BJJ Elbow, Part Three: Soft Tissue Release

The purpose of this post is to show the lay person a simple way to relieve tightness in the forearms, it is in no way intended to replace treatment by a qualified professional.

Soft Tissue Release (STR) is a form of manual therapy used to treat soft tissue, in this case muscle, fascia and tendon. Quite often tightness in soft tissue is not uniform and there will be specific areas of myofascia that are restricted or that may contain scar tissue and adhesions.

Traditional stretching methods normally involve movng the muscle insertion (where one end of the muscle attaches to bone) away from the muscle origin (where the other end of the muscle attaches to another bone). This will usually result in the less-restricted portions of the muscle stretching first with little effect on the restricted portion. By determining which parts of the muscle are tightest and 'locking' it with various tools (digits, forearms, elbows, massage tools) to create a false muscle origin before moving the insertion away from that false origin, it is possible to isolate the stretch to the portion of the muscle that needs it most.

To perform STR on the flexors of the wrist and fingers:

• Determine which portions of the muscle are restricted. Such areas will normally seem tight during movement and will feel hard or 'grisly' to the touch.
  

• Apply a 'lock' to the muscle just above the area of tightness. The lock should be applied obliquely at a 45° angle and all excess tissue should be moved away from the wrist. The effect of applying this pressure is to create a false muscle origin. (You may notice that I have applied the lock with my thumb, this is fine for me as I am accustomed to applying pressure through my thumbs. If your thumbs are weak or hyperextend please use a massage tool to avoid injury.)
  

• Whilst maintaing the pressure of the lock, extend the wrist (bend it backwards) to apply the stretch. By locking the tissue to create a false muscle origin all the tissue below the lock will be stretched and the tissue above the lock will be uneffected. By performing STR it is possible to isolate the stretch to the tightest parts of the flexors. It is also possible to avoid aggravating the muscle tendons which are currently inflammed.

• Repeat the process several times until the muscle feels 'stretched'

Please note that I have only demonstrated how to apply STR to the flexors because I have pain at the medial epicondyle. If your problem is elsewhere you can still use the same principles but you will need to adapt the technique accordingly.

BJJ Elbow, Part Two: Training the Extensors

To train my finger extensors (the opposing muscles to gripping) I will be using a set of 'Expand Your Hand Bands' purchased from Ironmind (www.ironmind.com). 'Expand Your Hand Bands' are a set of rubber bands designed specifically for training the finger extensors and can be used for prehab, rehab and active recovery. They come colour coded and graded in four strengths, from light to heavy, and the set should be suitable for most people.

To begin the exercise, place a band around your closed fingers:

To complete one rep, open your fingers against the resistance of the band:

It's no surprise to me that my finger extensors are weaker on my left side, the side on which I have been experiencing more tendinopathy. I will be doing 3 sets of 12 reps on most days as well as the other strategies I outlined in my previous post on the subject.

BJJ Elbow

My elbow tendonitis has flared up again. It started a few months ago and I thought it was almost resolved but it is now back. My tendonitis is at the medial epicondyle (the little finger side) which is the common attachment site for the muscles that flex the fingers and wrist. These are the muscles that tend to get overworked when someone does a lot of gripping, which I tend to do in my work (Sport and Remedial Massage) and leisure time (BJJ, Judo and weights training).

To treat this I will:

• Try to refrain from activities that aggravate my problem. This will be difficult unless I intend to give up BJJ and work! I will modify the techniques that I use in my work to try to mininise the amount of gripping I do.

• Ice my elbows to reduce inflammation.
• Strap my forearms before training and possibly for work. By strapping my forearm two or three centimetres below the elbow I will take some pressure off the common flexor tendon.
• Receive soft tissue work on my wrist and finger flexors to reduce their tone.
• Train my wrist and finger extensors (the muscles responsible for the opposite actions) to improve the balance of strength around the these joints.

Hopefully a combination of these methods will help me to manage and resolve this problem.

Regeneration

Following my previous post, I thought it would be useful to clarify what I intend to do for the 'regeneration' component of my planned training week, partly because it is an important part of a complete training programme and partly because it is an area of training that seems to be ignored by a number of BJJ fighters. By the term 'regeneration' I am referring to activities that improve the body's recovery from the rigours of exercise, assisting to restore the body to its pre-exercise state and improve soft tissue (particularly muscles, tendon and fascia) quality. In spending time on improving my body's ability to recover I can train harder, with greater frequency and a reduced risk of injury.

It's important for me to schedule regeneration into my weekly plan otherwise it's just so easy to overlook it: In dedicating a time slot for it, I make it an integral part of my training program. I tend to plan this area of my training somewhat instinctively, varying the type, frequency and quantity of work depending on how I feel. Below are some of the modalities I have found useful; it is by no means an exhaustive list and I am certainly not using all of these methods all the time.

• Ice – Reduces inflammation and swelling of muscles and connective tissue; it has an analgesic (pain-killing) effect.
• Heat – Relaxes muscles and is therefore useful if something feels tight or spasmed. Heat treatment should not to be used during the acute (early stages) of an injury as this may exacerbate the injury and prolong the recovery period.
  
• Contrast – Can improve circulation to the muscles by pumping blood in and out of the muscle. If I want a full-body effect I will either use a contrast shower (alternating hot and cold water in the shower, always finishing with cold) or alternate use of a sauna with a cold shower. When I'm using it locally, I alternate heat and ice packs. As per heat treatment, should not be used locally on an injury in its acute stage.
  
• Sauna/Steam Room – Relaxes muscles in a similar way to heat treatment. Can't say I use it too frequently as I tend not to like the experience much and I can't sit still in the heat for more than a few minutes.
• Epsom Salt Bath – About 300g dissolved in a bath can help to relax muscles and reduce muscle soreness and inflammation.
  
• Static Stretching – Restores length to tightened muscles and realigns it's fibres, improving flexibility and tissue quality.
• Dynamic Stretching – Improves the active range of movement around a joint, improving mobility and joint function.
  
• Self-Myofascial Release (Foam Rolling and similar) – SMR reduces tension in hypertonic muscles, increases the pliability of muscle and fascia, breaks down scar tissue and fibrotic tissue in the muscle and deactivates active trigger points, resulting in improved mobility, tissue quality and muscle function.
  
• Sport and Remedial Massage – As this is what I do for a living, I am very keen on implementing it into my training programme. I usually have 1-3 treatments a month, depending on how I'm feeling. I will write a seperate post about this at a later date.