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 Post subject: Kiter's Elbow: A clinician's perspective
PostPosted: Mon Nov 12, 2007 1:46 pm 
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Let me start off by saying that this post is a GUIDE ONLY - the problem outlined below is not a definitive diagnosis for all elbow pain, it is merely an outline of the most common kiter's arm problem:

KITER'S ELBOW

I am a Sports Physiotherapist based in QLD, Australia, and have recently suffered from a bit of kiter's elbow whilst I was conveniently on a tropical island holiday with my kite. The biggest thing that struck me about it was how much it can ruin your day, and how intense the pain can be. I have summarised below a few points about this condition, and how it can be treated, in an effort to help anyone else out there who suffers from it.

Kiter's elbow - what is it?

"Kiter's elbow" is a term used by kiters to describe tendonitis of the common extensor origin in the forearm. Essentially, it is clinically indestinguishable from "Lateral Epicondylalgia", which is commonly known as "Tennis Elbow".

There is some variation in the clinical presentation among patients, but the main feature is a pathological change in the structure of the tendinous attachment of the wrist extensor muscles - principally the Extensor Carpi Radialis Brevis, but often extending in to the surrounding musculature - the Extensor Digitorum and the Extensor Carpi Radialis Longus.

Look at the Extensor Musculature here: http://en.wikipedia.org/wiki/Extensor_c ... vis_muscle

Read about "Tennis Elbow" here: http://en.wikipedia.org/wiki/Tennis_elbow


What are the symptoms?

The main symptom is, of course, pain over the lateral aspect of the elbow, but often the patient complains of a dull ache throughout the whole elbow, which cannot be localised well. The pain is aggravated by repetitive gripping or lifting motions, and often extension of the wrist. It may come on slowly over the course of a kiting session, or can be initiated as soon as you do your first run.

The pain is accompanied by a marked loss of grip strength, which is due to neural inhibition of the musculature (your brain tells you to stop gripping things, because it's making the problem worse!). Often the patient will complain that they drop cups of coffee or cannot lift their suitcase.

What causes it?

The cause is only partially understood, but like any tendonitis, it is thought to arise from repeated microtrauma to the muscle/tendon complex which starts a degenerative cascade. The muscle becomes painful, and it then gets weaker because of the pain and disuse. Grip loads which were previously fine begin to irritate the muscle even further, and so on the cycle goes.

There is evidence of morphological change in the structure of the muscle, as well as degeneration of the collagen structure at the attachment site.

In real terms, what this means for us is that we have been gripping the bar too hard, almost always because of heavy bar pressure in the kite. I have also found that wearing gloves when you kite can aggravate the condition, because you will subconsciously grip the bar harder to get the "feel" of the surface feedback to your brain. At the moment, I can kite just fine without gloves, but throw on a pair of Ronstan sailing gloves and the pain kicks in straight away.

Obviously, a stronger forearm will be able to handle higher grip loads without concern, so a bigger and stronger kiter will be able to handle a kite with heavier bar pressure without a worry. If, like me, you are a skinny bloke with rake-thin arms however, you are at a much greater risk of developing the problem!

What can you do about it?

Prevention: Prevention is the best form of cure. Strengthening your extensor musculature by doing regular exercise is a great idea. If you go to the gym regularly, you're probably already doing a whole bunch of exercises which are beefing up your grip strength. Anything involving a barbell or dumbbells and requiring a solid grip is helping. If you're really worried, you can do specific extensor grip strength exercises, which I have shown below.

Cure: This is a notoriously difficult thing to treat. Often you will get it fully better, only to have the problem recur 6 months later. I have outlined the main treatment techniques that I use below, in order of importance:

1) Modify the aggravating factor(s) so that they are no longer in play. For us, this means getting a kite with lighter bar pressure! Often this is all you will need to do in order to get rid of the problem once and for all, but if that is not enough, you need to seek treatment from a Physiotherapist or your local equivalent. I can personally recommend a GK Sonic for anyone with Kiter's Elbow, but most bow kites with a direct rear line attachment and 1:1 bar are usually pretty light on the bar.

2) Disable the active trigger points in the involved muscles. I use dry needling (acupuncture needles) to break up the tender local trigger points in the extensor tendons quite frequently. This appears to be the best method of providing instant relief, apart from perhaps the lateral glide manual techniques, which cannot be done effectively at home. YOU NEED TO HAVE THIS DONE BY A PROFESSIONAL! Don't go sticking needles into your arm at home, you'll only make it worse. Here's a pic of my arm with a needle stuck in it. Yes it hurts, but feels much better afterwards.

Image

Deep tissue massage and accupressure are also helpful, which basically means that you push on the sore muscles as hard as you can bear for about 30 seconds at a time.

3) Manual therapy and electrotherapy are useful in the clinical setting, your Physiotherapist will know more about these. There are a few mobilisation techniques which are brilliant for this problem, and combined with some heavy Ultrasound and Interferential therapy, can be very successful.

4) Therapeutic exercise is the long-term fix for this problem. Essentially you need to strengthen the extensors up so that they handle the loads of kiting without causing a problem. I usually tell my patients to do 4-5 sets of 10 of each of these exercises per day, on the provision that they are not painful, and do not aggravate the pain at all. If anything hurts, it is to be avoided!

a) Wrist extensions. Begin with a 1-3kg weight, with your palm facing towards the floor. Extend the wrist (lift the weight up using your wrist) and SLOWLY drop it down again. The key is to do the eccentric part of the exercise slowly, as that is where the most muscle strength is gained.

Image

Image

b) Radial Deviation exercises. Use the same weight, just turn your wrist 90 degrees so that your thumb is facing towards the ceiling.

Image

Image

The best thing you can do is to seek treatment as soon as you notice any pain. If the condition goes chronic (>3 months duration) it is MUCH harder to treat. In the extreme cases, you can have a corticosteroid injection (which almost never helps, and can often make it worse) or a surgical release of the tendons. I would recommend neither of these things. Go see your local Physio or equivalent and beat it before it becomes a serious problem!

Feel free to ask me specific questions in this thread, I'll do my best to answer. Mods might want to make this a sticky too?


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 Post subject:
PostPosted: Mon Nov 12, 2007 1:50 pm 
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Thanks for the info. I thought I was the only one that had this problem because I was doing something wrong. Nice to know the cause and prevention.


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 Post subject:
PostPosted: Mon Nov 12, 2007 2:46 pm 
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:thumb:

Bow kiter elbow


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 Post subject:
PostPosted: Mon Nov 12, 2007 3:03 pm 
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Excellent thread.

I did suffer terrible pain for quite some time for this very reason. I basically had to adapt my riding style.

My biggest cause was when doing grabs, one footers and board offs I would do them all with my front hand. This would mean swapping my back hand to the front hand postition, so the redirection of the kite was rather unergonomic. Trying to explain this to my physio was difficult as he didn't kite, but I'm sure you'll spot it immediately....check the pic out it makes sense.

Image
A session of doing board offs and I actually couldn't lift a beer up....seriously!


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 Post subject:
PostPosted: Mon Nov 12, 2007 3:07 pm 
That fixed harness line increases the force necessary to turn the kite as well.
The further from the center the harness line is on either side, the harder.
I am sure you already know that, though.


Last edited by Skyway Scott on Mon Nov 12, 2007 3:09 pm, edited 1 time in total.

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 Post subject:
PostPosted: Mon Nov 12, 2007 3:09 pm 
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I have one thing to to add for treating tennis elbow, (PROLOTHERAPY). This type of treatment is the best treatment for tendonitis and it is one of the least used. Prolotherapy is done by injecting irritants into and around the connective tissue.

This does 3 things;
Causes inflamation.
Makes the tissue think its injured, so it trys to repair itself, but its not injure so the tissue bulks up.
And lastly since the tissue is inflamed and it thinks its injured, the macrophages clean up past scare tissue.

When you think of what's going on with the other type of therapies, this is what is your trying to do.

Surgery fo tennis elbow is done by cutting the tendon off the bone and reattaching said tendon back to the bone, and the said cure is caused by the local inflamatary response to the surgery.

Steriods and ANTIinflamatorys just make matters worse and can cause more injury cause the healing response is blunted or arrested.


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 Post subject:
PostPosted: Mon Nov 12, 2007 3:29 pm 
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Nice article, particularly on the conditioning exercises! Thanks for putting it together. Some more info appears below:

Some other things that can help in addition to warming up and down for sessions include trimming kites for lower bar pressure. This often means trimming on the pigtails in the middle area or closer to the end of the pigtails. If this leaves you without enough power, rig a larger kite or sit this one out. Using the proper sized bar for a given kite can also help. IF your kite has a good stopper system consider using this to ease the load when well offshore in steady wind when not setting up for jumps or tricks. Using kites with known lower bar pressures and smaller kites can help as well.

One thing that I have found helps with irritation like this are ice massages (although not nearly as well as avoidance in the first place!). Freeze a styrofoam cup of water, peel a 1/2 inch or so off the bottom exposing a lump of ice. Press this lightly into the irritated area with circular motions. I find it works much more effectively than just putting an ice compress over the area. You can also buy plastic cups for this purpose:

Image
http://www.chirocity.com/index.asp?PageAction=VIEWPROD&ProdID=1272



More kiteboarding ideas on dealing with kiters elbow appear at:

http://www.kiteforum.com/phpbb/viewtopic.php?t=2315961

http://www.kiteforum.com/phpbb/viewtopic.php?t=2315982
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Last edited by RickI on Mon Nov 12, 2007 4:47 pm, edited 1 time in total.

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 Post subject:
PostPosted: Mon Nov 12, 2007 4:17 pm 
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I had a cronic kite elbow and I noticed that keeping both thumbs on top of the bar instead of under the bar, the way one usually grips a bar, helped me to get rid of the pain. Of course I had to stop kiting for a long time and switch to a kite with less bar pressure but keeping the thumbs on top of the bar helped me a lot.


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 Post subject:
PostPosted: Mon Nov 12, 2007 8:41 pm 
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I agree with N1ckl4s. I used to fly a Starkite with pulleys - and very heavy bar pressure. My elbows were very bad, and I found moving my thumbs up so they rest on the bar reduced the pain. Changing to kites with lighter bar pressure has helped enormously and if I ever feel a little bit of pain in my elbow now I just move my thumbs up and its fine. But a good post, Neill, thanks :thumb:


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 Post subject:
PostPosted: Mon Nov 12, 2007 9:03 pm 
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thanks for that post. my elbows have been killing me for month now. very informative.


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