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Walk
Around in Pain If You Want To, Get Help if You Don't
By
Tapan Raut, PT, CSCS, foreword by Kathleen Daelemans
I've had knee pain for ten years. I've mentioned
it to my doctors over the years but each and every one of
them shrugged it off as part of aging. At the start of cycling
season this year, the pain was so acute I couldn't squat,
lunge or kneel. I could stand, walk for short periods pain
free and lay down. Not great when you're an active person
who happens to love cycling. I cycled anyway and got a horrible
case of tennis elbow and pain in my wrist because I started
leaning to the left to take pressure off the knee. It's
one thing to limp but having to sip hot coffee through a
straw because you can't hold the cup is a deal breaker.
I did what I've been putting off for years. I went to a
specialist and was extremely disappointed when instead of
handing me a box of imported dark chocolates with instructions
to take twice daily, he handed me a prescription for physical
therapy. I went to five sessions and with each session the
pain increased. My girlfriend told me that pain plus pain
doesn't equal no pain so I phoned the doctor and asked if
I really had to continue. I could tell it was all
he could do to keep from hollering, "Of course you
do, you moron!" into the phone but he was the epitome
of polite and suggested a new therapist he'd recently heard
about who was having incredible success with patients suffering
from all sorts of hard-to-treat ailments.
Enter Tapan Raut, the most passionate, well versed, open
minded and dedicated physical therapist I've ever been treated
by. Ten years of knee pain and 10 sessions with Tapan later
and I'm almost out of the woods. He doesn't accept the notion
that we have to walk around in pain. Period. And you shouldn't
either. For every unexplained ache and pain, I will seek
treatment and I implore you to do the same.
In the meantime, I've recruited him to contribute to the
web site. I encourage you to send
in your questions. This week, I asked him to talk to
us about tennis elbow.
Tennis
Elbow
Tennis elbow, also known as lateral epicondylitis, is an
inflammation of the forearm muscles that attach to the bony
prominence on the outer side of elbow. It is an overuse
injury involving repetitive contractions of the forearm
muscles that straighten and raise the hand and wrist.
As the name Tennis elbow indicates, playing tennis, particularly,
the repetitive use of the back hand stroke with poor technique
is a primary cause. However it may occur in other activities
where forearm muscles are overused such as hammering, painting,
holding and carrying infants and children and other activities
such as cycling.
Usually patients complain of pain over the outside of the
elbow which may radiate to the forearm and wrist. Patients
experience pain on touch to the outer part of elbow. Certain
activities such as twisting door knobs, shaking hands and
lifting small household items are painful.
At the initial stage, a physician may prescribe rest, ice,
pain medications and physical therapy. A thorough evaluation
by a physical therapist is usually focused not only on the
elbow but also on other contributing factors to the pain
like flexibility and strength of the upper body and body
alignment. Additionally, the way the wrist and hand are
used in sports and everyday activities should be assessed
to prevent further stress on the injured tissues.
A physical therapist may use ultrasound, phonophoresis (ultrasound
with hydro cortisone medication), or iontophoresis (electrical
treatment with hydro cortisone medication). Soft tissue
mobilization of the outer elbow will help to decrease the
scar tissue at the injured site. Sometimes specific manual
therapy technique like Mills Manoeuvre, manipulations
to stretch tendons, is needed to break the scar tissue at
the injured site.
A Physical therapist will design and implement specific
exercise programs gradually to improve flexibility and muscle
strength. Patients are instructed in a comprehensive home
exercise program to accelerate the progress.
Preventive
measures also play a key role in reducing stress on muscles.
Some examples are as follows:
- Reduce
or avoid lifting objects with arms extended
- Reduce
repetitive gripping and grasping at the hand and wrist
and decrease overall tension of gripping.
- Work
or weight train with the elbow in a partially bent position.
- Use
wrist supports when weight training.
- When
using tools, increase the gripping surface of the tools
with gloves or padding.
- Use
a two handed backhand in tennis.
If
pain remains persistent, your physician may give a corticosteroid
injection at the injured site to reduce inflammation. One
in ten people with tennis elbow need surgery. Usually it's
done in an outpatient clinic and involves trimming of the
inflamed tendon or surgically releasing and reattaching
the tendon to relieve the pain. Overall, Tennis elbow can
be managed successfully with proper medical help and self
care.
Tapan
Raut
PT, CSCS
I read the last sentence of his piece twice. I'm lousy at
the self care part. I did hang the list of exercises he
gave me on the refrigerator so I have to look at them every
time I'm scouring the icebox. And I did the knee exercises
today. Okay, so a few of the knee exercises. Wasting his
valuable time and expertise by not following through on
a program he's designed to help me is irresponsible. And
I know better. I'm outta here. Gotta go do my exercises!
—kd
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