This guest post was written by Caron Doyle.

Caron is the Pro-Team Rehabber at SBG Manchester and Clinical Director and Lecturer at University of Salford, Manchester, she has been working with the fight team at SBG Manchester for a number of years now and her knowledge and expertise in prehab, rehab and sports related injuries has been invaluable.[/fusion_text]

We will be adding many more articles by Caron in our paid members area of the Essential Pad Man over the coming months.

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During Pad-work application the upper limb accepts between 400 and 1,300 pounds of punching force on every shot. If this force is not dissipated by being distributed equally along the continuum of the kinetic chain it will culminate in the weakest link in the chain and cause micro trauma to the underlying tissues. If this trauma exceeds the involved tissue’s ability to adapt to load it will eventually lead to breakdown and injury. This is why optimal physical structure is as vital during force acceptance as it is during force production. If you’re having any chronic joint problems it may be worth investigating your technique for leaks in the chain.

Even with optimal biomechanics the upper limb takes a tremendous onslaught, exposing the joints, ligaments, tendons and muscles to overuse injuries which is why a preventative programme should be part of any intelligent fighter’s or coach’s training regime.

In this article we will be focusing on the elbow which is intrinsically connected to the wrist and forearm. A basic knowledge of the biomechanics and muscle activity involved during pad work will enable you to appreciate the importance of a self-management strategy to keep your body in optimal shape

In order to understand what’s going on at the elbow when you’re holding the pads we’ll start with some very basic anatomy.

The upper arm bone is called the Humerus. If you feel downwards along the Humerus, you will notice the bone widens to form a ridge on either side just before you get to the elbow joint. The
ridges are called the medial and lateral epicondyles and if you press your fingers in here you will find it is quite tender due to the enormous amount of tendinous insertions that converge on these tiny areas and also the ulnar nerve lying quite close to the surface (squeeze these two points together sharply on someone and there’s your pressure point – (no Chi involved, just basic anatomy).  These two bony landmarks form the attachment points for the majority of muscles of the wrist and hand that you use during Pad work.

Below the epicondyles are the grooves and curves that form the upper part of the elbow joint.

Medial Epicondyle, flexor attachment

Medial Epicondyle, flexor attachment

The forearm consists of two bones, the Radius and the Ulnar. The top ends of these two bones form the lower part of the elbow joint. If you place your hand palm up in front of you the Radius is on the thumb side, and the Ulnar is on the little finger side. It is the Ulnar that forms the bony point of the elbow. Now, turn your palm to face downward, the Radius, still on the thumb side has pivoted on its axis at the elbow joint and the two bones have now crossed.  In anatomical terms, when we place the palm up, it is called Supination and when we place the palm down, Pronation. It’s no surprise that the muscles that do this job are called the supinator and pronator teres. (There’s also a pronator quadratus lower down toward the wrist.)

As pad man you will be in full forearm pronation whilst holding the pads for straight line punches and also in reverse pad positions and will be halfway between pronation and supination for hooks. The constant flicking back and forth from pronation to supination places enormous stress on the muscles creating these movements, which also attach on the heavily burdened epicondyles we discussed earlier.

Wrist_Flexor_Tendons

When we grip as in punching or when stabilising our hand inside a pad, the Flexor muscles of our hand and wrist are working concentrically in a shortened position, if you look on the inside of your wrist whilst forming a fist you can clearly see the tendons standing out as they tighten. The Extensor muscles on the opposite side are working somewhat eccentrically in a lengthened positon as the tendons stretch over the hand and wrist. This places enormous stress on the lateral epicondyle where Supinator also attaches and is also working eccentrically, right at the end of range. Stress is also placed on the medial epicondyle where the flexor and pronator muscles attach. Both muscle groups are also working strongly in an isometric (static) state as they stabilise the pads against the force of the strikes.

Muscle and Trigger Points

A muscle working concentrically is bringing two sides of a joint together. Muscles that are habitually used concentrically become short and tight and lose their ability to function smoothly throughout their range and also lose strength in a lengthened position. A muscle working eccentrically is controlling the forces of two sides of a joint as it opens out. Muscles that are habitually used eccentrically lose strength throughout range and create an enormous pull on their tendinous attachment points. Repetitive overuse in an eccentric position leads to a breakdown of the tissue homeostasis and creates inflammation. When this happens to the flexors and extensors of the hand and wrist this condition is more commonly known as tennis elbow on the lateral epicondyle and golfers elbow on the medial epicondyle.

When a muscle is overworked, “trigger points” can develop in the muscle belly (this is where some of the muscle fibres become trapped in the contract cycle). This then creates small, random bundles of contracted tissues that never get the opportunity to release/relax. Lactic acid and other waste products created from this constant contraction leads to pain and discomfort and this detrimentally affects the smooth functioning of the muscle. If you place your palm down and firmly press your fingers into the groove between the two bones of the forearm you may well find a few of these painful “trigger points”.

forearm_nerve

Nerve

Another structure worth mentioning here is the ulnar nerve, this nerve travels through a tunnel of tissue that runs under the medial epicondyle. (This is the nerve that is responsible for the electric shock feeling when you bang your funny bone.) When you bend your elbow this nerve is stretched over the bony ridge. If you hold this position for a long time or repeatedly bend and straighten the elbow this nerve can become irritated and produce pain, numbness or tingling along the inside of the forearm and little finger.

In the next instalment we will be discussing the self-management strategies you can put in place in order to prevent stress and strain of the elbow, forearm and wrist.

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