Wednesday, February 10, 2016

Marimba Body: Elbows

We may not be tennis players, but percussionists are no strangers to tennis elbow, one of their most common injuries. For most, pain in the elbow will occur in the less dominant arm, simply because the muscle strength (in some variation) is absent.  As with other joints, by examining the literal musculoskeletal structure of the arm in conjunction with our experience of it, we can apply new awareness to how to move, hopefully preventing or healing injury.


Joint Definition - in bone

The elbow is a hinge joint, articulated by the humerus and ulna, as visible in the drawing below.  The humerus is the bone of the upper arm; the ulna is one of two bones of the forearm. The radius is involved in the joint, but functions more as an anchor point for muscle and pivot point for the forearm rather than part of the hinge of the joint. You can examine your own movement to see that no matter if the elbow is bent or extended, the forearm can rotate - this is because the radius is not "locked" into being part of the hinge.  

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Though the picture above is only a drawing, it does accurately show that the elbow joint does not reside at what we observe as the bend in our arm (the inside of the "L" shape above), nor does it reside in the opposite corner (the outside of the "L").  You can probably feel part of the ulna (the olecranon process) through your skin at the very bottom of your upper arm, but if you look closely, you can see that the hinge is actually above that.
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Imagine: if the joint was at the bottom of the ulna rather than a little above it, the elbow would have more than 180 degrees of motion.  You could reach for something behind you without moving your upper arm at all!

Just as a door hinge has two exterior points that mark the location of the hinge movement, so the arm has two bony protuberances, known as the medial and lateral epicondyles, that mark the elbow's movement.  You can feel these easily by reaching across your torso and wrapping your hand around your elbow: your thumb will be on the medial epicondyle, and your fingertips on the lateral epicondyle.

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The hinge of the elbow occurs between the epicondyles, where the ulna meets the humerus.


Joint Definition - in muscle and tendon

The drawing below shows a right arm.  Notice the biceps tendon is long and thin, reaching all the way across the elbow hinge to the radial head.  You can also see the anterior band of the ulnar collateral ligament which connects the medial epicondyle of the humerus over and in to the radius.

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An extra tid-bit: the yellow line represents the ulnar nerve, aka what gets momentarily squished when you hit your "funny bone."

Here's another layer of muscle over the ulnar collateral ligament. Almost all of the muscles in the forearm connect via tendons to the medial epicondyle.

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Those that don't connect to the lateral epicondyle.

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Check out how many different muscles join at those two points.  If any of them aren't used properly, or are pushed past their ability, we'll experience pain at the elbow, even if the actual problem is somewhere else in the arm.


Injury Definitions


source   If this diagram wasn't so helpful, I'd delete it due to misspelling. 

Tendonitis of the elbow is typically related to sports due to the repetitive movements required to practice.  We know that our situation is the same, considering our arms can never catch a break between practicing all of our instruments, writing, and typing.  Though there is much to be said about tendonitis resulting from overuse, just as many painful cases must originate through misuse, as I've learned through my own observation.

My personal experience is that as I focus on keeping my shoulders dropped and supported by the lats, my elbow doesn't hurt. Which means that the tendons are not getting overworked, which is the whole goal. 

All of this goes to say that pain in the elbow doesn't mean you're a wimp or that you "dont' have what it takes," but it is your body screaming at you to figure out how to use it.  Perhaps your tendency was/is like mine: to raise a shoulder slightly, throwing off the joint's function. Or, maybe your tendency is totally different. 

Either way, when the body is in pain it's telling us to learn how and where movement happens. That, and to build muscle so that we are capable of far more than we would ever need.

2 comments:

  1. Wow! I am glad I came across this post. I have been suffering from some pain like this.

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  2. Thanks for reading, Zach! I have to remind myself every day about my shoulders and elbows - it's all improving, so I hope yours does, too!

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