Health & Wellness: Tennis Elbow

If you have pain on the outside of your elbow while playing, you may be dealing with “tennis elbow,” aka lateral epicondylitis. It is a slowly developed overuse/misuse injury that happens where tendons from the forearm attach to the elbow skeletal structure. Muscles involved in forearm extension and rotation (which make up nearly ALL of percussion playing) connect at the lateral epicondyle on the outside of the elbow. 

Percussion playing can especially aggravate (or even create) tennis elbow when it involves horizontal reach or sweep motions. Timpani, drum set, multi-percussion, tenors, and marimba all involve these highly specified motions. Our most challenging repertoire relies on these movements, so in this year of big competitions (TROMP, World Marimba Competition, The Universal Marimba Competition, PAS Drum Set Solo Artist, and many others) on top of our regular activities, tennis elbow is something of which we should all be aware.

BODY MAPPING
The elbow is a hinge joint that connects the upper arm with the forearm. There are two bony points on the sides where tendons attach; they don’t actively DO anything. There is no muscle in the elbow, so it can’t be worked, flexed, or made stronger; it’s justthere. Think of it like an airy channel that carries movement energy. 

The hinge of the elbow is at the back of the arm about an inch above the back “corner,” as the image shows. Correct body mapping of the hinge means we focus effort in the right place. When we focus effort in the wrong place, the elbow feels locked at points of tendon attachment—an immediate discomfort that precedes a long-lasting ache. We protect the elbow by supporting the forearm muscles whose tendons attach there, and that involves relaxing the shoulders and engaging the chest and back muscles when appropriate.

IN PERCUSSION 
In percussion playing, small movements can be led by mallet heads, sticks, or the wrist or elbow. But large movements, such as a reach of two feet or longer, should be led by the back, chest, and core in order to avoid misuse/overburden of the smaller, more delicate elbow and wrist joints. 

If it feels like you’re going to throw your elbow out reaching for a drum, then release everything around your elbow and, instead, engage your lats for the reach. Also try breathing in while you reach.(Repertoire examples: “Rebonds” (Xenakis), timpani excerpts, et al.)

If it feels like you have a tightness or pain outside your elbow when you rotate your arm, then check the side of your neck to be sure it’s released, let your shoulder fall back and down, relax at the elbow, and try again.(Repertoire examples: any marimba passage with laterals, et al.)

If it feels like your elbow locks when you pick up cymbals, then roll your shoulders back and down, let your chest float upwards, engage the lats, and pick up the cymbals.(Repertoire examples: orchestral rep, marching bass drums, et al.)

If it feels like your elbow locks when you pull your arms in quickly, then engage the big muscles of the chest to move your arms instead of the arm muscles themselves.(Repertoire examples: “Velocities” (Schwantner), muffling cymbals, et al.)

The repertoire examples above are more advanced, but teaching beginner repertoire also presents the opportunity to guide players through the supportive principles mentioned above as a way to prevent overuse/misuse.

Since tennis elbow can also be caused by gripping an object tightly, take notice of how little work it actually takes to hold a stick, beater, or instrument. Most of the time, we are holding on much more tightly than needed! That’s something even a beginner can grasp.

The stretches and strengthening exercises on this handout from the American Academy of Orthopaedic Surgeons are a great back-pocket reference.

LINKS
TROMP
World Marimba Competition
The Universal Marimba Competition
PAS Drum Set Solo Artist
AAOS Handout

Laurel Black (percussion, collaborative piano) is a founding member of L+M Duo, previous co-host of the @percussion podcast, co-creator of research project PercussionMind, and member of the PAS Health & Wellness committee. She teaches percussion and piano in Knoxville, Tennessee, and is excited about her current journey: the pursuit of a Doctorate in Physical Therapy. For more information, visit laurelblackmusic.com.

Connect with the PAS Health & Wellness committee.