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Elbow Injuries Part 1

    Thu, 2008-03-06 18:14 — Dr. John H. Park

    Anyone who’s watched the UFC or other mixed martial arts events is familiar with an armbar, and every single one of us who’s trained in MMA has undoubtedly been caught in one.

    Anyone who’s watched the UFC or other mixed martial arts events is familiar with an armbar, and every single one of us who’s trained in MMA has undoubtedly been caught in one. The armbar is one of the first submissions jiu jitsu students learn, and it is the basis of many submission attempts in BJJ and MMA. We know how to put our opponents in an armbar, but what exactly happens when we make our opponents tap? Though injuries to the tendons and cartilage in the elbow are most common, we can’t forget what happens to the ligaments and bones in the elbow as well.

    In Part 1, we’ll take a look at the soft tissue injuries that occur in the elbow. In order to appreciate what happens to the elbow in a properly executed armbar, we first need to understand basic elbow anatomy. The elbow is primarily a hinge joint that is composed of three bones – the humerus (upper arm bone), the ulna (the bone on the pinky side of forearm), and radius (the bone on the thumb side of forearm). The elbow normally flexes from 140° to 150°, extends from 0° to 10°, and rotates (pronates and supinates) the forearm in both directions about 90°. Ligaments known as the ulnar collateral and radial collateral ligaments stabilize the elbow joint on opposite sides to prevent the elbow from bending too far inwards or outwards. These two ligaments are fan shaped structures that combine together to form a capsule which surrounds the elbow joint and keeps synovial fluids that lubricate the joint where they need to be. There is also an annular ligament that wraps around the head of the radius to keep it in place next to the ulna. The biceps tendon attaches on the front of the radius and allows us to flex our elbows (i.e. to resist an armbar attempt), while the triceps tendon attaches on the ulna behind the elbow.

    If an armbar is held for too long, or if we are determined not to tap, the joint capsule and collateral ligaments are the first structures in the elbow to get damaged. The elbow can hyper-extend up to 15° in some people (more so in women and adolescents) before some kind of structural damage occurs. Since the joint capsule is made of connective tissue that has little elastic properties, it will tear if enough force is applied. Over time, repetitive strain on the joint capsule and ligaments can cause pain and laxity in the elbow joint. As the joint capsule and ligaments are stretched beyond their normal limits, part of the ulna known as the olecranon compresses into the back of the humerus called the olecranon fossa. This direct pressure from bone on bone contact can be very painful and is usually what makes us tap before more damage occurs.

    Repetitive stress in the forearms from heavy training can also lead to what is known as medial and lateral epicondylitis (more commonly referred to as “golfer’s elbow” and “tennis elbow”). The pain is typically described as a generalized ache that gets sharp with activities that require gripping as when performing a cross collar choke in BJJ. The repetitive stress from practicing Muay Thai elbow strikes on hard focus mitts can also lead to a condition known as bursitis. The bursae are fluid filled sacs found between tendons and bones that lubricate the joints and allows for smooth movements. Bursitis in the elbow is easily recognizable by the swelling at the tip of the elbow that can get to about the size of an egg.

    Treatment for tendinitis, bursitis, and minor sprains of the ligaments in the elbow involves rest, ice, and anti-inflammatory medication. Chronic cases are generally more difficult to manage so early treatment is always recommended. Tough cases of tendinitis and other soft tissue injuries in the elbow can be effectively managed with physiotherapy modalities like ultrasound and electrical stimulation. We always combine stretching and strengthening exercises along with manual therapies including massage and ART (www.activerelease.com) as the part of treatment. If conservative measures don’t work we’ll often try bracing to reduce the stress on the injured tissues. When all else fails we sometimes recommend cortisone injections, but it is important to remember that cortisone injections usually only offer temporary relief at best. Some type of activity modification and physical therapy is necessary for the longest lasting results. For more information on elbow injuries in mixed martial arts, you can reach Dr. Park at the address below

    Contact info:
    Dr. John H. Park, D.C., C.S.C.S.
    Progressive Spinal & Sports Rehab
    10076 Darnestown Road
    Suite 200
    Rockville, MD 20850
    www.ProSpineRehab.com
    www.yourMMAdoctor.com
    Phone: (301) 294-5101

    Dr. Park is a chiropractor specializing in sports medicine and orthopedics. He has studied martial arts for over 10 years including karate, tae kwon do, Muay Thai boxing, and Brazilian jiu jitsu. Dr. Park holds a black belt in tae kwon do and is a BJJ blue belt under Mike Moses/Lloyd Irvin (www.evolveacademy.com).

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