Today’s blog ‘(Part 5a) Grip Dilemmas at the Elbow’ explores an interesting area in our ‘Understanding Hand Exercise & Grip Strength’ series. It may seem confusing to some readers at first glance. What do the grip and the elbow have to do with one another? The truth is… lots! I’m hopeful that by the end of this blog the link between the two will be as clear as day. Too many people suffer – and so many more WILL suffer – if we don’t draw attention to this correlation.

OK. Here we go. Please now… leave all pre-conceived beliefs behind about the elbow, hand exercise, and grip strength training in general. It is an essential time in our interrelated cultures of health and fitness to be open to looking differently at this area of the body. Change is needed.

A quick review. You’ve learned in this series thus far (Parts 1 & 2) that the 9 muscles that open the hand are generally located on the BACK of the fingers, thumb, hand, wrist, carpal tunnel, forearm, and elbow. Similarly, the 9 muscles that close the hand are generally located on the FRONT of the fingers, thumb, hand, wrist, carpal tunnel, forearm and elbow. You’ve learned (in Part 3) that when we grip or grasp something, the finger extensor muscles contract as part of the kinetic chain of grip in order to support the action of the finger flexor muscles. In other words, grip a cooperative co-contraction of both the finger extensor muscles AND the finger flexor muscles. In Part 4 of this series, you learned that two of the main finger extensor muscles contribute towards forming the common extensor tendon which likely becomes unstable in cases of tennis elbow (aka. lateral epicondylitis).

Whew. Seems like a lot, but is really just basic factual information about grip and hand muscles that have traditionally been unknown, or have simply drawn little interest, or little discussion, or all of the above.

Historically, when it comes to gripping in general, there has somehow been a firmly established belief that ‘squeeze-only’ is how grip works. You’ve heard it. I’ve heard it. Everybody I discuss it with has heard it. ‘Grab a squeeze ball or a coiled or spring-loaded grip device or ring and start squeezing.’ In other words, it has been quietly accepted that the hand-closing muscles ONLY are at work (or are important) when it comes to gripping or grip training. It is a belief that needs to dissolve. NOW. I beg of you… Let this idea go.

For the last 5 decades, I believe this ‘squeeze-only’ perception has created many and varied limitations and problem conditions for athletes, musicians, workers, hobbyists, and mankind in general, no more so than its effect at the elbow.

So, what is meant by ‘grip dilemmas at the elbow?’ To introduce this concept properly requires two separate blogs.

In today’s blog (Part 5a), we will examine the first 3 core dilemmas of the 7 grip dilemmas. These first 3 dilemmas expose the elbow to various problems directly due to repetitive gripping itself.

In our next blog (Part 5b), we will examine the final 4 of the 7 grip dilemmas at the elbow. These dilemmas are caused by repetitive gripping combined with stressful motions.

We will then discuss what we can do differently to prepare and protect the elbow as much as possible in activities where gripping combined with stressful motions is inherent.

These two blogs will open your eyes to several very real threats to elbow function and performance.

Let’s get started…

Dilemma #1 – Static Finger Extensor Muscles

It is always worth reviewing the premise within (Part 3) The Kinetic Chain of Grip. Again, what is meant by the ‘kinetic chain of grip’ is that: 1) the finger extensor muscles contract statically (i.e. in one static position) to 2) support the actions of the finger flexor muscles. Grip is indeed a cooperative co-contraction.

As well, when we discussed tennis elbow (lateral epicondylitis) in Part 4, we were quick to observe that the kinetic chain of grip creates chronically shortened, static finger extensor muscles, two of which (i.e. extensor digitorum, extensor digiti minimi) contribute tendons to the common extensor tendon that originates at the lateral epicondyle. Instability at the common extensor tendon creates the breeding ground for injury and swelling at the lateral epicondyle, thus lateral epicondylitis, aka tennis elbow.

Finger extensor muscles by design serve two functions: 1) they open the hand (extend the fingers), and 2) they support grip (by contracting statically to support finger flexor muscles). The first function allows these extensor muscles to act through their full range of motion (ROM). The second, as noted, is STATIC.

Now ask yourself: How often do I perform the first function and simply open my hands? The answer is – most commonly – rarely. If ever. Ask yourself this: How often do I open my hands against resistance. Likely, never.

Yet how often do you grip something against resistance? Often. Think about sports, music, work, art, gardening, briefcase carrying, coffee cup holding, fitness, dumbbell & kettlebell workout, hand-shaking, cellphone operating, painting, cleaning, repairing, maintaining, grabbing, helping, etc. The list goes on and on. We are all constantly gripping. Constantly shortening our finger flexor muscles. Constantly creating static finger extensor muscles. Constantly.

When our society’s finger extensor muscles are being developed statically, they eventually become a cog or a weakness to our health and our performance. Our repetitive grip society is helping, even encouraging, the development of these problems. And we remain unaware. We continue to repetitively grip in our day to day world.

Then add to the equation that if and when we decide to exercise our hands, it is very commonly accepted that we perform aggressive repetitive gripping motions using squeeze balls, rings, and coiled or spring-loaded grippers.

In essence, we are active and compliant in creating weak, static finger extensor muscles.

What we are also compliant in is creating what is ‘not a fair fight’ between the strength of our hand closing muscles compared to the strength of our hand opening muscles.

Which leads us to our next dilemma…

Dilemma #2 – Imbalanced Finger Flexor vs. Extensor Muscles

It is understood in fitness that when one exercises their chest muscles, they will also equally address the training of their back muscles. The same can be said for all body areas including the biceps and the triceps, the quadriceps and the hamstrings, the stomach and lower back, as well as the left side of the body and the right.

It is only sensible. In order for our bodies to move maximally in 3 dimensions – as well as stay in balance – we must always consider the harmony of the opposites.

Why then has this balance been ignored for 5 decades or more when we speak of the hand muscles? For a person (the author) who has studied hand muscle structure and function specifically for over 20 years, the overlook is truly confusing.

The hands are not a boring area at all. Quite the opposite. They are fascinating. 9 muscles close the hand. 9 muscles open the hand. Some muscles are intrinsic within the hand. Some muscles are extrinsic, largely existing outside of the hand and crossing many joints. Nerves weave in and out and over and through to help you with life’s daily demands. Simple, yet super-intricate. Super-important. Completely fascinating.

And the hands are completely relevant because hand muscle strength and balance directly effect fingers, thumbs, hands, wrists, carpal tunnels, forearms, and elbows.

Yet low and behold our fitness and healthcare markets have historically chosen to separate the body into areas, and somehow the hands have been overlooked. Left for dead apparently.

It is time for us of all to awaken. Everyone with hands, take note and think for yourself; hand muscles affect the function of every joint they cross. And possibly more.

As we learned in Parts 1 and 2, the elbow is the starting point for the main hand opening muscles (outside of the elbow) AND the main hand closing muscles (inside of the elbow). Elbows are silently being abused and imbalanced, yet nobody in science, health nor fitness seems to be concerned. Elbow problems and grip? Go ahead. Seriously. Try to find someone who is concerned about it.

Insert cricket sound.

When we repetitively grip in our daily activities, we create strong but shortened finger flexor muscles. In the short term. The longer we repetitively grip, we are more likely to have our grip strength plateau and then decrease (true for most poor training mechanics). Repetitive grip is a direct burden on the medial epicondyle (medial epicondylitis) due to finger flexor muscle overuse and shortening without an appropriate healthy opposition.

How many tradespeople, body-builders and fitness enthusiasts do you see with chronically flexed/curled fingers? All finger flexion habits. No opposing finger extensor muscle training. I refer to it as ‘Lego-hand’ as the appearance mimics the hands of Lego characters. This is neither healthy nor functional, yet is so commonplace that we don’t question it. It is indicative of a chronic finger flexor muscle dominance imbalance.

Concurrently, because of the kinetic chain of grip, daily repetitive gripping is also creating chronically static and overworked finger extensor muscles. This becomes a burden at the lateral epicondyle (lateral epicondylitis), as previously discussed. When I see extremes of the ‘Lego-hand’ appearance, individuals are almost always weak when they demo Handmaster Plus finger extension, no matter how strong they appear.

Finger extensor muscle bellies can appear strong when simply ‘looking’ at an individual’s lateral forearm. It can appear toned, even bulky. But static is not strong, stable, nor healthy. Finger extensor muscles must be trained through their full, natural ROM in order to: 1) create healthy tendon attachments at the lateral epicondyle, 2) create healthy grip, AND 3) best create balance with the opposing finger flexor muscles.

Does the future sound bleak for society’s current elbows? Without a new level of learning, open discussion, and proper training, I believe it is.

But it doesn’t have to be. As a whole, we simply have to become familiar with the actual structure and function of the 18 hand muscles, and then create an environment where hand muscles are regularly trained according to their natural balance. Full ROM opening. Full ROM closing. Strength. Balance. Performance. Shangri La.

Handmaster Plus was developed over 15 years ago to give ANY user the easiest path to strength, stability, and balance, especially at the elbow.

When we do train our hands through full, natural opening with resistance and full, natural closing with resistance, we also solve the 3rd core dilemma at the elbow…

Dilemma #3 – Poor Circulation

This dilemma (poor circulation) used to be ‘barely on my radar’ but has now moved to where I believe it likely should be #1. Unfortunately, it takes a bit more explanation and more levity from the reader to consider, so I don’t scare people away. That’s why it’s #3.

When we repetitively grip, we are not truly exercising ANY of the 18 muscles maximally.

Think about it. The finger flexor muscles are generally closed fully when gripping (think golf, tennis, carrying a suitcase, gripping a steering wheel, etc.). They are not fully active. They are not contracting through any active range of motion.

‘Squeeze only’ grip devices are also guilty of not taking the hand through a full closing motion, only a partial motion. The hand is half-closed to begin the exercise in order to hold a ball, ring, or spring-loaded/coiled device).

The finger extensor muscles (as we have discussed ad nauseam) are contracting statically to support the finger flexor action during grip. Again, no functional range of movement. Only static contraction.

Little or no movement means little or no blood flow is being stimulated to and away from the muscles, tendons, and joints of the elbow (and upper extremity in general).

True, the 9 finger closing muscles are contracting in order to grip an item, so there is muscle contraction evoking some blood flow response by the body. But the response is not near as strong when compared to hands actively moving through a full range of natural opening and closing with resistance.

There is an exercise physiology phrase ‘functional exercise hyperemia,’ which sounds confusing but basically means that the body knows to increase blood flow when, where and to what degree an area is commonly exercised.

I often use shoulder motion scenario to illustrate blood flow in relation to exercise.

If I was to move my arm through a small range of motion (such as rocking my arm at waist level), compared to moving move arm through a full ROM windmill motion, which exercise would stimulate more blood flow? The second full ROM exercise, of course. This is an over-simplification, yes, but I do believe it allows most people to come to a common agreement intuitively.

Do you think closing your hand against resistance compared to closing AND opening your hand against resistance would produce any difference in your body’s blood flow or circulation response? Turns out it does.

I have faced this same question (in a roundabout way) during the first ten years of working with Handmaster Plus. We have always had strong positive feedback relating to the specific issues and conditions that our users addressed intentionally, but there were always regularly comments like ‘I also feel better in general.’ This general wellness comment may seem strange in relation to a hand exercise. At least it did to me… Kind of.

At trade shows and presentations, I’ve been pointing out to users for years to sense how much blood flow they feel in their entire arm after demo-ing Handmaster Plus’ most basic exercise. They are inevitably nodding, blown away. So when I hear people say ‘I feel better in general’ after using Handmaster Plus, I always wrote it down as a healthy response to better blood flow. More blood flow means more oxygen and nutrients to the area, and thus better health and stability.

In October of 2017, we compared common ‘squeeze-only’ grip device approaches to the Handmaster Plus exercise, having thermograph pictures taken one minute after each exercise. The Handmaster Plus exercise was clearly superior to the ‘squeeze-only’ devices for stimulating circulation.

Soon after, I was exposed to the work of Dr. Raymond Perrin who stresses the importance of regaining the proper function of the lymphatic system in regards to healing from chronic fatigue syndrome. He spoke specifically about stimulating the proper flow of lymph to the lymphatic ducts, which permit drainage of waste and toxins back into the venous blood flow for elimination out of the body.

I believe that proper hand exercise may be more important than we ever imagined. Full ROM hand exercise clearly improves circulation. I don’t believe it to be too great of a stretch to say that better upper extremity circulation means better lymphatic drainage and indeed better lymphatic duct efficiency.

This statement is certainly bold and unproven, but if it is true, let’s remember that the lymphatic ducts drain toxins from the head, neck and whole body, including the brain (via the glymphatic system). Could proper, complete hand exercise stimulate better detoxification and maybe contribute to better mental and emotional well being? It’s possible.

While Handmaster Plus and its full-range-of-motion hand exercise may eventually be proven to be the ultimate stress ball, we know for sure now that it improves blood flow and venous drainage to and from the upper extremity when compared to traditional ‘squeeze-only’ exercise.

A main benefit of proper hand exercise to the elbow is a better supply of oxygen and nutrients to the muscles, tendons, and joints and more efficient drainage of waste products away. Better circulation means healthy tissues.

Better circulation means healthy elbows. Period.

This ends the first half of ‘(Part 5) Grip Dilemmas at the Elbow’

In the next blog, we will reveal ‘(Part 5b) Grip Dilemmas at the Elbow’ and examine  Dilemmas 4-7 which address what is at stake when the elbow is not only trained poorly but is then asked to perform stressful motions.

Here we see less room for error and more exposure to injury, hence more demand for proper training.

And we will show you how Handmaster Plus addresses proper training of this vital elbow area.

See you again soon.

References:
*1 2.4.2019 By Matt Zender Modern Restaurant Management https://www.modernrestaurantmanagement.com/recent-trends-in-restaurant-claims/

Dr. Terry Zachary is an advocate for proper and complete hand exercise & grip strength training in sports, music, the workplace, modern computer, electronics/gaming/esports, therapy/rehab/wellness, and hobby. Dr. Zachary discovered that repetitive gripping imbalances have gone under the radar as a cause of muscle imbalance, weakness, poor blood flow, and poor lymph drainage for over 5 decades. He developed Handmaster Plus to provide the world with fast, easy and complete hand training to create maximum strength, balance, performance, and overall health. The result is healthy, stable fingers, thumbs, wrists, carpal tunnels, forearms, and elbows… and healthier lives.

Dr. Zachary can be reached at terry@doczac.com. For information on Handmaster Plus, visit www.handmasterplus.com