Massage for the Martial Artist
One of the most annoying things about
dealing with martial arts injuries is that the medical establishment sees
things only in terms of "conventional" sports and activities.
Medial epicondylitis, known to doctors as "tennis elbow" is extremely common for practicioners of Japanese weapons arts because of energetic and repetitive movement with a weighted object, mostly with one arm or the other.
Most doctors would tell you to ice the elbow, take some anti-inflammatories and lay off for a while. Unfortunately for the rabid budo student, in some cases this is pretty good advice.
In this article, I hope to give you some insight into the causes of "Tennis Elbow" (much as I would like to rename it "Iai Elbow" I don't think the establishment would get it) and give you some tools with which to heal faster and perhaps resolve the problem.
There are three things to look into:
1. Training methodology: Are you paying enough attention to form? If you are putting a good deal of energy into incorrect movement, or not giving your body time to adjust to new movements, you open yourself up to problems. Are you stretching and strengthening your arms enough? The line between forging the body and damaging it can be thin, but a damaged body will certainly prevent further "forging". Keep that in mind.
2. Diagnostic methodology: Try to consult a sports orthopedist, osteopath, or myofascial specialist rather than a family doctor. Family doctors are used to dealing with the average, inactive person. I know this is a generalization and in many cases untrue, however, in my experience it is true all too often. Understand that you practice a "sport" and educate your health professional about it. This way they can understand how important it is for you to heal and continue. Remember that "when all you know how to use is a hammer, the whole world looks like a nail" and consult practicioners with different methodologies if what you are receiving is not working.
3. Understanding recovery: Tissue needs time to heal. A small injury can lead to chronic problems later if not encouraged and allowed to heal properly. Soft tissue injuries to ligaments and gristle heal very slowly, muscle tissue heals quickly (two weeks as opposed to six or eight). Use of deep friction massage, ice and heat, stretching, and careful strengthening can take care of specific problems if you will take care of the whole picture. That is; eat your fruits and veggies, don't smoke, drink lots of fresh water, and strive constantly to be more relaxed and aware of your movement patterns.
Let's start with that sore elbow and diagnosis from a doctor. If it happened suddenly, then it really could be a sprain and needs to be rested for several weeks. If the ligament is truly damaged, only time and rest will cure it. Apply ice daily (20 minutes with a cold pack is sufficient) and study books and videos instead of training.
If it came on slowly, and there is no evidence on X-rays of bone spurs or other problems, the problem may well be a relatively simple soft tissue one.
The main muscle you use to hold your weapon in place as you bring it down in a strike, together with the brachialis and bicep muscle, is the brachioradialis. (Diagram: http://www.meddean.luc.edu/lumen/meded/grossanatomy/dissector/muscles/mus_ue.html) It's the muscle which was incredibly sore when you started iai or kendo. Beginners may feel it in the right arm, but as technique progresses and you learn to use your left arm, that arm will have to adapt and may be sore instead.
Many problems of the elbow and wrist are due to tightness of the muscle and fascia of the forearm. These problems can be resolved with self-massage in many cases.
The first thing you can do to discover if you have such problems is to probe the muscles of your own forearm with the thumb of the opposite hand. Press in behind the big bone on the top outside of your wrist. Now glide up between the bones of the arm to the big bone on the outside of your elbow. Did you encounter lumps and sore spots? Those may well be trigger points and muscle adhesions from overtraining. The best way to attack them is to warm up the arm by generally massaging it, using your other forearm to "iron" the tissue. Go as hard as feels good. Use some lotion if you want, but not too much. You need some "grip" on the skin, and therefore the fascia underneath. Press your thumb, or another blunt object such as a Knobber or golf ball, on the sorest spots. Start relatively softly and slowly sink in to maximum bearable pressure. Don't strain your thumb, and don't bruise yourself. You should feel the lumps start to resolve with moderate pressure. A count of 10 to 20 seconds is usually sufficient. Work the entire upper forearm, including the insertions of the muscles into your upper arm, and the tough fascia just above the "blade" of your forearm on the lateral (outside)of the arm.
Now turn your arm over, and do the same to the underside. You may find that the most painful spots are just under the big bone on the underside of your upper forearm. Place your right hand palm up on the desk in front of you. Place your other elbow in your palm, and reach up with your thumb into the thick muscle on the underside of your arm. Press gently but firmly, using a slow circular motion of your thumb. Don't press too hard on nerves (they feel funny and don't like massage).
As always, if you can find a qualified and certified myotherapist, sports massage therapist, trigger point specialist or just plain old good massage therapist in your area, they can do the work and teach you more in person.
You need to stretch out your massaged muscles
for them to recover properly. Execute aikido's classic wrist stretches
as a very effective forearm flexibility routine (http://www.labs.agilent.com/personal/Danny_Abramovitch/wrist/wrist.html).
I suggest stretching during a hot shower,
and before and after training.
I also suggest attaching a light (and I mean light!) weight by a string to your jo, and reeling this up and down by winding the string around the jo to strengthen your wrists.
If you are experiencing a great deal of soreness, contrast baths can help. Fill one large bowl or basin with water and ice, and another with hot (just comfortably hot!) water. Immerse your whole forearm first in the ice for a full minute (time it with your watch), then in the heat. Repeat this at least four times. It's okay to make faces. This causes the tissues to flush, and metabolic toxins you have stirred up with massage and stretching will be forced out. It's my best cure for overwork after a long day of massage. Drink at least a liter of clean water during and afterwards.
For an acute attack, or to work on a particularly sore spot, ice the area directly with an ice cube. Don't let it rest in any one spot for any time at all, but keep the ice moving over the sore area and the entire forearm. Follow with stretches and moist heat.
A great technical resource on elbow function, anatomy, and problems in English from the Netherlands: http://www.tenniselleboog.nl/onderzoek.htm
Great resources for learning about myofascial
pain and how to deal with it:
http://www.round-earth.com/Myofascial.html
A great book for self-treatment, the best
for the lay person:
http://www.triggerpointbook.com/index.html
Inform yourself about how your body works and pay attention to its warning signals. It will enable you to train longer, learn more, and perform better.
Author's print references:
Myofascial Pain and Dysfunction, Vol 1,
Travell and Simons
Listen to your Pain, Ben E Benjamin
Sports Medicine: Prevention, Evaluation,
Management, and Rehabilitation, Steven Roy/Richard Irvin