Elbow Pain

Anyone who’s watched the UFC or other mixed martial arts events is familiar with the armbar, and everyone who has trained in MMA has undoubtedly been caught in one. The armbar is one of the fi rst submissions Jiu-Jitsu players learn, and it is the basis of many submissions in BJJ and MMA. We know how to put our opponent in an armbar, but what exactly happens when we make our opponent tap? Injuries to the elbow joint are most common, but damage can extend to the ligaments and bones in the elbow as well.

To understand what happens to the elbow in a properly executed armbar, we fi rst have to understand basic elbow anatomy. The elbow is primarily a hinge joint composed of three bones: the humerus (upper arm), the ulna (pinky side of forearm), and radius (thumb side of forearm). The elbow fl exes from 140° to 150°, extends from 0° to 10°, and rotates (pronates and supinates) in both directions about 90°. Ligaments known as the ulnar collateral and radial collateral ligaments stabilize the elbow joint on opposite sides to prevent the elbow from bending inwards and outwards. These two ligaments are fan-shaped structures that combine to form a watertight capsule which surrounds the elbow joint and keeps the synovial fl uids that lubricate the joint where they need to be. There is also an annular ligament that wraps around the head of the radius to keep it in place next to the ulna. The biceps tendon attaches on the front of the forearm and allows us to fl ex our elbows (and resist an armbar attempt), while the triceps tendon attaches on the ulna behind the elbow.

If an armbar is held for too long, there are a number of injuries that can occur at the elbow. The most common are injuries to the joint capsule and collateral ligaments. In some people (primarily women and adolescents), the elbow can hyperextend to about 10° before some kind of structural damage occurs. Since the joint capsule is made of inelastic connective tissue, it will tear if enough force is applied. Over time, repetitive strain on the joint capsule and ligaments can cause pain and laxity in the elbow joint.

As the joint capsule and ligaments are stretched beyond their normal limits, the part of the forearm known as the olecranon compresses into the back of the elbow called the olecranon fossa. This direct pressure from bone on bone contact can be very painful and is usually what makes us tap before more damage occurs. If the elbow is hyperextended repeatedly from years of training, or suddenly from a quickly executed armbar, it can result in small chips to the bone and cartilage which is referred to as osteochondritis. Sometimes these loose fragments need to be removed if it causes pain and interferes with normal fl exion and extension at the elbow.

As a general rule, our bones are the strongest parts of our bodies, but it is not uncommon for the connective tissues to withstand more force than bones before being damaged. We all grimace when we see replays of what happened to Tim Sylvia’s arm in his fi ght against Frank Mir in UFC 48. When an armbar is applied, the knees and thighs are squeezed around the arm while the hips are extended upwards exerting a tremendous amount of force on the bones in the forearm. The resistance supplied by the inherent strength of the ligaments and the additional resistance from the action of the biceps pulling upwards can put more stress on the forearm. This can lead to a fracture in the shaft of the radius or ulna. A fracture to the ulna is referred to as a Monteggia fracture and almost always requires surgical repair through open reduction and internal fi xation with plates and screws.

Anytime you sustain an elbow injury from an armbar, the most important thing to do is avoid further trauma. No good will come from continuing to train or compete with a serious injury. Tenderness and swelling around the elbow are obvious signs of injury. Popping or clicking sounds are also common following elbow injuries, but should not be a cause for concern unless the elbow locks or is painful as it makes noise. Any visible deformities around the elbow and forearm could indicate more serious injuries, including fractures or dislocation and should be evaluated by a physician immediately. X-rays, CT scans, and MRIs can rule out conditions like osteochondritis, bursitis, bone fragments, and stress fractures.

Once the elbow pain has subsided and you are able to do basic drills, a solid rehab routine is always recommended. Any strength training or resistance exercises to increase grip, wrist, and forearm strength along with biceps and triceps exercises would be appropriate. Elbow braces and certain taping techniques may help with problems with laxity and can help prevent further injury during training, but it probably won’t do much during the heat of competition. Elbow injuries are inevitable in BJJ and submission grappling, so be prepared to deal with the consequences next time you decide to go for an armbar or refuse to tap out from one.

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