Elbow Pain in Crossfit Athletes
While tennis and golf are not involved in Crossfit, pain on the inside or outside of the elbow are common in Crossfit athletes. Elbow pain on the inside portion of the elbow is commonly called golfer's elbow (medial epicondylitis) while elbow pain on the outside of the elbow is called tennis elbow (lateral epicondylitis).
Cause of Medial & Lateral Epicondylitis in crossfit
Medial and lateral epicondylitis are overload conditions of the elbow. Due to all of the gripping involved with weight lifting, the muscles of the forearm can become irritated and lead to elbow pain. Even though most lifts emphasize the primary movers (cleans = quads, glutes, and traps, deadlifts = hamstrings and glutes), the muscles of the forearm still have to hold the weights.
This overload causes a tendinopathy of either the wrist flexors (medial epicondylitis) or wrist extensors (lateral epicondylitis). Although the term epicondylitis refers to inflammation, this can be misleading because inflammation is not the primary driver of epicondylitis. The overload of the wrist flexor and extensor tendons causes the tendons to swell to reduce the load on the tendon fibers. It is the continued overload of the tendons that causes epicondylitis, not inflammation. This is why the terminology to describe this condition has changed to epicondylopathy instead.
Treating Medial & Lateral Epicondylitis
Initially reducing the load on the muscles of the forearm is a priority. With continued overloading of the wrist flexor and extensor tendons, there will be continued swelling and separation of the tendon fibers leading to pain and a weaker tendon structure. This doesn't mean that you have to stop working out, but some modifications may be necessary to avoid gripping during the workouts.
Soft tissue therapy is a beneficial treatment for pain relief. Soft tissue therapy can either be performed by hand or by instrument, such as Graston. Since pain and touch converge on the same nerve fiber, stimulating touch through soft tissue therapy helps to reduce pain.
Isometric contractions, muscle contractions without moving the joint, have also been shown to have a pain relieving effect on tendon conditions. These contractions are usually held for 30-45 seconds and can be performed multiple times per day to manage the pain. Holding these isometric contractions while performing Graston have been particularly useful in decreasing elbow pain.
As the pain of medial and lateral epicondylitis decreases, progressive loading to strengthen the wrist flexors and extensors is important for safely returning to Crossfit. If the muscles and tendons aren't strengthened as part of rehab, they will become overloaded again creating a recurring injury. Slow and heavy wrist curls can be used to strengthen the muscles and tendons, eventually progressing towards faster movements.