Muscle Medicine by Rob DeStefano & Bryan Kelly & Joseph Hooper

Author:Rob DeStefano & Bryan Kelly & Joseph Hooper [DeStefano, Rob]
Language: eng
Format: epub, mobi
Publisher: Simon & Schuster, Inc.
Published: 2009-09-02T12:00:00+00:00

* * *

WHAT GOES WRONG, AND HOW TO FIX IT

Mostly Muscular

Tennis Elbow (Lateral Epicondylitis)

Bob is a fifty-seven-year-old teaching tennis pro in northern New Jersey who has been treated for tennis elbow off and on for over a decade. He’s received corticosteroid injections for the trouble spot, which helped for a little while, until the next flareup, when the outer side of the elbow would again become painfully tender. Bob has a classic overuse injury. The forearm muscles that constantly work to straighten out the elbow (for instance, hitting backhand shots over and over) get irritated, along with the tendon on the outside of the elbow to which they are attached. The muscle medicine approach is to manually work to relax the muscles of the forearm that are tugging on that tendon and, in Bob’s case, to work on the tight shoulder that was contributing to the problem. He was out of trouble after six visits. Then he was able to begin physical therapy to strengthen the muscles that supported his newfound normal range of motion in the shoulder. He’s been pain-free for the past two years.

We actually don’t like the label tennis elbow. Therapists and physicians see lots of lateral epicondylitis patients who play tennis and lots who don’t. What they all tend to have in common is poor form doing their chosen activity. Often the problem begins at the shoulder—think of it as the first domino to fall. If the shoulder muscles are tight and the shoulder joint is not able to rotate normally, the elbow and wrist will have to make up the difference with extra motion, in this case overextension. That’s true whether you’re hitting a backhand or taking care of home repairs with a screwdriver. Muscle imbalance can be another contributing factor. If the biceps is tight or overdeveloped, the antagonist muscle, the triceps will have to overwork to straighten out the elbow, stressing that same outer-elbow area.

Golfer’s elbow, or medial epicondylitis, is a similar story, except this time it’s the flexor muscles and tendons on the front of the forearm that attach to the inner knob of the elbow, the medial epicondyle, that get overstressed. Golfers, bowlers, and baseball pitchers, who flex or snap their wrists, are vulnerable, as are people who put in long hours working with hand tools.

The textbook explanation of what happens in these tendinitis cases is that over-stressed tendons and muscles suffer repeated microscopic tears that lead to inflammation. It’s inflammation that the itis in lateral epicondylitis or Achilles tendinitis refers to. As we mentioned in chapter 3, researchers now understand that tendons, unlike muscles, have only a limited capacity to become inflamed. With chronic tendinitis, the initial swelling goes away. It is more likely that the pain is caused by the repeated scarring of the tendon or irritating chemicals produced by that scarring. Both of these reduce the blood supply and make the tissue brittle and more susceptible to further injury. (Tendonosis is a better term for this degeneration of the tendon’s collagen fibers, but the medical profession has been slow to update its vocabulary.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.