Archive by category "Fitness" (Page 2)

What is Fitness? Learn how to measure your progress

What is fitness? – A measurable definition!

Fitness is being physically able to do what you want to do, when and how you want to do it. If you are wholly-fit, you can do your job, play games and sports, and do the normal activities of daily living on any level you wish without limitations produced by illness, injury, low self-esteem or stress.

Physical fitness is how you look, feel and perform. It comprises two related concepts: Health-related fitness (a state of health and well-being) and Functional fitness (a task-oriented definition based on the ability to perform specific aspects of sports or occupations). Physical fitness is generally achieved through exercise, correct nutrition and enough rest. It is a vitally important part of life.

Fitness is relative. Just as your fitness will affect your goals, your goals will affect your fitness.

 Health-related fitness

This is a depiction of the the sickness-wellness-fitness curve in the 2002 Crossfit Journal Article defining fitness. (I’d look at body composition rather than just body fat; our understanding of cholesterol has developed since 2002; Systemic inflammation (through C-Reactive Protein and other markers) is also something I’d want to measure as a ‘wellness’ marker. This diagram IS a good starting point for understanding Health-related Fitness.)

Health

One way of looking at health is as our ability to survive and thrive RIGHT NOW. What’s your blood pressure? Blood sugar? Mental outlook? Stress level? Immune response? Ability to survive falling off a 12’ ladder? This is perhaps a simplistic view of health but I think it works quite well.

The indicators of sickness and wellness are measurable. The relative health of a person can be estimated using a range of biomarkers. Please keep in mind that across a population there are large variations in “normal”.

Using the scale, “Sickness” implies something may be amiss e.g Blood Pressure is above 140/90. This doesn’t necessarily mean there’s a problem or illness, but can spark further investigation and preventative measures if required. “Wellness” indicates normal or average health e.g BP of 120/80. A lower (but not too low) reading would suggest greater cardiovascular efficiency and greater “fitness”. Health and fitness do overlap, but the ‘ultra-fit’ do tend to be more prone to illness than ‘fit’. (Probably due to compromised immunity through chronic stress or inflammation)

Longevity

What if we considered health (the moment to moment ability to survive) over time? We would have longevity. Longevity is health over the long haul.

Longevity CAN simply mean surviving for a very long time. Quality of life does matter. One’s health may be such that any stressor, a cold, a fall, will be more than the individual can deal with. Conversely, perfect health, as measured on the day-to-day level, may curtail longevity. People who have a cold here and there tend to have lower rates of cancer. An occasional drop off in health may translate into improved longevity.

Functional fitness

Capability: Put simply, are you physically able to do the task?

Capacity: What volume of work/task are you able to accomplish?

The Crossfit model of fitness would include the concept that “He or she who does best at the widest variety of tasks is on average the “fittest”.” I would say that would make you the best generalist, or best at Crossfit. Ultimately, your ‘fitness’ is highly dependent on the tasks you wish to do.

Recovery

The ability to recover after a physical challenge or illness is in itself an indicator of fitness. Consider two people. Both perform a gruelling task e.g shovelling a large load. At the end of the day, both are shattered. The following day, one is able to continue the task, the other can barely move. They have different levels of fitness / capacity (at least for that task).

Having a performance bias may be at odds with health and longevity. Loads of endurance training may lead to oxidative stress, immune compromise and suboptimal dietary requirements necessary to fuel such efforts. If endurance sports are your thing, that’s fine. It’s perhaps good to know some of the down sides so one might make smart alterations to nutrition and training plans. Similarly if you aspire to be a Super Heavy Olympic Lifter you may need to consume an amount of food and carry a body mass that is absolutely at odds with health and longevity.

Another model is the notion that to be fit one should have a good balance in the development of all the engines that drive human activity: the ATP/CP pathway, glycolytic, and aerobic paths. The specifics of these energy pathways, ways to train them and implications for everyday life will feature in future articles.

What all this boils down to is for general fitness you need capability in various modalities, physical adaptations and metabolic engines, and capacity across a wide variety of tasks and time-frames. This offers a quantifiable way of measuring fitness. Do more work in less time and you are fitter!

Once again – Fitness is relative. Just as your fitness will affect your goals, your goals will affect your fitness.

9 ways bands can help you stretch

Have you ever used bands to stretch?

Aside from providing elastic resistance in workouts, bands are also a great tool for stretching. Improve your flexibility by using this guide for a 9 stretch sequence you can do with just one little band.

Technique Tuesday: Dave does a Power Clean

Here’s the first of our new regular feature, Technique Tuesday, in which Tim analyzes the technique and form of a particular lift. This week, the power clean as performed by Dave.

As always, we’re interested in your thoughts and comments, so please post them below!

Quad, Hamstring and Lower Back Mobility Video

Here’s the inimitable Kelly Starrett of Mobility WOD delivering a great lesson on how to improve mobility to hips and spine and flexibility to quad, hamstring and lower back.

Also check out an earlier post on thoracic spine and hip mobilization.

Check it out – and do it!

Also have a look at Kelly Starrett’s book, Becoming a Supple Leopard, for more great mobilization tips.

Pregnancy and exercise – a guide for training

Many people seem to treat pregnancy as an illness. Pregnant women do not need to be wrapped in cotton wool. While pregnancy does mean significant physiological changes, the expectant mother has not turned into an alien! ^[1][3] A sensible approach to pregnancy and exercise training can mean a happier, ^[9][11] healthier, ^{[2][3][6][10]} fitter ^[2][3][10] mum. This can lead to better recovery post-delivery ^[2][4][5] and better headspace ^[2][9][11] for dealing with sleepless nights!

If in any doubt at all consult your obstetrician. This is especially important if you have complications. Some of the things to discuss include:

The type of exercise you like to do
Your general fitness level
How much exercise you did before you conceived. ^[1][3]
Your desired intensity level ^[7]
Any complications with your pregnancy

Ultimately – see the conclusion below – especially number 5!

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Some general benefits of exercise

You might actually (shock, horror!) enjoy exercise – or at least the social aspect ^[9].
A more efficient engine means more energy
Improve your posture ^[2] and circulation ^[10]
Improve your cardiovascular health
Get stronger
Improve your work capacity (see work capacity below)

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Pregnancy specific benefits of exercise

Stronger back muscles – help alleviate back pain as your belly grows ^[2]
Stronger core muscles – help prevent incontinence ^[2][4][5]
Relieve stress ^[9][11]
Improve your sleep and ward off insomnia ^[11]
Ward off pregnancy-induced bone loss ^[6]
Prepare for the physical demands of labour (see work capacity below)
Improve your recovery after labour ^[2]
Initiate a faster return to pre-pregnancy fitness and weight ^[2]
Increase your ability to cope with the physical demands of motherhood (see work capacity below)

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Changes	Cautions (things to be aware of)
Increase in body weight	Changes in Balance / Coordination due to increased weight and the distribution of the weight
Loosening of all ligaments (Relaxin)	The loosening of ligaments can make you more prone to sprains and other injuries
Increase in resting heart rate	Don’t use heart rate to guide intensity as it has increased – use Rate of Perceived Exertion (RPE)
Decrease in Blood Pressure (2nd Trimester)	Avoid rapid changes in position due to decreased blood pressure
Increase in Blood Volume, Haemoglobin and VO2 Max (First few weeks after birth)	Improved performance!
Abdominal separation (painless)	Sit-ups or crunches may worsen this, and are ineffective.

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Things to avoid

Overheating has been linked to developmental problems for baby in animal studies
Lying on your back (from 4 months) can restrict circulation. Modify exercises to on your side.
Excessive intensity is thought to have effects on birth weight (3rd Trimester), though there is conflicting evidence and opinions, so this is still inconclusive ^[2][3][7][8]

Avoid jolts or falls ^[3]. Unfortunately vigorous or extreme activities such as horse riding, skiing, mountain climbing are out. You should also avoid most contact sports, such as football, basketball and so on. In the later stages of pregnancy, avoid activities that involve jumping, frequent changes of direction and excessive stretching (such as gymnastics).

Pregnancy is not the right time to start any new intensive ^[7][8] exercise, but it is safe to continue with most types of exercise if you’re used to them.

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Limitations of Guidelines

Public health recommendations by their very nature are designed to capture as many members of the public within their umbrella as possible. They are an excellent starting template. They often have current information and links to resources for further inquiry and should not be overlooked.

A great example of sensible pregnancy and exercise recommendations can be found at:

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pregnancy_and_exercise

The reason I particularly like these recommendations is their acknowledgement of relative capacity, which is often lacking in Public Health statements.

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Relative capacity

If you haven’t exercised before becoming pregnant, you would approach the new activity pretty much the same way as if you weren’t pregnant. That is, you’d seek the help of a professional who can design a structured program with your particular goals and needs in mind. Gradual development of strength and fitness with incremental improvement over time.

On the other hand, someone who’s been exercising for years, has built up a baseline of strength, endurance and other general physical skills is going to have greater physical capacity than someone who has not. This woman would be able to do much more than her previously inactive counterpart. Her loads and speed would be reduced compared to pre-pregnancy levels as a margin of safety, but she could still outperform others at her gym of lesser capacity.

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Pelvic floor exercises and pregnancy ^[4][5]

Strong abdominal muscles support your spine. The internal core and pelvic floor abdominal muscles act as a natural ‘corset’ to protect the pelvis and lumbar spine.

Your pelvic floor muscles are weakened during pregnancy and during birth (vaginal delivery), so it is extremely important to begin conditioning the pelvic floor muscles from the start of your pregnancy.

Appropriate exercises can be prescribed by a physiotherapist or a personal trainer who has training and experience with pelvic floor. It is important to continue with these throughout your pregnancy and resume as soon as is comfortable after the birth.

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Warning signs when exercising during pregnancy ^[3]

If you experience any of the following during or after physical activity, stop exercising immediately and see your doctor:

Headache
Dizziness or feeling faint
Heart palpitations
Chest pain
Swelling of the face, hands or feet
Calf pain or swelling
Vaginal bleeding
Contractions
Deep back or pubic pain
Cramping in the lower abdomen
Walking difficulties
An unusual change in your baby’s movements
Amniotic fluid leakage
Unusual shortness of breath
Decreased foetal movements

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Conclusion

If the exercise you’re doing makes you feel strange or hurts in a non-working-muscle kind of way – stop! The best guide to whether something is working for you or not is how it feels. The rough guide can be summarised as follows:

Get advice for your particular circumstances
Every woman is different
Try things out
Listen to your body
You can still work hard but don’t overdo it.

Consider exercise during pregnancy an opportunity for ‘maintenance’ rather than for ‘improving performance’.

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Further Reading

Victorian Government Better Health Channel Guidelines:
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pregnancy_and_exercise

Sports Medicine Australia FactSheet:
http://sma.org.au/wp-content/uploads/2009/10/WIS-ExPreg.pdf

The website babycenter has some useful articles, including:
http://www.babycenter.com.au/a622/tips-for-a-safe-workout
http://www.babycenter.com.au/a637/when-not-to-exercise

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References

^[1] Lokey, E. A., Tran, Z. V., Wells, C. L., Myers, B. C., & Tran, A. C. (1991). Effects of physical exercise on pregnancy outcomes: a meta-analytic review. Medicine and science in sports and exercise, 23(11), 1234-1239.

^[2] Nascimento, Simony L.; Surita, Fernanda G.; Cecatti, José G. (2012). Physical exercise during pregnancy: a systematic review. Current Opinion in Obstetrics & Gynecology: December 2012 – Volume 24 – Issue 6 – p 387–394

^[3] Horak, T. A., & Osman, A. (2012). Exercise in pregnancy: review. In Obstetrics and Gynaecology Forum (Vol. 22, No. 4, pp. 13-16). Sabinet Online.

^[4] Hay-Smith J, Mørkved S, Fairbrother KA, Herbison GP. (2008) Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD007471. DOI 10.1002/14651858.CD007471.

^[5] Mørkved S, Bø K. (2014) Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med 2014;48:299-310 doi:10.1136/bjsports-2012-091758

^[6] Brandao KL, Mottola MF, Gratton R, Maloni J. (2013) Bone status in activity-restricted pregnant women assessed using calcaneal quantitative ultrasound. Biol Res Nurs. 2013 Apr;15(2):205-12. doi: 10.1177/1099800411423807. Epub 2011 Oct 13.

^[7] Salvesen KÅ, Hem E, Sundgot-Borgen J. (2012) Fetal wellbeing may be compromised during strenuous exercise among pregnant elite athletes. Br J Sports Med. 2012 Mar;46(4):279-83. doi: 10.1136/bjsm.2010.080259. Epub 2011 Mar 10.

^[8] Szymanski LM1, Satin AJ. (2012) Strenuous exercise during pregnancy: is there a limit? Am J Obstet Gynecol. 2012 Sep;207(3):179.e1-6. doi: 10.1016/j.ajog.2012.07.021. Epub 2012 Jul 20.

^[9] Poudevigne MS, O’Connor PJ. (2006) A Review of Physical Activity Patterns in Pregnant Women and Their Relationship to Psychological Health. Sports Medicine – January 2006, Volume 36, Issue 1, pp 19-38

^[10] Kramer MS, McDonald SW. (2006) Aerobic exercise for women during pregnancy. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD000180. DOI: 10.1002/14651858.CD000180.pub2.

^[11] Goodwin, A., Astbury, J. and McMeeken, J. (2000), Body image and psychological well-being in pregnancy. A comparison of exercisers and non-exercisers. Australian and New Zealand Journal of Obstetrics and Gynaecology, 40: 442–447. doi: 10.1111/j.1479-828X.2000.tb01178.x

My love hate relationship with Crossfit

The motto of our gym is “Better than Yesterday”. Tied into this idea is that there’s no perfect system or perfect person – there’s always something to work on, always something that can be improved.

I first heard about Crossfit from a friend when in Japan in 2006. I remember I tried a ‘mainsite’ workout (scaled) with dumbbells and got through it – barely. At that stage I’d been doing Martial Arts regularly for about 5 years and considered myself reasonably fit for a 25 year old. I was so shot through the core that when I was getting into the shower afterwards I was unable to maintain my spine position and had to lie down. I felt like if I’d stayed standing I would have done myself some potentially serious damage.

That experience taught me a valuable lesson. Scaling is good but is second choice after progression. (Also, learn what you’re getting yourself into and don’t push too hard at first!)

I did my Certificates III and IV in Fitness in 2008 and got my Crossfit Coach’s Certificate in 2009. Looking back I recognise how important the ‘mainstream’ skill set has been in terms of my understanding of simple anatomy and physiology. The Crossfit Certification has been instrumental in my growth as a Strength & Conditioning coach and the application of functional movements to the prescription of exercises to my clients.

Had I never encountered Crossfit I am fairly sure I wouldn’t be nearly as effective as a trainer as I feel I have become. That said, had I not had the grounding of the Cert III & IV, and just had the weekend Crossfit Coach Cert – I would be downright dangerous.

Let me be clear – I am not saying that all Crossfit coaches are dangerous. Most aren’t, some are. Some ‘mainstream’ coaches are dangerous. I’m just saying I feel I would have been a dangerous trainer without the conventional skills and experience to be my (and my client’s) seat-belt.

What does all this have to do with a love-hate relationship with Crossfit?

The concept of Crossfit is great. I think the idea of constantly varied, high intensity, functional movements is fantastic. The implementation of that idea has evolved, for me, over time (Better than Yesterday). No longer do I program 20+ minute AMRAPs where at the end of the session you feel like you need to be scooped up with a trowel. The sledgehammer has been replaced with a scalpel. Clients who have been with me for the last 5 year would readily agree that the programming has changed – and for the better. A progressive overload strength program is now the bedrock. A strength-endurance or Olympic lifting progression is alternated cyclically. Constantly varied (within a thought-out pool of purpose-driven) Metcons of no more than 10 minutes duration rounds out the ‘cardio’.

Great results for clients (with very low injury rates) have been the result.

Many a coach seems to confuse ‘constantly varied’ with ‘random’. Random workouts is an easy out for the coach as they can just check the Crossfit main site or other Crossfit gyms WOD feed for ideas to pinch or modify. This method does the coach and the clients a disservice. Copying another coach’s programming without understanding the intended progression (if there is one) or appropriate scaling (if you must use scaling) means the workout will not be optimally challenging for the client(s) or fit their needs or goals.

‘High intensity’ is not the same as ‘wiped out’. If your client doesn’t walk out feeling better than when they walked in – this is a symptom of overloading them and can be steps down the path to adrenal fatigue – or unhappy clients who get sick of ‘punishment’ (especially if it is associated with eating habits). At the end of a workout the headspace should be ‘proud of my achievement of completing a tough workout’ not ‘I’m glad I survived and kind-of dread next time already.’

‘Functional Movements’ are hard to get wrong. You do need to remember to ask yourself “functional for what?” The movement you ask the client to perform should have some link to the things they want to be able to do in their everyday life, or specific sporting event or challenge they’d like to participate in. Doing a hard workout full of functional movements is good – and better than hard non-functional movements – but there needs to be a point. There needs to be a WHY this movement is good for you and how it applied to YOU.

There is huge variety in the quality of training in the fitness industry. There is huge variety in the quality of coaching in Crossfit. My major criticism of Crossfit is that (perhaps due to the prevalence of the competition aspect, bromances or macho vibe) people do things they shouldn’t. (Clapping Fran??? – see below) Often those things are cool TO BE ABLE to do – but can and should aren’t the same thing. I don’t think this was addressed in 2006, and I still think it hasn’t been adequately addressed in 2014.

Very, very keen to hear your thoughts.

Goal Setting: Planning to Succeed – this is really Important!

Do you know how to set a goal that will help you achieve what you want?

“You can’t cross the sea merely by standing and staring at the water.”
– Rabindranath Tagore

Goal setting may be one of the most important skills you can learn.

In fitness, knowing what you want means you and your trainer can put together a plan to work towards your goals. Whether you want to lose ‘weight’, improve your strength, get leaner, improve your core strength, get more flexible/improve mobility, increase your cardiovascular or muscular endurance or have sport-specific goals has a huge impact on the programming – exercise selection, timing, rest, sets, reps and loads.

In martial arts, knowing whether your true interest lies in MMA, fitness, kata (patterns), tournaments or street-realistic self defence can have a huge impact on the style you choose or the emphasis you want to put on different aspects of your training.

Start the process by choosing 1-3 targets. Limiting the number means you won’t get discouraged if you have lots of things you’d like to improve. Map them out – making sure they are SMART:

Specific
Measurable
Achievable
Relevant
Time-based

Specific
This means the goal is clear and unambiguous; without vagaries and platitudes. To make goals specific they must say exactly what is expected and why is it important.

A specific goal will usually answer five “W” questions:
What: What do I want to accomplish?
Why: Specific reasons, purpose or benefits of accomplishing the goal.
Who: Who is involved?
Where: Identify a location.
Which: Identify requirements and constraints.

Measurable
This stresses the need for concrete criteria for measuring progress toward the attainment of the goal. The thought behind this is that if it is not measurable, it is not possible to know whether progress is being made toward successful completion. Measuring progress is supposed to you stay on track, reach target dates, and experience the exhilaration of achievement that spurs on to continued effort required to reach the ultimate goal.

A measurable goal will usually answer questions such as:
How much?
How many?
How will I know when it is accomplished?

Achievable
This stresses the importance of realism and attainability. While an attainable goal may be a stretch to achieve, the goal is not extreme. That is, it is neither out of reach nor below standard performance, as these may be considered meaningless. When you identify goals that are most important to you, you begin to figure out ways you can make them come true. You develop the attitudes, abilities, skills, and capacity to reach them.
An attainable goal will usually answer the question:
How: How can the goal be accomplished?

Relevant
This stresses the importance of choosing goals that matter. A bank manager’s goal to “Make 50 peanut butter sandwiches by 2:00pm” may be specific, measurable, attainable, and time-based, but lacks relevance. Many times you will need support to accomplish it. A goal that supports or is in alignment with other goals would be considered relevant.

A relevant goal can answer yes to these questions:
Does this seem worthwhile?
Is this the right time?
Does this match my other efforts/needs?

Time-based
This emphasizes the importance of grounding goals within a time frame, giving them a target date. A commitment to a deadline helps efforts to be focussed on completion on or before the due date. This part of the SMART goal criteria is intended to prevent goals from being overtaken by the day-to-day crises that invariably arise in life. A time-bound goal is intended to establish a sense of urgency.

A time-bound goal will usually answer the question:
When?
What can I do six months from now?
What can I do six weeks from now?
What can I do today?

Using these criteria – think hard about what you really want. Write it down. Start planning. Start achieving your goals!

The Best Strength Training Program

What is the most successful strength gain program?

Starting Strength? Wendler 5-3-1? Stronglifts? Madcow? Texas Method? Smolov? OPT? Catalyst? A hybrid system? [Insert other serious sounding name here]?

The most successful strength building program is:

is…

The one that you stick with!

I know, I know – you really want to know which program will give you the best “bang for your buck” to get you lean/jacked/cut/shredded/toned/pumped/(flayed?) the fastest, ideally with the least effort.

Sorry to burst the bubble. Real, lasting progress takes time and effort. If it was easy – everyone would be doing it. It takes determination to show up week-in week-out, when you don’t feel like it, when it’s cold, when it’s hot, when you’re tired, when you’re [insert excuse here]…

Just show up.

The world’s best strength coaches do have differences in their philosophy, approach and programing. They may differ on small stuff like “a huge impact on the programming – exercise selection, timing, rest, sets, reps and loads”, but I challenge you to find a decent (reputable and respectable) strength coach, be it Mark Rippetoe, Jim Wendler, Jason Ferruggia, Greg Everett*, Charles Poliquin or anyone else who would say that for consistent gains you can or should do anything other than “show up consistently”. Anyone who would say that you should do anything other than low reps and high load on Back Squat, Bench Press, Deadlift, Press and Power Cleans. The auxiliary exercises may differ, but the main lifts are the main lifts for a reason.

*Greg Everett has an Olympic Lifting focus, so would put more emphasis on development of the Clean and Jerk and the Snatch – two AWESOME strength and power development movements, but I’m sure if you asked him about the utility of ‘the Big 3’ and presses and power cleans for strength development he would agree they do get the job done well.

Yes, your exact sets and reps are open to debate. Do I do 3 sets of 5, or 5 sets of 5 for maximal strength gains with some size development? Answer: it depends. Are you a beginner who needs volume? Are you an intermediate lifter who is closer to your genetic potential where doing 5 heavy sets would be too much volume and stress on your central nervous system? How old are you? How did you sleep? Are you eating properly? How much recovery do you get?

What ever program you do – to get progress you need to train consistently and train hard. Almost all strength programs call for at least 80% of your 1 rep max for the work set(s). The idea of progressive overload is shared universally. The way to get stronger is to lift more than you did last time. Expand your comfort zone by working outside your comfort zone. You only know what you can do when you try to do more than you can.

That’s not to say you should always train all out. If you’ve had 3 hours sleep, are stressed to the eyeballs or are sick. If you’re contagious stay home – but otherwise, show up “oil the groove”, de-load if you need to but show up and lift.

You might even do what Mike did last night. Really not feel like it, show up anyway, eventually get into it and hit a clean and jerk PR!

So show up – even when you don’t feel like it.

Hip and thoracic spine mobility drills

Fantastic drills to test/re-test and mobilise areas of tightness you may have issues with at the hip and the thoracic spine.

Broudly speaking, extensibility refers to the ability of muscles to lengthen. Flexibility refers to the range of motion a muscle will allow a joint. Mobility refers to the full range of motion afforded a joint by all attached tissue – muscles, ligaments, tendons and fascia.

Kelly Starrett, PhD Physiotherapist, , Founder of Mobility WOD, Owner of San Francisco CrossFit and all-around mobility superhero and nice guy here at Crossfit Copenhagen to help with this video on how to assist mobility for overhead squats.

If overhead squats (or regular squats or any lifts requiring overhead position) are uncomfortable for you then definitely try these drills out. Best to get on to this before you have a rotator cuff issue!

After that, have a look at PhD physio Kelly Starrett’s book, Becoming a Supple Leopard, for more great mobilization tips.

Tennis Elbow: Cause and Treatment

Tennis elbow is a type of tendinitis, with it’s name coming from the sport commonly associated with causing it.
In this condition there is inflammation of the tendon of the forearm muscles that extend (pull back) the wrist.
Many activities that involve repetitive gripping can aggravate the tendon structure.

Typically people have: pain over the outside of the elbow, inflammation on the outer tip of the elbow and extreme tenderness over the inflamed area.

People with a tennis elbow injury often find it difficult to pick up objects (especially heavy items) and grip or hold objects for an extended period.

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