Prevention/Occupational Safety·Supports

“We have to use compression for prevention as well”

Elbow protection during work – with EpiTrain and EpiPoint 

From Bauerfeind Life Magazin

Story Check Dr. med. Christoph Voigt, occupational physician, looks after all sorts of occupations, such as hairdressers, painters, assembly staff, chefs and surgeons, that have an increased risk of suffering from epicondylitis.

  • Causes of the painful tendon insertion irritation can include the same non-physiological and highly repetitive movements of the hand and elbow.
  • Supports like the EpiTrain and braces like the EpiPoint can alleviate pain and help with early mobilization by using extensive and targeted compression.
  • Compression therapy as a preventive measure can lower the risk of not being able to work and taking sick leave.

It is not only athletes who suffer from tennis or golfer’s elbow. Epicondylitis, the painful irritation of the tendon insertions in the area of the forearm, is also responsible for a great number of sick days in the work place. But it does not have to be that way.

Dr. med. Christoph Voigt

Pain in the elbow is usually handmade. The flexor and extensor muscles of the fingers are attached to the forearm, meaning that strain on the wrist influences the elbow joint, says Dr. med. Christoph Voigt. He is the Medical Director and Managing Director at the Center for Occupational Medicine in Jena, Germany, and, together with his medical colleagues, he supports companies in all issues relating to occupational medicine. This includes occupations such as painters and hair dressers, office workers and production staff, but also professional musicians, chefs and surgeons. These are all occupations that are associated with a significantly increased risk of developing epicondylitis. “This condition is often triggered by carrying out the same hand movements over and over again but also by highly repetitive, fine motor tasks performed with the fingers that go beyond the physiological joint axes. An example of this is the simple use of a mouse when working with a computer, as is the fingers’ full motor movement during assembly work or playing an instrument. Overstretching the hand with great force or lifting heavy objects can also cause epicondylitis,” Dr. Voigt explains. 

Irritation impairs the working hand 

In cases of epicondylitis, the insertion points of the fingers’ extensor and flexor muscles on the forearm are affected by painful irritation. Lateral epicondylitis, also known as tennis elbow, and the less common medial epicondylitis, also known as golfer’s elbow, that occurs on the inside of the forearm, are referred to as insertional tendinopathies. “Those are microtears in the collagenous tendon tissue that are caused by cyclical and excessive strain in the hand and elbow area, resulting in inflammation and a lengthy healing process,” Dr. Voigt reports. “Severe pain associated with functional restrictions of the forearm and hand are the consequences. During the acute phase, those affected cannot even raise a cup to their mouths, let alone work.” 

Dr. Voigt sees the use of supports and forearm braces as a worthwhile measure, both to combat problems and for prevention. “I recommend offering and supplying braces for preventive care if the employees’ working processes involve continuous strain.”
Dr. med. Christoph Voigt

Therapeutic compression 

During the initial stage as well as acute phase of inflammatory conditions of the tendon insertions, supports can promote movement and therefore the healing process, thanks to their pain-alleviating compression. They help with early mobilization, contributing to maintaining mobility. In cases of radiating pain, the occupational physician finds an elbow support, such as the EpiTrain, more appropriate because its large-area compression not only relieves the tendon insertion points but also stabilizes the muscles in the forearm area: “Tendons and muscles can be provided with protective guidance during movement. Increased circulation and the induced metabolic processes result in the resolution of the local inflammation.”
In cases of localized problems that originate from a painful area, it is beneficial to apply targeted compression using a forearm brace such as the EpiPoint. The compression of the brace’s five-point pad can modify the ulnar or radial muscle traction on the bony tendon insertion in a way that causes relief. “That means we can address the main trigger point and provide targeted treatment for tennis or golfer’s elbow,” Dr. Voigt explains. The viscoelastic pads are crucial for promoting healing. “They exert massaging pressure in the right areas, which is comfortable and alleviates pain when wearing the support.” Dr. Voigt is convinced by the treatment approach of the EpiPoint and EpiTrain: “Even though, as a company medical officer, I rarely see the whole course of a condition, I know the outcomes of curative treatment with compression and therefore believe that we have to create awareness and provide products for prevention in companies, too.”

Compression for preventive care

Helping people successfully return to their jobs is not the only important aspect of Dr. Voigt’s work: “When symptoms occur, we’re already at the beginning of the condition and, as a specialist in preventative medicine, this is obviously something I’d like to prevent.” He recommends putting on medical products, such as the EpiTrain or EpiPoint, for preventive care before carrying out persistently repetitive movements with the hand or elbow that take longer than three hours per day. If load peaks in the elbow are foreseeable, employees who previously suffered from symptoms should also protect themselves to prevent these symptoms from returning or becoming chronic. The risk of an occupational disease is very real. “That’s why I also recommend offering and supplying braces for preventive care if the employees’ working processes involve continuous strain.”

EpiTrain: Innovative pad technology

The EpiTrain’s Epicon+ Pads are two-component pads. Nubs made of firmer material are incorporated in the viscoelastic pads that change their shape during movement and exert a massage effect. These nubs target the muscle-tendon junction and the muscle fibers. The Epicon+ Pads are positioned on the lateral and medial sides of the elbow and provide the hand’s flexor and extensor insertions with targeted relief. The flexible massage nubs also create targeted stimuli to promote proprioception of the radial and ulnar muscles. Cutouts are integrated into the pads to protect the epicondyles from pressure peaks.

Epicondylitis – an occupational disease

In the German Ordinance on Occupational Diseases (BKV), epicondylitis is listed under “Occupational disease 2101 Conditions of the tendon sheaths or of the paratenon as well as of the tendon or muscle insertions”. In order to be recognized as an occupational disease, certain work-related conditions must be fulfilled as causal criteria. The threshold is three hours per day for a period of at least five years (excerpt):

  • Repetitive tasks involving static and dynamic elements and gross application of force,
    e.g. assembly, picking fruit
  • Fine motor tasks of the hand in short cycles with a high frequency of movement (> 10,000 movement sequences/h), e.g. playing the piano
  • High frequencies of fine motor tasks, e.g. knitting, sewing by hand, darning
  • Forced dorsal extension of the hand, e.g. using a hammer for a long time, backhand stroke in tennis 
  • Similar repetitive or sudden pronation and supination movements, e.g. inserting screws or light bulbs

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Images: Bauerfeind, zfa-jena/Grit Hiersemann

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