Epicondylitis

The next time you watch Randy Johnson throw high heat, or witness Kobe Bryant stop short, pump-fake and seal the deal from way downtown, give an extra cheer for their elbows. That's right, those overlooked joints that help us pitch, drive, serve, eat and toss back a few cold ones.

And where would biceps curls or the Kama Sutra be without them?

"The elbow is a complex intersection of three bones--the humerus in the upper arm and the ulna and radius of the forearm--that enables extension, flexion and rotation and facilitates the function of the hands," says Gary Brazina, M.D., an orthopedic surgeon in Los Angeles. "The muscles and tendons of the forearm, which insert at the elbow, serve to stabilize the wrist, and when they become inflamed through overuse, repetitive motion or poor form you get pain and limited range of motion."

Dislocated elbows are among the most common adult injuries, second only to dislocated shoulders, according to the American Academy of Orthopaedic Surgeons. Who hasn't broken an impending fall with an outstretched hand, which can jar the bones of the elbow out of place? And despite the misnomer of "funny bone," that teeth-gritting, tingling pain you get when you whack your elbow in just the right way is actually the unamusing ulnar nerve that's screaming for attention. As for long-lasting pain directly on the back of the elbow joint, that may be an indication of bursitis.

But most ordinary elbow problems stem from overuse. Two of the best-known and most-suffered ailments are lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer's elbow). The tennis type occurs when the extensor muscles in the forearm become inflamed on the outside of the elbow. Similarly, duffers often find that the muscles and tendons that flex their fingers and wrists become aggravated on the inner side of the elbow.

Don't think you can switch to volleyball and be safe. Any sport or activity that requires a strong grip, repeated or forceful movements, a clenched fist, or turning and twisting movements of the forearm muscles can be the culprit, whether you're lifting weights or painting the house.

"It's a lot about technique," explains Brazina. "Elbow injuries are often the result of poor form or repetitive bad habits, like grounding your golf swing or incorrectly twisting your wrists at the end of a triceps pull-down."

It's far better to protect your elbows than to rehab them. "Invest more in lessons or trainers," Brazina says, "and less in doctors."

Your elbows are especially vulnerable if you try to do too much when starting an exercise program, or if you accelerate the intensity of an existing routine too quickly. One of the most important rules of training is to give your body adequate time to recover between each workout. To avoid becoming a statistic:

* When lifting heavy objects, keep your palms facing your body.

* Listen to your body. If you feel a twinge or tweak as you hit your 50th drive of the day, back off. Mix up your strokes, practice putting of work on your short game. If you're at the gym, put the barbell down and head for the leg machines.

* Do you still believe in "no pain, no gain"? You shouldn't.

* Adhere to the "10-percent rule": Increase your training, weights or mileage by no more than one-tenth per week to give your body adequate time to compensate.

* Warm up properly. Pay particular attention to your game muscles. If you're not warm, you'll feel it in your first serve or tee shot. Stretching after you exercise is just as important.

* One size doesn't fit all when it comes to equipment. Play with the right racket or clubs. Ask questions of your coach, trainer or course pro, and try out various models before you make a financial or physical investment.

* Avoid the fate of the weekend warrior trying to recapture his glory days. Maintain a solid, consistent conditioning program year-round.

In the acute stages of an elbow injury, health care workers advise RICE: rest, ice, compression and elevation. For more serious injuries, such as a fractured or dislocated elbow, immobilize the area and go to the doctor or emergency room immediately for treatment. This may include relocation of the bones, X-rays, splinting the elbow or, in rare occasions, surgical procedures.

Once you've got the initial injury under control, evaluate your form with your coach or trainer to determine if your technique needs an overhaul. Assess your biomechanical factors as well: Body alignment, pronation or supination of your feet, or even old injuries that were never properly rehabilitated can be weak links that should be addressed by a professional.

WORK YOUR ELBOWS

Exercises to strengthen your forearms can be helpful, both to promote recovery and to prevent future problems. As you do the following exercises, pay attention to your form and the position of your wrists. Do three sets of each exercise, working up to 20 reps or muscle exhaustion. If you're injured, start with light weights (two or three pounds), and increase as your strength improves.

1. STANDING ARM CURL Stand holding a dumbbell at your side with your palm facing forward (1a). Bend the elbow and lift the weight to your shoulder (1b). Slowly lower to the starting position. Keep your wrist straight.

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2. REVERSE ARM CURL Stand holding a dumbbell at your side with your palm facing backward (2a). Bend the elbow and lift the weight to your shoulder (2b). Slowly lower to the starting position. Again, keep your wrist straight.

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3. WRIST CURL Stand holding a dumbbell at your side with your palm facing forward (3a). Flex your wrist forward (3b) and back to the starting position.

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4. REVERSE WRIST CURL Stand holding a dumbbell at your side with your palm facing backward (4a). Flex your wrist up as far as it will go (4b) and return to the starting position.

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5. ELBOW STRETCH #1 Extend your left arm straight out and parallel to the floor, with the elbow locked and your palm facing down. With your right hand, pull the fingers on your left hand down toward the floor, bending your wrist. (The arm doesn't move.) Hold for 15 to 20 seconds. Switch arms.

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6. ELBOW STRETCH #2 Extend your left arm straight out and parallel to the floor, with the elbow locked and your palm facing up. With your right hand, pull your left hand back and the fingers toward the floor. Hold for 15 to 20 seconds. Switch arms.

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