The Official eNewsletter of TODAY! Fitness

vol. 2009 issue 9



Elbow Pain

I wanted to dedicate some time in this newsletter to address a very common injury that I have received a number of questions about recently... elbow pain.  Over the years, I've had a few bouts of elbow pain myself, and it is often helpful to have an understanding of what is actually going on.  Of course, there are a variety of things that could cause elbow pain, ranging from direct impact, to more indirect causes.  What I would like to focus on in this article are the repetitive use injuries to the elbow joint that can often occur as a result of weightlifting or sports.

The inflammation around the elbow joint (epicondyle) who's symptoms include localized soreness and tenderness is referred to Epicondylitis.  There are two common types, lateral epicondylitis and medial epicondylitis.  Lateral epicondylitis is commonly referred to as tennis elbow, whereas medial epicondylitis is also known as golfer's elbow.

Tennis elbow

Lateral epicondylitis, also referred to as "tennis elbow," is a very common cause of elbow pain. It is considered a cumulative trauma injury that occurs over time from repeated use of the muscles of the arm and forearm, leading to small tears of the tendons (Tendonitis).  It is a condition that is commonly associated with playing tennis and other racquet sports, though the injury can happen to almost anybody.

In racket sports, overuse of the forearm muscles and repeated impact can increase the risk of tennis elbow developing. Other factors that may contribute to tennis elbow include lack of strength, poor technique, and more duration or intensity of play. Sometimes the pain and inflammation of the tendon is caused by a direct injury or impact. Occasionally, the muscles may partially tear.

The strongest risk factor for lateral epicondylosis is age. The peak incidence is between 30 to 60 years of age. No difference in incidence between men and women or association between tennis elbow and the dominant hand has been demonstrated.


  • Pain about 1-2 cm down from bony area at the outside of the elbow (lateral epicondyle)
  • Activities that use the muscles that extend the wrist (e.g. pouring a pitcher or gallon of milk, lifting with the palm down) are characteristically painful.
  • Pain on the outside of the elbow when the hand is bent back (extended) at the wrist against resistance.
  • Pain on the outside of the elbow when trying to straighten the fingers against resistance.
  • Pain when pressing (palpating) just below the lateral epicondyle on the outside of the elbow..
  • Gripping and movements of the wrist hurt, especially wrist extension and lifting movements.
  • Lifting or grasping objects may be difficult. Some people have pain that radiates down the arm.


Rest is the treatment of choice when the pain first appears; the rest allows the tiny tears in the tendon attachment to heal. Athletes treat more serious cases with ice, anti-inflammatory drugs (ibuprofen or aspirin), soft tissue massage, stretching exercises, ultrasound therapy, and cortisone injections.  Sometimes a counter-force brace or "tennis elbow strap" is used to reduce strain at the elbow epicondyle and to limit pain provocation as well as to protect against further damage.

There are several recommendations regarding prevention, treatment, and avoidance of recurrence that are largely speculative including:

  1. Stretches and progressive strengthening exercises to prevent re-irritation of the tendon.
  2. Progressive strengthening involving use of weights or elastic theraband to increase pain free grip strength and forearm strength.
  3. Racquet sport players also are commonly advised to strengthen their shoulder rotator cuff, scapulothoracic and abdominal muscles by Physiotherapists to help reduce any overcompensation in the wrist extensors during gross shoulder and arm movements.
  4. Soft Tissue Release or simply Massage can help reduce the muscular tightness and reduce the tension on the tendons.
  5. Strapping of the forearm can help realign the muscle fibers and redistribute the load.
  6. Use of a racket designed to dampen the effect of ball striking.
Golfer's elbow

Medial epicondylitis, is an inflammatory condition of the elbow which is cumulative trauma injury similar to tennis elbow. The condition is called Golfer's elbow because in making a golf swing this tendon is stressed; many people, however, who develop the condition have never handled a golf club. 

It is thought that over time, repeated use of the muscles of the arm and forearm may lead to small tears in the tendons. The muscles that are used to pull the hand down (wrist flexors) are located on the palm side of the forearm. These muscles attach to the common flexor tendon, which attaches to the medial epicondyle (on the inside of the elbow). When the wrist flexors are overused (or sometimes for no obvious reason at all) the common flexor tendon becomes inflammed and painful. 

Pain at the medial epicondyle (inside of elbow) is a classic symptom of medial epicondylitits. The pain may increases when flexing the wrist, and may radiate down the forearm. Activities that use the flexor muscles in a bending motion or grasping with the hand can increase the symptoms.


Discontinuing activities that cause the pain is the first step to proper treatment of medial epicondylitis. As with tennis elbow; ice, anti-inflammatory drugs, soft tissue massage, stretching exercises, ultrasound therapy, and cortisone injections are used.  Icing the elbow for 10-15 minutes at a time will decrease the inflammation and swelling and relieve pain. Wrapping the forearm near the elbow may help protect the injured muscles as they are healing.

A physical therapist may use ultrasound or other modalities to help heal the damage of an injury. Additionally, they may prescribe flexibility and strengthening exercises to allow you to return to the activity. In some cases, a wrist splint or brace may be recommended.

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Try This

I've been thinking about adding this column to my newsletter for a few months now.  Basically a "homework" section with some quick ideas of what you can try this month to better your health and fitness.

My first tip is regarding cardio.  If you've been good about getting your 30-45 minutes per session, 3-5 times per week on the treadmill, elliptical, or bike... then try this.  Keep a nice "cruising" pace for a minute, then go all out for 30 seconds, go back down to cruising pace for a minute, then back to high intensity for 30 seconds.  Continue this 2:1 ratio of low intensity to high intensity for as much of your workout as possible.  Interval training has been proven to be the best form of cardio that you can do to lose fat and increase cardiorespiratory performance.  Don't overdo it to a point that you feel dizzy, but challenge yourself during the high interval and recover during the low.  Give it a shot and let me know how you do!  Good luck : )

Elite Bodyweight Exercise of the Month!

Elbow Walking

Elbow walking may look funny, but you will find that it can challenge both your core and chest when incorporated into a push-up circuit.  If you cruise around YouTube, there are clips like a pushup pyramid with 10 reps of elbow walking between each bout of pushups.  This is obviously not something that you want to do on the concrete, but on carpet or mats it is a great way to mix things up a bit.


Target:  chest, shoulders, triceps, abs (pectorals, deltoids, triceps brachii, rectus abdominis)

Count:  4 count

Description:  Starting from a plank (top position of a pushup), drop to one elbow, then the other elbow, then come back up to one hand, and then the other hand.  Depending on your number of repetitions, do half of them starting with one side, and the next half starting with the other.

American College of Sports Medicine

The American College of Sports Medicine (ACSM) is the largest and most respected sports medicine and exercise science organization in the world.  Working in a wide range of medical specialties, allied health professions, and scientific disciplines, the members are committed to the diagnosis, treatment, and prevention of sports-related injuries and the advancement of the science of exercise.

From astronauts and athletes to people with chronic diseases or physical challenges, ACSM continues to look for and find better methods to allow individuals to live longer and more productive lives. Healthy people make a healthier society.

ACSM’s Mission Statement reflects this goal: The American College of Sports Medicine promotes and integrates scientific research, education, and practical applications of sports medicine and exercise science to maintain and enhance physical performance, fitness, health, and quality of life.

ACSM Weight Training Principles
The American College of Sports Medicine (ACSM) issued a 2009 position statement on resistance training principles for healthy adults.  Recommendations include:
  • Optimal strength-training programs include concentric (shortening), eccentric (lengthening), and isometric (static) muscle contractions and include single and multi-joint exercises.
  • Maximize exercise intensity by training large muscle groups before small muscle groups; multiple joint before single-joint exercises; and high intensity before lower-intensity exercises.
  • Beginners should do 8-12 reps per set, two or three days per week.
  • Intermediate and advanced weight trainers should vary their program between 1-12 reps per set using a periodized program that systematically varies the volume and intensity of the workouts.  They should train three to five days per week.
  • Intermediate and advanced strength trainers should work toward using heavier loads (1-6 repetition maximum) with 3-5 minutes rest between sets.
  • Programs designed to promote muscle hypertrophy should use loads equivalent to 6-12 repetition maximum, with 1-2 minutes rest between sets.
  • Power programs should include strength training and light-load exercises performed at fast speeds with 3-5 minutes rest between sets.

Almost any systematic program works.  The important thing is to train regularly and consistently.

- American College of Sports Medicine, 2009

ACSM on Nutrition and Athletic Performance

The American College of Sports Medicine, the American Dietetic Association, and Dietitians of Canada issued a joint position statement on nutritional factors important for athletic performance.
  • Athletes must consume enough energy during high-intensity or high-volume training to maintain body weight, maximize performance, and sustain health.
  • Athletes should not be overly concerned with weight or body composition.  Fat loss should occur during the off-season.
  • Carbohydrates are the main fuel for intense exercise and are important for maintaining blood sugar and replacing muscle and liver glycogen (stored carbohydrate).
  • Endurance and strength athletes should consume 1.2-1.7 grams of protein per kilogram bodyweight per day.
  • Fat intake should be 20-35 percent of the total caloric intake.  Fats are important sources of energy, fat-soluble vitamins, and essential fatty acids.
  • Athletes who restrict energy intake are at risk for nutritional deficiencies.
  • Athletes should consume adequate amounts of fluid before, during, and after exercise.
  • Pre-game or pre-practice meals should promote hydration, include little fat or fiber, and contain high amounts of carbohydrates in moderate amounts of protein.
  • Nutrient consumption during exercise should maintain hydration and blood sugar levels.
  • Post-exercise meals should contain enough fluids, electrolytes, energy, and carbohydrates to promote recovery and replenish muscle and liver glycogen.
  • Athletes don't need vitamin and mineral supplements if they consume enough energy to supply their needs.
  • Vegetarian athletes are particularly at risk for developing nutritional deficiencies and should consult a sports dietitian to avoid problems.

- American College of Sports Medicine, 2009

It's Go Time!

So summer's over... how did you do?  Did you make use of the weather to kick start your workout routine or take your existing workout to a new level... or did you find yet another excuse about why you're going to get back into it again and start back up when the kids go back to school?  Hey, I'm not judging you... the choice is yours.  I'm just asking the question that you should be asking yourselves : )

I know a lot of people.  Some of them are workout fanatics that make it a top priority.  Others have no interest in working out and don't even consider it as an option.  Then there's the rest of them that fall somewhere in the middle.  These people are the ones that I am typically targeting in my little pep talks here!  These are the people that understand the benefits that exercise can bring, and that like the idea of exercise, but find themselves making excuses about why they can't start TODAY!  Hey, at least they are considering it, but for whatever reason they are typically stressed enough about it to find a reason not to.  I've said it before... getting started again is no picnic.  However, if you get past that first 2-4 weeks, and you get into the routine, you'll be happy that you did!  I promise : )

So it's back to school time.  Cover all those books and get ready for the joy of homework : (  If the students are not participating in athletics, consider getting them involved in some type of exercise outside of school.  Get the good habits started now before the cold weather saps all the enthusiasm and energy!  Good luck this season!

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Exceed Your Potential!

Pete Mazzeo, CPT

"The best way to get the ball rolling, is
to start pushing it"

youtube video of the month --> Fitness Modeling
Good video describing what it takes to be a female fitness model.

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