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Research & Science

Lateral Epicondylitis or “Tennis Elbow”

This condition involves inflammation or microtears in the tendons of the wrist extensor muscles where they attach to the lateral epicondyle (the bony bump on the outside of the elbow). These are confusingly called “extrinsic hand muscles” because they live in the forearm, but actually act on the hand & wrist.

• Muscles Involved:

  • Extensor Carpi Radialis Brevis (ECRB): A primary wrist extensor and secondary stabilizer of the wrist during gripping.

  • Extensor Digitorum: Assists in extending the fingers, but also works to help extend the wrist.

  • Extensor Carpi Radialis Longus (ECRL): Provides additional wrist extension and additionally helps with radial deviation (sideways movement of the wrist - think false edge cuts and coupes).

  • Attachment Point: The tendons of these muscles all originate at the lateral epicondyle of the humerus.

Medial Epicondylitis or “Golfer’s Elbow”

This condition involves irritation or microtears in the tendons of the wrist flexor muscles where they attach to the medial epicondyle (the bony bump on the inside of the elbow). They are also extrinsic hand muscles because just like the lateral ones, they live in the forearm but work to flex the hand and wrist.

• Muscles Involved:

  • Flexor Carpi Radialis (FCR): An important wrist flexor that additionally helps with radial deviation (sideways movement of the wrist). Important for true edge cuts, and fine technical bladework like disengages.

  • Flexor Digitorum Superficialis (FDS): Assists in bending the fingers (holding your weapon!) as well as flexing the wrist.

  • Pronator Teres: Aids in rotating the forearm (pronation, think 1st position in Italian rapier) and also assists with elbow flexion.

• Attachment Point: These muscles’ tendons all attach at the medial epicondyle of the humerus.

For a more dynamic explanation you can check out the short videos on my clinical website:

HEMA Hot Take

Why These Muscles Get Overused in HEMA:

• Repetitive Movements: Wrist-dominant motions place repeated stress on these tendons. Drilling certain forearm and wrist-heavy techniques over and over - like moulinets or false edge cuts - can strain these muscles that don’t get used as much in our activities of daily life.

• Grip Pressure: The tighter your grip, the more these muscles are working. Keeping a tense grip especially on a heavy or tip-weighted weapon increases the strain on both the flexor and extensor muscles. Even experienced fencers can find themselves gripping their weapon in competition when tensions are high, resulting in post-competition soreness or pain.

• Poor Biomechanics: Misaligned wrist positions during fencing actions or poor elbow positioning (hello chicken wings) can exacerbate tension on these structures.

• Overenthusiasm: Sometimes you fall in love with a new weapon and just can’t help yourself. Or, an injury prevents you from using one hand, so you seize the opportunity to practice just with the other. You wouldn’t start marathon training by immediately running 20 miles, however. Like with any other new load on the body, there needs to be a gradual ramp up to prevent injury.

Coach’s Corner

Applying Your Knowledge
Understanding which muscles are at play with various fencing motions can help you train your students smarter and reduce the risk of strain on the elbow during fencing.

As a coach, you can help fencers avoid or manage elbow pain by:

1. Teaching Proper Mechanics:

   • Reinforce alignment of the wrist and forearm during cuts and guards.

   • Demonstrate how to use the pelvis, back and shoulders to generate power, not just the arms.

   • Watch for flared elbows or “chicken winging” on cuts and parries, which signals the fencer is using the rotator cuff and forearm muscles rather than recruiting the large muscles of the lats and back.

2. Educate on Preventative Exercises:

   • Show fencers how to do wrist, forearm, and grip-strengthening exercises and explain their importance.

   • Make available a set of grip strengthening tools like balls, bands, or other equipment for fencers to use during free time

3. Encouraging Rest and Recovery:

   • Encourage students new to one-handed weapons to ramp up gradually over several weeks rather than jump in immediately to hours of training each week.

   • If a student experiences pain, encourage them to back off intense drills and focus on light, technique-based exercises instead.

   • Consider purchasing a set of dueling sabers or foils for fencers seeking to practice techniques without the full weight of a heavier historical weapon

4. Recommending Professional Evaluation:

   • Persistent pain should always be checked by a healthcare professional to rule out serious issues or identify underlying causes.

Health & Fitness Tips

Strengthening and Protecting Your Wrist & Forearms
Although it’s arguably far more glamourous to hit the squat rack or the kettlebells at the gym, a little time spent building your forearm and grip strength can go a long way in preventing pain and dysfunction. Too often people don’t get started on these exercises until they’ve been dealing with elbow pain for months. The good news is these exercises can be done in as little as 5-10 minutes, making them an ideal way to end a training session or spend a commercial break during TV time. Others like to keep equipment at their desk and knock out a few reps on Zoom calls or business meetings.

Easy Ways to Strengthen:

• Wrist Curls and Wrist Extensions:

  • Strengthens the flexor and extensor muscles using a very light weight or a resistance band.

• Tennis Ball Squeeze:

  • Improves grip strength and endurance by strongly gripping a tennis or lacrosse ball for 10-15 seconds and then releasing. Repeat 8-10 times on each side. Websites like amazon sell colorful balls expressly for this purpose.

• Supination and Pronation Drills:

  • Use a light dumbbell or resistance band to rotate the forearm palm up (supination) and palm down (pronation). Make sure to focus on rotating the forearm and not cheating with the muscles of the shoulder.

• Towel Twist

  • Grab a towel with both hands shoulder distance apart. Twist your two hands apart from one another like you are wringing out a soggy towel. Wring it fully one direction, hold, then wring the towel fully the other. Repeat 8-10 times.

For a live explanation of many of these exercises, check the video below!

Conditioning Move of the Week

4 Exercises for Lateral Epicondylitis

Upcoming Events

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