I have a client who is a dental surgeon and is experiencing pain in the medial left elbow during rotation-type movements, similar to repetative movements made during surgery. He is also missing two lumbar vertebrae. He insists on wearing a weight belt during exercise, and we've been doing lighter weights with increased reps. I've been focusing on upper and lower cross syndrome correction as he also is experiencing lateral epicondylitis (right elbow). Any suggestions on the medial elbow pain, in particular the source? And do you have any information regarding missing lumbar?
First things first, you need to read my article regarding Lateral Epicondylitis. It will offer you strategies far beyond the status quo approach of wrist curls and tennis ball squeezes. Next, regardless of medial or lateral injury sites, your client has bilateral elbow issues. This leads me to believe the problem reaches beyond the elbow joint. The source of your client’s elbow problem is primarily due to the fact that he is (how should I say this?) a dentist! What do I mean? I have personally trained more than a few dentists and dental surgeons in my day, and there are some things you can count on. Let’s have some fun and generalize for a moment. Dental surgeon=hunching over people all day=repetitive bilateral wrist flexion, extension, pronation and supination=high stress level=tonic upper traps=resultant atrophy of scapular stabilizers=go to gym and cause destruction of joints at the weakest point in the chosen kinetic chain=sore elbows for Doctor Pain. Whew! The point is that your choice to correct your client’s posture in this case is to be commended. Just make sure that your methods are both effective and results oriented. Also, avoid heavy dumbbell exercises with straight arms by his sides, check his golf swing, look for any examples in the gym of exercises that he performs using excessive or heavily loaded wrist flexion or supination (i.e., heavy bicep curl with wrist flexion). Beyond that, use pain as your guide to avoid any movements that irritate the region. Get him to ice or heat it, depending on the timing of the injury (acute vs. chronic phase), and use his pain as an opportunity to press on with the necessary corrective work.
As far as information regarding your client’s missing lumbar vertebrae, I would need to know more details to offer any definitive advice. For example, if the absence of his vertebrae is a congenital abnormality (from birth), then the issue of congenital scoliosis can become important. This form of scoliosis can be caused by missing vertebrae and is treated by bracing, surgery and a host of other methods that are far beyond our scope of practice. If there is no pain and no lateral spinal deformity present, most research points towards the “no harm, no foul” approach. If your client insists on wearing a weight belt, find out why. Does he have pain in his lumbar spine without it? Maybe the issue is less related to his vertebral deficit and more associated with his trying to push and lift heavy things with an excessive lumbar curve. (One weight belt $39.99…one hip flexor stretch and pair of strong glutes...priceless!) The belt could simply be his crutch or security blanket against his weak deconditioned core musculature. If this is the case, you aren’t doing him any favors by continuing to let him use it for his lifting. Instead, keep focusing on corrective exercise and stretches but also provide a complete core stability program that progresses safely, properly, and effectively. When you put him into exercises that load the lumbar spine, be sure to focus on body position and not the amount of weight he is lifting. Use a broom stick or wall to keep his spine in a nice neutral position. Also get him to contract his glutes and abdominals prior to the concentric portion of every rep. His butt should be stiff for two days after he trains this way, not to mention the “light weights” you are using with him suddenly won’t feel so light. Take him through his corrective stretches and cobra holds (again, see my Lateral Epicondylitis article) prior to his lifting, in order to allow him to achieve a relatively neutral spine in the exercises that follow. If you run into pain related issues or resistance from this client after shedding the belt, then get him thoroughly checked out by a medical expert. Stick to your guns on this issue, and I’ll bet he gives you free root canals for life! Lucky you.