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This Stopped me from Acting and Modelling

(Cubital Tunnel Syndrome)

My Experience

I feel it’s important for you to hear my story because if yours is similar I may be able to help you.

Roughly between September – October 2014 I experienced elbow pain with a flicking sensation around the elbow joint. The following four years I tried to fix this problem. I saw every type of practitioner under the sun (chiros, doctors, acupuncturists, physio’s, sports specialists, elbow specialists) take mark of the plurals. All practitioners had different opinions on what was wrong and what I should do. I had multiple tests done (MRI, ultrasounds, x-rays). I tried all the suggestions

I now believe the cause of this was from over-training, improper form while exercising and poor posture.

Like me, you’ve probably tried a number of ways to fix this problem. Let me save you some time and money by letting you know the steps to immediately alleviate the pain/discomfort and hopefully with enough understanding and practise, fix the problem for good!

Lastly, I’m not a doctor and my advice is to consult with a healthcare professional before undergoing any of the suggestions I give below.

Step 1: Understand what is happening

 

 

 

 

 

 

 

 

 

 

 

 

 

For most people with this injury they experience a subluxation of the ulnar nerve at the elbow (as shown in photo A and B). For others, their medial triceps also flicks across the elbow.

Symptoms of ulnar nerve entrapment/subluxation and/or snapping triceps syndrome:

  •  Flicking sensation on the inside of your elbow when going from elbow flexion to elbow extension or vice versa.
  •  Ring and/or little finger tingling, numbness or difficulty with coordination.
  •  Pain or inflammation in the medial triceps. (This symptom alone is not necessarily a sign of the subject problem).

Step 2: Determine the cause

Everyone’s case is going to differ slightly, if you have previously had an accident, like a fracture or dislocation of the elbow then addressing the elbow itself would be wise. If this isn’t you, I encourage you to look at different areas of the body to determine the root cause of why this is happening. Just because you are experiencing these symptoms in your elbow doesn’t necessarily mean the problem is stemming from there.

Below are areas the ulnar nerve travels, which have high chances of entrapment:

The spine (the nerve root)

The neck (brachial plexus)

The arm – (medial intermuscular septum)

The elbow (cubital tunnel).

Within the forearm flexor muscles

The wrist (Guyon’s canal)

A very common issue with people is their shoulders are rounded inward, they have an excessive arch in their back and their head is protruding forward. As you’re reading this, have a look at yourself now!

This is just one postural trait that could easily contribute to entrapment of the nerve. Why? When an area like the shoulders are rounded inwards this can narrow tunnels, like the one the ulnar nerve runs through. In turn, causing compression to the nerve.

So again, addressing areas other than just the elbow is imperative.

Testing:

To rule out any other causes of this problem, tests on other areas of the body (neck, spine, shoulders) would be a wise move.

Assuming you’ve already had tests done to the elbow/nerve. I would recommend talking to your doctor about other possible causes and he/she will be able to provide more information on which test will be suited for you.

If you’re getting an imagining test done on the elbow for the first time, the radiologist who views and writes your report may not be able to identify this problem as it’s quite uncommon. If possible, ask the practitioner if he/she can take two images (before/after) of the movement where you feel the problem occurs. For most people it is when elbow extends past the 90* angle.

Step 3: Something needs to change

 

Posture:

As a starting point, I would address your posture. Even if this isn’t the main cause of the problem, it’s still an imperative aspect of good health. In my professional opinion there are, but not limited to, 6 checkpoints to good posture. Now a simple way you can improve your posture is by googling/you-tubing – “how to keep good posture”. Unfortunately, most videos don’t cover these 6 checkpoints and don’t offer you a guided plan to gradually improve your posture. I have a program specifically for people suffering from ulnar nerve entrapment and/or flicking triceps. Part of this program will teach you the right posture but also how to implement it into your life.

Most of my clients who have completed this program reported significant pain reduction after addressing their posture!

For people with a sedentary job an ergonomic set up is imperative for the recovery process. I usually recommend my clients to have a sitting, standing and lying option for doing work. I also recommend that they set a timer or download an app to remind themselves to move multiple times throughout the day.

For people with an active job, the first step is becoming aware of the movements that aggravate this problem. From there we try make sure you’re doing the movement correctly and if you are and you are still noticing pain I recommend an adjustment or alternative ways to achieve the task.

Movement, exercise and sport:

As someone who is Personal Trainer, I am still constantly revising how to execute exercises properly, so I highly suggest you do the same. You’re probably aware of movements, exercises and/or sports that aggravates this problem. For example: 

 Tricep dominant exercises: push-ups, dips, triceps extensions, some pushing movements.

 Sports that involve throwing or overhead actions: tennis, golf, baseball, NFL, cricket.

 Resting your elbow(s) on your desk or car window.

 Going to sleep in a certain position.

 Driving, twisting lids/taps, carrying objects, operating machinery, writing, holding a phone.

Understanding how to do the exercise, sport or movement properly is an imperative step in recovery. Most of the time it’s a simple modification to alleviating the pain. For example, keeping your elbow close to your body while doing a push-up, as opposed to the letting them flare out to the side, which can put pressure on the shoulders, elbows and wrists, in turn causing the nerve to get compressed.

If you’re unable to modify it, then my suggestion would be to stop or minimise those certain exercises, sports or movements until we make some overall improvements.

I know, the idea of stopping your favourite sport or having to minimise movements such as driving, sounds ridiculous and you’re probably already thinking I’ll be able to skip this step. You might be right but what happens if you don’t fix the problem but follow all of the other steps. You’ll forever wonder if this step could have changed things forever.

I also encourage you to ask yourself why you do that certain sport. Is it for the exercise? If so, then what can you substitute it with for the time being.

Or maybe it needs to be a change in perception. You need to stop driving for a while and the thought of that absolutely kills you. But you never know what opportunities are awaiting you on public transport! 

For the bodybuilders and weightlifters out there. Yes, I feel you! The thought of losing all your gain(z), not lifting weights for a while, feels like the worlds going to end eh… I put this question to you. Would you rather spend a short amount of time fixing your problem and then coming back stronger and smarter? Or would you rather continue lifting, stay the same or even worse, aggravate the problem and not be able to lift again!

Step 4: Treatment

Stretching

For stretches I’d focus on the whole body. Why? Because the human body functions as one unit, meaning if one area is tight or not functioning properly, it can affect other areas.

If the thought of having to stretch the whole body is overwhelming, then I would suggest finding a yoga class, as that will also help improve your posture, which again, is an imperative aspect of good health and can be the underlying root cause.

On the other hand if you are in pain then targeted stretches as you’ll see in the video below, can be beneficial for alleviating symptoms.

Strengthening

You can stretch all day but if you don’t learn how to strengthen your body, you will remain weak and be unable to stabilise your body, which will prevent you from fixing the main problem.

These are my top five strengthening exercises for ulnar nerve entrapment and snapping triceps syndrome.

  1. Scapular Pull-up
  2. Straight-arm Plank
  3. Thoracic Rotations
  4. Bird/Dog
  5. Shoulder W’s

Myofascial release

With myofascial release work, I’d focus on releasing these areas: Neck, trapezius, shoulder (front, middle, rear), bicep/triceps and forearms.

Flossing

For flossing I’d recommend sticking to the 3 flossing techniques in the video below.

If you’d like further guidance on what stretches, flosses and release work to do and more importantly how to do it. Feel free to shoot me an email at info@drewderriman.com 

Equipment to help with recovery:

  • Massage tools: foam rollers, massage gun, lacrosse ball
  • Icing to reduce inflammation and promote blood flow
  • Anti-inflammation creams or gels
  • Strapping tape for exercising
  • Gravity Boots (to help decompress the spine)

Breathing:

Majority of people breathe into their chest and stomach from day to day. Excessive chest breathing can cause a group of muscles in the neck (scalene muscles) to become tight. Why is this important to know? Because the ulnar nerve originates from the neck (brachial plexus) and passes through these muscles. If these muscles are tight and aren’t functioning properly, the ulnar nerve could become entrapped. So learning to breathe into your diaphragm (diaphragmatic breathing) is another crucial step forward.

Get treated:

Sometimes it can be beneficial to see someone who has experience in the field of manual therapy and get a second opinion on what you should / shouldn’t be doing.

These are a few types of active treatments I suggest to my clients. Please note what works for one person might not work for you. I would encourage you to research the place before booking and see if they have helped patience with similar problems. I would also prepare some question for the practitioner on anything you might be struggling with in regards to this problem.

  • Chiropractic adjustments
  • Dry needling
  • Acupuncture
  • Physiotherapy
  • Electro-Acupuncture

Step 5: Improve your sleeping position

As we touched on above, your ulnar nerve runs through many areas. So if any of those body parts are compressed for 6-10hrs! Do you think this could contribute to your problem? Sleeping with your hands behind your head is one of the biggest contributors to this problem. Have you woken up with hand numbness or tingling sensations down your arm or hand? That’s your nerve telling you it’s irritated.

Below are some pictures of optimal sleeping positions:

 

 

 

 

 

 

If you sleep with a partner then I’d suggest having a look at these two videos: Video 1, Video 2.

If the sleeping positions don’t help, try wrapping your arm in a towel when you sleep. This will prevent elbow flexion and nerve compression.

Step 6: Back to training

The timing of when you step back into training is going to be case dependent.

If you weren’t doing any type of training prior to this problem arising, then I’d highly suggest you start. We all know the pros and cons of exercising vs not exercising but specifically those who do not strengthen their bodies will notice atrophy (muscle wasting) at a much quicker pace as they get older. This can lead to more nerve compression. My suggestion would be to start weight training under the guidance of a professional.

While I would suggest trying non-surgical treatments to try and get to the root cause of why you’re experiencing these symptoms, some people may be in quite a lot of discomfort or pain and may want to discuss with your specialist about these surgical options:

Ulnar nerve transposition. The nerve is moved from the cubital tunnel to a new place in front of the medial epicondyle.

Medial epicondylectomy. This is where they would remove part of the medial epicondyle (bone). So the ulnar nerve can move freely.

Cubital tunnel release. The ligament of the cubital tunnel is cut and divided. This operation increases the size of the tunnel and decreases pressure on the nerve.

Conclusion:

If you have any questions, please don’t hesitate to contact me via the contact page.

I truly wish you all the best in finding a solution to this interesting problem.

With love,

Drew Derriman.

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