slide off.

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Squeezing

Pressure with the Knuckles

After wrapping the area, begin squeezing the area or otherwise applying pressure with the offhand or by pressing it against a solid object.

Compressing the muscle with the band locks out blood from entering the area.

Further compressing it with the off-hand or blunt object begins to break down adhesions, improving the soft tissue quality.

Now, remove the band and allow fresh blood to enter the area. You should be able to feel the warmth of the new blood flowing in.

Do this several times per day over the course of several days until the pain subsides.

In order to get a more focused compression on the soft tissue that is harboring the stress, a small object like a ball of duct tape, marble, or soda bottle top can be put against the skin. Once I started doing this with the bottle top is when I started to see a difference in the way my thumb felt. After doing this just a few times over the course of a couple of weeks, the pain in my thumb was gone, after struggling with it for 6 months.

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This technique does not have to be reserved for the thumb. It can be done anywhere on the lower arms where there is build-up of tension and discomfort.

It is recommended to do this several times a day when there is an increase of discomfort and pain in the lower arms.

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Hot Tub / Whirl Pool Hot Tubs and Whirl Pools are great for increased circulation and massage of trouble spots on the body. Hot Tubs and Whirl Pools often have warm water in them, so overall body temperature and circulation throughout the body is thoroughly increased.

Whirl Pools have the additional benefit of their water jets. Placing the part of the body that is giving you trouble near the underwater jet feels great and makes even some of the most uncomfortable pains feel better for the short term.

The downside to a whirl pool or hot tub is that it can be difficult to get the pressure that is needed in order to trigger measurable benefit. Take note though that other recovery and prevention methods can be used in tandem with hot tubs and whirl pools, especially dexterity balls, gentle stretching and SMR techniques.

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TENS Unit

TENS (Transcutaneous Electrical Nerve Stimulation) Units, such as the one pictured above, run on AA batteries and send subtle charges through lines and into adhesive patches that are placed on the skin. The charges cause the muscles to flex, stimulating the soft tissue and bringing in new blood and nutrients.

This stimulation is important, especially if the area has reduced blood flow due to restrictive fascial conditions or because of swelling.

The dials on these devices can be adjusted to suit the athlete’s preference and pain tolerance, and the packs have become very reasonable in price. The one above was between $60 and $70 and comes with the stimulation machine, padded carrying case, and adhesive patches. It is very easy to use and can be worn when doing other activities such as eating a meal, watching television, or studying.

Research backing the effectiveness of TENS Units is limited, but I have used mine many times in the past and although it has not seemed to clear up my conditions 100%, I have often felt that the area seemed more relaxed following treatments. In addition, because it is a passive treatment (you literally just attach it, set it up and then just sit there) it is just one more way to get some attention on the injured area.

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Professional Therapeutic Measures There are many therapeutic measures that exist for treating conditions such as epicondylitis and other conditions of the lower arms. Listed below are some of those measures, many of which I have benefited from personally.

ART – Active Release Technique One form of massage that is gaining popularity is ART – Active Release Techniques. Developed by P. Michael Leahy, DC, CCSP, ART is a form of massage used to assess and correct problems with muscles, tendons, ligaments, fascia and nerves. Consistent treatments with an ARTcertified practitioner can improve strength and performance greatly. At the ART website, http://www.activerelease.com, athletes can find out more about how ART works and locate an ART provider near them.

Trigger Point Therapy Trigger Point Therapy is another form of massage that is used to improve soft tissue quality. The principle behind this therapy is that muscle fibers can develope small palpable knots that can cause reduced performance, pain referred to other parts of the body, and twitching. Practitioners assess pain reported by the patient and then find and treat the corresponding nodule, or Trigger Point, that is causing the referred pain.

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Myofascial Release Myofascial Release is a method for relaxing muscles, improving circulation, promoting venous and lymphatic drainage and exciting the stretch reflex of the overlying fascia.

Fascia is a covering which is found on most tissue in the body and when trauma is accumulated, the fascia can become restricted and cause pain, tension and reduced circulation to the area. The objective of Myofascial Release is to un-restrict the fascia using many techniques. Myofascial Release can be performed by a qualified masseuse using their hands or other tools.

Regarding Specialized Massage It is important to understand going in that the aforementioned styles of massage can be very uncomfortable. These styles of massage often require appreciable pressure to be put onto the muscles and other soft tissues of the body in order to cause the desired responses of more mobile tissue, improved circulation and other benefits. However, although the experience can be somewhat painful, these techniques are also very effective, and sometimes after just one or two sessions you can be well on your way to full recovery. This is how it has been for me on many occasions.

Chiropractic Occasionally, performance issues and pain come about due to misalignment of bones in the forearm and wrist. If this is the case, a chiropractor can help to realign everything. This could be as simple as one visit to their office. I have had excellent luck with chiropractic in the past, and encourage anyone to give this a try. If the root cause of the pain you are experiencing is misalignment, all of the massage in the world might not be able to correct it as well as the tactics a chiropractor can perform for you, so make sure to keep this option available, especially if you have insurance which covers chiropractic care.

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Fixing Elbow Pain: Prevention Pre-habilitation Preventive Measures Pre-habilitation Exercises In all the years I have been doing Strongman and Grip Sport competitions, my forearms have always felt the best when I have been proactive with them. In other words, since experiencing a few bouts of extreme epicondylitis when I first started out, I have tried to maintain a routine where I do certain exercises consistently in order to keep these flare-ups from coming back. This has helped me to prevent these conditions very well.

These specific exercises are so beneficial because they pre-habilitate the areas in three separate ways: (1) antagonistic balance between the flexors and extensors of the lower arms, (2) strength in rotation of the forearms, (3) increased blood flow and increased recuperative elements throughout the lower arms.

As you go through the layout of exercises, below each exercise will be an estimated volume and frequency for doing the movements. This is estimated and you are free to increase or decrease based on your individual needs and levels. The most important thing is to include these drills on a regular basis in order to keep your body strong.

The first section of movements will be based on maintaining antagonsitic balance.

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Maintaining Antagonistic Balance Antagonistic Balance (AB) refers to maintaining a balance of strength between the opposing muscle groups. AB is often completely overlooked, even by those who run the risk of suffering from epicondylitis the most.

In the case of the lower arms, wrists and hands, antagonistic balance most often refers to the strength balance between the muscles that shut the hands (flexors) and the muscles that open the hands (extensors). That is why in all my manuals and DVD's I put such a heavy emphasis on doing consistent extensor training. If Antagonistic Balance is not maintained in the lower arms and hands, it is not a matter of IF an injury will occur, it is a matter of WHEN it will occur. With that in mind, let's look at the exercises you can begin doing right away as a preventive method against developing medial and lateral epicondylitis.

Rubber Band Finger Extension A great way to work the extensors is with rubber bands. The kind I use are #84 Rubber Bands from Staples. They are about 3 inches long and 1/2 inch thick, but they are perfect for training the extensors of the fingers and warding off Tennis Elbow.

Finger extensions involve wrapping the rubber bands around the back of the thumbs and fingers and then opening the hand. These can be done quickly or slowly, and when using one rubber band, even individual fingers can be trained well. Also, you can carry rubber bands around in your pocket and do them just about anywhere. Incorporate a variety of efforts with the rubber bands, including multiple repetitions, holds for time, and even try to fully open the hand with many rubber bands on the fingers for the Max Effort type of approach.

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IronMind.com sells a set of thick rubber bands called “Expand Your Hand Bands.” This set includes several strength levels from very light to very tough. This variety of strength levels can be attained using the store-bought rubber bands by adding or taking away bands to and from the fingers. I perform basic extensions with rubber bands on a near daily basis and try to include them at the end of every training session. Vary the number of sets, repetitions and speed at which you do them for the best training results.

Suggested Frequency: As often as every day to every training session Suggested Volume: 1 sets of 20 to 50 repetitions (Extensor work is so important, my suggestion is to do this drill every day, even multiple times per day, and at least every day you train)

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Rubber Band Double Extension Remember that the muscles that extend the fingers also cross the wrist, and a muscle that crosses a joint will also affect that joint. With that in mind, we can perform a hybrid movement with the rubber bands by first extending the fingers against the bands and then also extending the wrist.

You can extend the fingers against the band and then extend the wrist for a hold for time or you can extend the fingers and then perform repetitions of wrist extensions. Holding the stretched band in finger AND wrist extension like shown in the picture above and to the right, is very intense for the extensor muscles and can be felt all the way up to the elbow. This is exactly what we are looking for when it comes to training for antagonistic balance in the lower arms. Suggested Frequency: As often as every day to every training session Suggested Volume: 1 sets of 20 to 50 repetitions (This drill can also be paired with other rubber band drills for a more demanding and varied lower arm workout)

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Rubber Band Extensions with Rotations

This movement involves isometrically contracting the finger extensor muscles while simultaneously performing rotational movements of the forearm. This stimulates a great deal of synergistic muscular activity in the forearm and helps to ensure we will not develop any weak points that could turn into injuries down the line.

When performing this movement, effort should be made to fully rotate the forearm in each direction for best training results. Suggested Frequency: As often as every day to every training session Suggested Volume: 1 sets of 20 to 50 repetitions (This drill can also be paired with other rubber band drills for a more demanding and varied lower arm workout)

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Extensor Bucket Lift Not truly a bucket, this lift involves filling a container with scrap steel, dirt, or sand. It can be any type of container with an opening that will allow you to lift it up by extending the fingers inside - a protein container, pretzel container or other similar jug will work fine. Next, place the hand inside the container so that the fingers and thumb are spread apart and wedged underneath the lip of the container. Initiate a strong engagement of the finger and wrist extensors and lift the container up off the floor.

The type of container is not the most important part of the equation with this lift. Instead, attention should be placed toward the size and orientation of the opening of the container. It must be wide enough to allow your hand inside, while being narrow enough that the fingers reach the opening and can lift the jar.

Be careful about what you put into the container for this lift. If there is anything sharp in there and you drop the container, the sharp point could bounce up and get you. For this reason, it is advisable to use some dull stones or something like dirt, sand or rice to prevent injury. Suggested Frequency: Bi-weekly to Monthly Suggested Volume: 3 sets of 3 to 5 repetitions per hand (Rubber band work can make up the majority of your extensor training, adding extensor lifts every so often for variety. Once every two to 4 weeks is more than fine)

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Theraband Extensions Therabands are another tool for training the extensors. What is great about performing extensions with this type of band is that the band can be adjusted to make the movement easier or harder by either loosening or tightening the band. Also, all the fingers can be worked all at once, or fingers can be hit individually. Finally, Therabands take up almost no room. They can be packed easily in any bag or a pocket and taken along on trips.

Thereband Finger Extensions

You can see above that the Theraband works the fingers very hard, especially at the ends of the fingers where rubber bands general fail to hit. Suggested Frequency: Bi-weekly to Monthly Suggested Volume: 3 sets of 10 to 12 repetitions per hand (Rubber band work can make up the majority of your extensor training, adding Theraband Extensions every so often for variety. Once every two to 4 weeks is more than fine)

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Sand / Rice Bucket Extensions An easy and cheap method to train the fingers in the reverse movement is Rice Bucket or Sand Bucket Extensions. Simply pour rice (or sand) into a bucket, dig the fingers down into it and open the hand. This will be a very interesting pump, but you will get a lot out of it in the way of injury prevention.

Some people do not enjoy getting sand under their nails and cuticles. In that case, gloves can be worn while doing this exercise. Also, the sand or rice bucket can be used when rehabbing injuries to the fingers, thumbs, and wrists. Just dip the injured part of the lower arm into the sand to isolate it.

Suggested Frequency: Weekly / Bi-Weekly Suggested Volume: 2 to 3 sets of 20 to 50 repetitions (Adding in some sand bucket extension work once a week/two weeks is great. A good spot is on a Friday or weekend. Sand bucket extensions can be paired with sand bucket digs, shown later on)

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Forearm Rotation Training One of the ways to keep the epicondyle region of the elbow injury free is to train rotation of the forearm, including the pronation and supination of the forearm, circumduction of the wrist, and hybrid movement patterns of the lower arm, known as N-Planar movements.

Forearm rotation training works the pronator and supinator muscles as well as the musculature and connective tissue that ties into the epicondyles.

This is a type of training that is often neglected and is thus a weakness for most people. Fortunately, this type of training is easy to perform and to implement using simple equipment, sometimes found around the house or garage.

Leverage Rotations Leverage Rotations involve taking a long implement and then moving the forearm through rotation (pronation / supination). For the tool, anything from a normal carpentry hammer, to a sledge hammer, length of pipe or a loadable dumbbell handle can be used. The most important thing is to make sure the implement is long enough to create some respectable leverage.

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To perform Leverage Rotations, grip the Sledge Hammer or other tool somewhere near the middle of the handle with the end sticking up, perpendicular to the floor. Next, under strict control, lower the heavier end of the implement downward under control, into pronation. Once you have reached the end-pint, you can then begin to move in the opposite direction until fully supinated. That is one repetition.

Like many others, this exercise is simple in nature but also very beneficial. The connective tissues near the forearm get trained, strengthened, and stimulated very well, even with light resistance. Do not think you need to use a great deal of weight with Leverage Rotations.

Take note that this exercise can be done in a seated, standing or leaning position, whichever is most comfortable for you. Bracing the forearm is a good decision if pain has already set in, but when the forearms are healthy, bracing is most likely not needed.

Suggested Frequency: Weekly Suggested Volume: 2 to 3 sets of 10 repetitions in both directions for healthy forearms. More sets of fewer repetitions when sensing pain. (Leverage rotations will make up the majority of your rotation work and should be done on a weekly basis. It can also be paired with extensor work or other leverage work for variety and a more thorough workout)

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Sand/Rice Bucket Digs Extensions are not the only movements one can perform in a sand or rice bucket to get the benefit of antagonistic balance. Because the rice or sand completely surrounds the fingers and thumbs, it can provide resistance to all angles, not just opening and closing the hands. For this reason, the sand or rice bucket can become extremely valuable for performing n-planar movements such as making circles, zigzag lines, tracing the numbers and alphabet, and other movements.

Sand/Rice Bucket Digs are a great way to strengthen the entire forearm. All you need to do is force your hand into the sand and then randomly move it about, or use the resistance of the sand to find specific movement patterns that stimulate the areas of the forearm where you have had pain in the past, and concentrate on those movements. For instance, I have found that if I dig my clenched fist into the sand and then extend my wrist and move my hand back and forth, I am able to hit the upper region of my forearm where I have had lateral epicondylitis. Continuing this small, concentrated movement pattern allows we to engorge the upper forearm with blood. Suggested Frequency: Every two weeks Suggested Volume: 3 sets of 30 second intervals per hand (Leverage Rotations will make up the majority of rotation work, but digs can be substituted for variety. They can also be paired with sand bucket extensions for a more thorough workout of the lower arms)

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Circumduction Training Circumduction combines all of the movement patterns and postures of the wrist and forearm: flexion, extension, radial deviation, ulnar deviation, pronation and supination. Circumductions can be done with a variety of implements in order to bring about many benefits and to change the emphasis of the drill.

Basic Circumductions Basic Circumductions are performed with smaller implements, where the hand can wrap around them and control them without having to contend with additional leverage. For example, Basic Circumductions can be performed while holding heavy balls or shots, and then moving the hand through a range of motion that targets the area you wish to work.

The movements can be random, where the hand just moves throughout a variety of plains. The movements can also be more planned. For instance, the trainee can hold onto the ball or shot and do Figure-8's (shown above), or write the alphabet in the air. Suggested Frequency: Once per month Suggested Volume: 3 sets of 30 second intervals per hand (Use occasionally to spice up rotation training. Remember, Leverage Rotations should make up the majority of rotation training)

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Leverage Circumductions Leverage Circumductions increase the difficulty of the movement somewhat because now, not only are you holding an implement, but you will also contend with leverage of the implement due to its length. More effort will be required in order to maintain command of the implement and control momentum during its path.

Some examples of Leverage Circumductions are shown below using a loadable leverage bar. Hammers or other leverage tools can be substituted.

Always with circumductions, the emphasis should be to keep tension on the muscles, control the speed, and limit momentum for the best results. Also, having the leverage implement at different heights and arm angles can change the emphasis and where you feel the movement the most throughout the forearm.

Suggested Frequency: Once per month Suggested Volume: 3 sets of 30 second intervals per hand (Use occasionally to spice up rotation training. Remember, Leverage Rotations should make up the majority of rotation training)

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Increasing Blood Flow and Recuperative Elements in the Lower Arms Blood flow and recuperative elements can be blocked from reaching the elbow area and forearms due to swelling in the area, tight, restricted fascia, and other reasons. With this in mind, we can keep these areas in the lower arms healthier by purposely increasing the circulation. We can do this by using the muscles in the areas under sustained light loads. The exercises in this section will promote this blood flow, thus bringing more reparative nutrients to help repair tissues after tough workouts, sporting sessions, and demanding manual labor.

EZ Bar Reverse Curls The EZ Bar was mentioned above in the equipment section as a piece that takes your grip out of pronation slightly to make it less traumatic to the forearm. Performing Reverse Curls with very light weight is also a way we can use the EZ Bar to our advantage to strengthen and prehabilitate that region of the forearm.

This is an exercise I perform on a weekly basis. When I do so my Tennis Elbow is non-existent. If I get complacent and do not do it, I know I am at risk for developing it. The heaviest I go on this is a 25-lb plate on each side, for a total of about 70 to 75-lbs. I make sure to perform the lift with impeccable form, as I have found it works best to target the upper forearm that way.

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If I start having issues in my elbow, I will actually drop the weight of the exercise down to a bare bar and perform very high-rep sets, sometimes up to 20 or 30 repetitions, making sure to eliminate all momentum and keep the focus there.

As a slight modification, when I go empty bar, I will sometimes move the elbows forward so that the upper arm is at about a 45-degree angle from the shoulder and perform the unloaded EZ Bar Reverse Curls that way, because it seems to put even more emphasis on the upper region of the forearm. Suggested Frequency: Weekly to Bi-weekly (pronated training) Suggested Volume: 3 sets of 8 to 10 (loaded); 2 sets of 20 to 30 (empty) (Incorporate on a regular basis for added attention to the upper forearm - bi-weekly should suffice)

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Shot Rotations Shot rotations are great for flushing the lower arm, hands, fingers, and thumbs with blood and speeding up recovery between training sessions or sporting outings. The heavier the shots, the more difficult the rotations will be.

Do not let this drill fool you into thinking that shot rotations are only good for the hands. Because the finger angle changes so much throughout the drill, the entire length of the flexors is worked, and you can feel it very nicely in the deep belly of the muscle just as well into the origin of the flexors, at the medial epicondyle.

It is important to find the right size and weight of shots for your individual characteristics. It will do no good to train with shots that are too large or too heavy because you won't be able to do anything with them. At the same time, if the shots are too light, or too small, there will be no challenge involved and you won't get as good of results.

For me, I prefer using large, heavy shots. My hands are pretty large, so small ones do not make me work as hard as larger ones. I also feel that my thumb gets stimulated more with the heavy shot, so I get more out of it, plus the weight really loads the full flexor muscles well.

The shots pictured above are steel demolition balls I received from a friend who works in demolition. These are rare, but they come in many different sizes. Of course if you can not get your hands on shots such as these, there are other options to explore, or you can just make your own.

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Chinese Health Balls can be picked up at novelty stores. They have an internal chime that rings and hums as you turn them in your hands. While they look and sound very cool, they are somewhat small and light, so they do not offer much resistance for shot rotations.

Billiard Balls and Golf Balls, are small in size and are easy to rotate in the hands. They are also very easy to attain, which makes them good options, but like the Chinese Health balls, they offer little resistance.

If you look around, you should be able to find "shots" that are the right weight to fit your current strength levels and the right size to match your hand size. If not, then you can make your own for about $5 (shown below).

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Suggested Frequency: Daily (shot rotation training) Suggested Volume: Done during downtime, in 15 to 30 second blocks) (Incorporate away from normal training as a way to flush the lower arms with blood and nutrients. Daily sessions can be short and mixed in throughout the day while doing other things, such as watching TV and riding to work)

How to Build Your Own Shots I feel shot rotations are so important for those susceptible to medial and lateral epicondylitis that I think everyone should have them. Here is a way for you to build your own shots for about $5.

This is what you will need:

Two Tennis Balls Industrial Knife $3.00 or $4.00 worth of pennies

Start out by cutting a slit in one of the tennis balls. This slit should be about 1.5 to two inches long.

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Next, begin sliding pennies into the slit. Do so until the ball fills up. I tried to keep track of how many pennies it took me to fill up the tennis balls, but I lost count…

Do the same with the other tennis ball and you have two home made hand health shots. Although they will not be as heavy as actual steel shots, you will see that the furry outer edge of the balls creates friction and makes them more challenging to spin around in your hands.

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To get the most out of your hand health shots, use them often and try to go both ways with each hand. Most people find that turning them one way in their hand is much easier than going the opposite direction, and the easier direction may change between hands.

When doing shot rotations, make sure all the fingers and the thumb are involved. The objective of shot rotations is control of the implements. Try to make the hands work to move and manage the shots, and avoid using body English to make the balls rotate and stay in the hand.

You

should do the rotations long enough to feel a good pump throughout your fingers, hands, wrists, and forearms.

For an additional challenge, you can also attempt rotating the balls with the hand pronated. Going against gravity this way makes you work much harder! 93

DynaFlex Power Ball Although the Dynaflex Power Ball was mentioned earlier as a means of specific warm-up for the lower arms, it can also be used as a way to periodically flush the lower arm and elbow area with blood.

The lateral and medial epicondyles can be targeted by strategically choosing the movement patterns you perform with the device. For instance, if you start with the hand in neutral and then extend the wrist, you can focus the stress on the origin of the extensor muscles. Slightly deviating the wrist toward the ulna can also sometimes heighten the emphasis on the lateral epicondyle.

Conversely, the medial epicondyle can also be targeted by flexing the wrist and moving through varying degrees of pronation and supination. Suggested Frequency: Daily to weekly or as needed, during downtime at home Suggested Volume: 1 sets of 60 seconds focusing on each epicondyle (both hands) (keep in a handy spot to use during downtime in order to promote better recovery between workouts)

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Band Hammer Curls Band Hammer Curls involve standing on one or two light Jump Stretch bands and then gripping the opposite end so that the forearm is neutral. Then curls can be performed for the desired rep range.

There are two distinct speed modifications that I use with this movement. If my emphasis is more to promote recovery from a hard workout, or if I had to do a bunch of manual labor, then I will work to do as many repetitions as possible with this movement and I will use a lot of momentum and focus on pumping the area full of blood.

If I am feeling any degree of discomfort, I will knock the rep count way down and stick with a much more strict technique. Suggested Frequency: Bi-Weekly to Monthly Suggested Volume: 2 to 3 sets of 20 to 50 (less strict); 3 sets of 8 to 10 (strict) (Mix in occasionally during arm workouts as a high forearm/elbow intense variation)

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Fixing Elbow Pain: Prevention Quick Reference Guide for Pre-hab Movements This section will serve to help you reference the suggested frequency and volume for each type of training

Maintaining Antagonistic Balance (Primary)

Rubber Band Finger Extension Suggested Frequency: As often as every day to every training session Suggested Volume: 1 sets of 20 to 50 repetitions (Extensor work is so important, my suggestion is to do this drill every day, even multiple times per day, and at least every day you train)

Rubber Band Double Extension Suggested Frequency: As often as every day to every training session Suggested Volume: 1 sets of 20 to 50 repetitions (This drill can also be paired with other rubber band drills for a more demanding and varied lower arm workout)

Rubber Band Extensions with Rotations Suggested Frequency: As often as every day to every training session Suggested Volume: 1 sets of 20 to 50 repetitions (This drill can also be paired with other rubber band drills for a more demanding and varied lower arm workout)

These three drills make up the Rubber Band Battery and can be done all together in succession. Volume can be modified in order to accomplish this.

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Maintaining Antagonistic Balance (Auxiliary)

Extensor Bucket Lift Suggested Frequency: Bi-weekly to Monthly Suggested Volume: 3 sets of 3 to 5 repetitions per hand (Rubber band work can make up the majority of your extensor training, adding extensor lifts every so often for variety. Once every two to 4 weeks is more than fine)

Theraband Extensions Suggested Frequency: Bi-weekly to Monthly Suggested Volume: 3 sets of 10 to 12 repetitions per hand (Rubber band work can make up the majority of your extensor training, adding Theraband Extensions every so often for variety. Once every two to 4 weeks is more than fine)

Sand / Rice Bucket Extensions Suggested Frequency: Weekly / Bi-Weekly Suggested Volume: 2 to 3 sets of 20 to 50 repetitions (Adding in some sand bucket extension work once a week/two weeks is great. A good spot is on a Friday or weekend. Sand bucket extensions can be paired with sand bucket digs, shown later on)

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Forearm Rotation Training (Primary)

Leverage Rotations Suggested Frequency: Weekly Suggested Volume: 2 to 3 sets of 10 repetitions in both directions for healthy forearms. More sets of fewer repetitions when sensing pain. (Leverage rotations will make up the majority of your rotation work and should be done on a weekly basis. It can also be paired with extensor work or other leverage work for variety and a more thorough workout)

Forearm Rotation Training (Auxiliary)

Sand/Rice Bucket Digs Suggested Frequency: Every two weeks Suggested Volume: 3 sets of 30 second intervals per hand (Leverage Rotations will make up the majority of rotation work, but digs can be substituted for variety. They can also be paired with sand bucket extensions for a more thorough workout of the lower arms)

Basic Circumductions (Shots or other implement) Suggested Frequency: Once per month Suggested Volume: 3 sets of 30 second intervals per hand (Use occasionally to spice up rotation training. Remember, Leverage Rotations should make up the majority of rotation training)

Leverage Circumductions Suggested Frequency: Once per month Suggested Volume: 3 sets of 30 second intervals per hand (Use occasionally to spice up rotation training. Remember, Leverage Rotations should make up the majority of rotation training)

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Increasing Blood Flow and Recuperative Elements in the Lower Arms (Primary)

EZ Bar Reverse Curls Suggested Frequency: Weekly to Bi-weekly (pronation training) Suggested Volume: 3 sets of 8 to 10 (loaded); 2 sets of 20 to 30 (empty) (Incorporate on a regular basis for added attention to the upper forearm - bi-weekly should suffice)

Shot Rotations Suggested Frequency: Daily (supination training) Suggested Volume: Done during downtime, in 15 to 30 second blocks) (Incorporate away from normal training as a way to flush the lower arms with blood and nutrients. Daily sessions can be short and mixed in throughout the day while doing other things, such as watching TV and riding to work)

Increasing Blood Flow and Recuperative Elements in the Lower Arms (Auxiliary)

DynaFlex Power Ball Suggested Frequency: Daily to weekly or as needed, during downtime at home Suggested Volume: 1 sets of 60 seconds focusing on each epicondyle (both hands) (keep in a handy spot to use during downtime in order to promote better recovery between workouts)

Band Hammer Curls Suggested Frequency: Bi-Weekly to Monthly Suggested Volume: 2 to 3 sets of 20 to 50 (less strict); 3 sets of 8 to 10 (strict) (Mix in occasionally during arm workouts as a high forearm/elbow intense variation)

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Fixing Elbow Pain: Prevention About the Author Jedd Johnson played Basketball and Baseball at Towanda High School in Pennsylvania. Later, he played Division 2 baseball for two years at Mansfield University of Pennsylvania, before taking on strength training as his main interest. In 1999, Jedd and Jim Smith, ‘Smitty,’ formed the Diesel Crew and began formulating the Diesel Method, a strength and conditioning system involving the incorporation of various training disciplines. Now, the Diesel Crew is recognized as the Leaders in Grip Strength. Jedd has Certified Strength and Conditioning Specialist credentials through the National Strength and Conditioning Association, and is a regular speaker/presenter at the Pennsylvania State Strength and Conditioning Clinic. Jedd has been featured at Zach Even-Esh’s Underground Strength Clinic. Jedd regularly competes in Grip contests throughout the United States and is active behind the scenes of the annual Hand Strength Season, assisting in setting up the qualification system, qualifying contests, and the National Hand Strength Championship, the Global Grip Challenge. Jedd’s training focuses includes a variety of disciplines, including strongman, grip strength, speed bag striking, kettlebells, powerlifting, and more.

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Fixing Elbow Pain: Prevention Additional Products from Jedd Johnson Braced Bending (Jedd Johnson & Mike Rinderle) - This DVD will show you how to destroy EVERYTHING in your path. From frying pans, to steel bars, to horseshoes, and wrenches, Jedd and Mike team up once again to bring you everything you need to know on how to do odd object bending like a champion. It's fun to destroy things around the house - start today. http://www.thegripauthority.com/braced-bending-dvd.htm

Call to Arms (Jedd Johnson & Joe Meglio) - In this ebook, Jedd and Joe show you how to go beyond BroScience and hand-me-down knowledge that is so rampant in fitness centers, high school gyms, and other places the iron is tossed around, and take your Arm Training to the next level. It's time to not only go for mass, but for some serious strength as well. http://megliofitness.com/call-to-arms/

Card Tearing eBook (Jedd Johnson) – The Card Tearing eBook is loaded with techniques you can use to build the hand strength to start doing serious damage to a deck of cards. With the extensive exercise index, designed to build strength in all the components needed for card tearing (strong wrists, fingers and thumbs), in no time flat you’ll be ripping stuff up! http://www.cardtearing.com

CRUSH: Total Gripper Domination (Jedd Johnson) - This product explores every aspect of Gripper Training you need to know in order to improve your crushing grip strength and even certify in the major gripper certifications. Be amongst the best in the world once you watch this awesome video. Normally an on-line DVD, but you can also upgrade to the hard copy as well. http://www.thegripauthority.com/gripper-dvd/crush-dvd2.htm

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Deceleration Training to Prevent ACL Tears (Jedd Johnson & Jerry Shreck) - One of the most common season-shortening and career-ending injuries in the morning is preventable - the ACL Tear. In this DVD, you will learn the time-tested protocol Jerry Shreck conducts with his athletes at Bucknell University that has helped drive his ACL injuries down and keep them down for over 8 years. http://dieselcrew.com/ACL/deceleration-training.htm

Fixing Elbow Pain (Jedd Johnson & Rick Kaselj) - For people who train hard in the gym like us, one of the most common injuries that sets back out training is elbow pain: tendonitis, tennis elbow, golfer's elbow, epicondylitis - call it what you will. But one thing is for certain, once you get it, it can be tough to get rid of it. With this product you will learn how to rehab your elbow pain to get back to pushing the big numbers in the gym, and you'll learn how to keep it from coming back. http://www.fixingelbowpain.com

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Home Made Strength II: Grip Strength Edition (Jedd Johnson) - It's time to build up your grip strength so you can start benefiting from having a set of strong hands, wrists and forearms. All you need to do is add some equipment to your arsenal, and I will show you how to do it on the cheap. Get ready to develop a world class grip strength and build fun and rewarding grip tools that will last you for years. http://www.homemadestrength.com/homemadegrip.htm

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How to Make Atlas Stones with Slater Stone Molds (Jedd Johnson & Steve Slater) - Let Steve Slater, the man who has made more atlas stones than anyone else walking the Earth, show you exactly how the process is done. He will show you live all the ingredients you need for stone making, plus give you all of the hints and tips he has developed all of the years for making top quality atlas stones that you can be proud of in your training. http://dieselcrew.com/how-tomake-atlas-stones.htm

Introduction to Strongman Training (Jedd Johnson & Steve Slater) - Learn the basic techniques of some of the most common and beneficial events in the sport of strongman. With this DVD, you can be confident you are being taught proper form and mechanics by two great strongman teachers, Jedd Johnson and Steve Slater, two men with over 20 years of Strongman Experience between them. http://www.dieselcrew.com/strongman-training.html

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PUSH and CRUSH (Jedd Johnson) - Discover the new wave of Gripper Training - pairing your gripper work with multi-joint movements for insane gains in crushing strength. http://thegripauthority.com/push-and-crush.htm

Road to the Record DVD (Jedd Johnson) – This Documentary shows you the exact Pinch Training I did from October to December of 2009 when I broke the record in the Two Hands Pinch. http://www.dieselcrew.com/road_to_the_record

Stone Lifting Fundamentals DVD (Jedd Johnson) – This DVD covers everything you need to know to safely add stone lifting to your training repertoire. Designed to benefit strongman competitors, strength coaches, and strength enthusiasts, we cover the basics of stone lifting as well as advanced stone training techniques. http://www.dieselcrew.com/stone-training/

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Ultimate Sled Dragging Manual (Jedd Johnson) – Sled dragging is a very beneficial type of training for athletes because of its potential to develop strength, power, speed, and to support restoration. Within this manual, we define dozens of sled dragging exercises which will bring a variety to your sled dragging that you never thought was possible. http://www.dieselcrew.com/dieselsled.htm

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