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