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Protecting the UCL and Other Elbow Structures: Trigger Points

I recently picked up a book on Trigger Point Therapy because I felt that pain science was a huge tool in my arsenal that I was missing. There are multiple scenarios where someone would come to me with pain and I could help them temporarily, but I never really understood the true science behind it.

The term “trigger point” was first introduced in 1942 by Janet Travell. Trigger points and their ability to cause displaced pain were well known about as early as 1938.

The true term of a trigger point is as follows: “a highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue”.

Trigger points also affect movement by maintaining a spasm in other muscle groups. When they are being worked, they contract excessively, causing for the muscle to tire too quickly, as well as partially disarticulating a joint causing the “pop” sensation.

In order to fully grow and grasp these concepts, I’m writing about the muscles of the forearm and some of the shoulder that will cause increased referred pain and tenderness in the elbow to help you baseball players!

Brachialis

  • Muscle that runs underneath the bicep, can usually create referred pain to the thumb due to compression forces on the
  • Trigger points usually make it difficult to fully extend the elbow, which is needed for arm deceleration during the throwing motion
  • Trigger points can be found under the outer edge of the bicep just above the crease of the elbow. Stay in a seated position with the arm relaxed on the opposite side, use your thumb and go to work!

Once you feel some sense of relaxation and relief, it’s time to begin mobilizing the joint. Here’s how I would do it:

Use a light DB to create a stretch. Contract the bicep for 5 seconds and then relax

Extensor Carpi Radialis Longus

  • Muscle that runs parallel along the forearm bones, can usually create referred pain to the thumb
  • Trigger points make it hard to bring the thumb towards the wrist during contraction. Keep the arm bent and bring the thumb towards your wrist to feel the contraction towards the elbow, use your knuckles and go to work!

Supraspinatus

  • Although a muscle of the shoulder, there is sometimes referred pain that goes down into the elbow. It can be located right at the top of the shoulder blade
  • Supraspinatus trigger points are usually the cause of a “popping” or “clicking” noise when raising the arm overhead
  • With repeated overhead throwing, the supraspinatus tends to get really cranky as a protective mechanism to protect the shoulder joint from dislocating
  • Grab a lacrosse ball or a peanut, lay down, and go to town!

Infraspinatus

  • Although a muscle of the shoulder, there is sometimes referred pain that goes into the front of the shoulder and in front of the elbow near the bicep
  • The infrapsinatus is larger than the supraspinatus because its job is to stabilize the joint while performing external rotation of the shoulder. Repeated throwing can cause an overactive infraspinatus and referred pain into the bicep

Finding these trigger points and releasing muscles around the shoulder and elbow can help take some unneeded stress off of the throwing elbow. When the elbow produces too much work, this creates more tensile stress on the UCL.

Therefore, by taking care of the entire throwing arm as a whole, and finding your trigger points, you’ll have a safer and healthier career in the long run!

Trigger away,

Jarad Vollkommer, CSCS

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