Monday, June 29, 2009

Location, Location, Location

This past weekend my colleague Peter and I had the privilege of working in the sports medicine center at the USA Track & Field Championships here in the Eugene.

It was a terrific experience that afforded a myriad of opportunities, ranging from the usual training room fare -- heat, ice, stretching, massage, "the magic wand" -- to bonafide injury assessment. It was also a great opportunity to work along side many of the talented sports med professionals at the U of O, and the Eugene area, who did a top-notch job at delivering the highest quality care.

Midday Saturday I was approached by a senior shot putter with lateral elbow pain. He described his pain as "above and below the outside elbow", and "it hurts to lift a glass". The dreaded "L-Word" -- Lateral Epicondylitis -- was suspected.

Lateral epicondylitis
-- also known as "Tennis Elbow" -- is the inflammation of the muscle originating or crossing over the bony prominences of the lateral elbow, muscles used to extend the wrist and aid in gripping tasks. It is a common sports injury (guess which one?), but it affects far more non-athletes, namely those who engage in repetitive grip and lifting tasks.

Common treatment for tennis elbow includes inflammation control (RICE), stretching and strengthening of the wrist extensor muscles, and activity modification. It also may involve addressing muscles and joints farther up the chain -- the shoulder and shoulder blade, which can dictate the position and stress on the elbow.

However, with this gentlemen, we did none of those things. Instead, we mobilized his elbow joint, focusing on the head of the radius, the bony formation most closely adjacent the lateral epicondyle. While working up a sweat pushing, pulling and rotating his brauny forearm, I explained to him my rationale:

Soft Tisse Injury: Rules of the Game

With a muscle-tendon injury (e.g. tendonitis, muscle strain or tear, etc.), the following "Rules" usually apply:
  • Stretching the tissue is painful.
  • Contracting the tissue is painful.
  • Resisting contraction is most painful.
  • Point tenderness -- the ability to point to a single area and say, "It hurts HERE!"
For example, with a calf muscle strain: a calf stretch (toes UP) is painful, doing a calf raise (standing on toes) is painful, and hopping on one foot is most painful. And poking at a single spot in the calf would produce a painful response.

In this gentlemen's case, neither stretching the wrist extensors (flexing the wrist), active wrist extension, or resisted extension were painful in the slightest.

Not Tennis Elbow.

Likewise, if you have what you believe is a soft tissue injury, but it neither hurts to use or stretch that tissue, it's likely not a true soft tissue injury.

So what do you do if you've ruled out soft tissue? Most common possibilities:
  • Joint dysfunction -- one of the joints in the area isn't moving the way it should (either too much, not enough, or out of sync)
  • Neurogenic pain -- a nerve (either nearby or near the spine) is aggravated, causing pain in that area.
And far less common:
Based on his symptoms, the joint was implicated. Joint dysfunction commonly creates pain with some movements, but in more general locations difficult to pinpoint, as was his case: pain "around the elbow" and pain lifting a glass: elbow flexion and pronation.

After several minutes of mobilization -- during which time I recommended a must-visit in Portland for some terrific post-competition donuts -- the gentle giant reported a significant decrease in pain and increase in elbow motion.


I wish I could say that the thrower notched Hayward's next 70-footer, but it's not all miracles in Track Town USA. He returned the next day to report lingering pain in the elbow -- a common finding in a chronic joint dysfunction -- that limited his best throwing.

We felt badly, but he was thankful to have competed, and for our help. I really hope he got his donut.

Thursday, June 25, 2009

Track Tyme

The 2009 USA Track & Field Championships begin today in Eugene. You can still pick up tickets here.

Peter Schrey and Joe Uhan from Eugene PT will be manning the sports medicine tent during these championships. If you a stretch or a pep talk, stop by!

Sunday, June 21, 2009

"Never Been Rolled"

After many turns on the "Injury & Burnout Carousel" (coming to a fair near you, if you're not careful), I'm finally healthy and running OK again. Today's run was a long one from our place off "Rainbow Road" to South Eugene and up Dillard to Ridgeline -- and back. It's a solid loop because it (A) includes four different trail networks and (B) provides a liberal dose hills.

By the time I crawl up the hill and hammer back down, I'm usually rolling pretty good. Today was no exception, and with a couple miles to go, I was definitely in the "Bring It Home" gear when I approached a trio of guys ahead on the Pre's trail. They looked fit but were clearly taking it easy.

As I passed, I turned and said "Hi" (my new habit with everyone I pass on the trail), to see that I recognized one of the guys that I knew from the Midwest. Turns out I had inadvertently rolled up on some of the
local talent, clearly on an easy run leading up to The Big Meet.

We chatted a bit and I mentioned the new gig and what we're up to; specifically how
Eugene PT is one of few practices to provide free public outreach -- be it through free injury screenings, phone calls, or e-mails -- to provide initial or on-going consultation, regardless of whether or not they're "paying customers". I'm very passionate about this, which is one of many reasons why I'm here.

I was happy to hear that these gentlemen -- unlike
many people our age (elite athletes and non-, alike) -- actually have good health insurance. As we jogged along I was told they have access to diagnostic testing for various injuries that is (gasp!) actually reimbursed by insurance!

He then added,
"Yeah, I've had several MRIs in the past year, which has helped save me from more serious injury".

About this time I'd reached my turn; I bid the guys farewell and good luck for next week.


As I picked it up towards home, I mulled over that last comment: several MRIs. A great luxury, indeed, but an pricey one. Then I realized there was one more thing I wish I'd mentioned to the guys, so I'll mention it here:

An MRI may indicate which structure is injured and causing pain
, but no scan -- nor magic wand, pill or elixir -- will tell you why it is injured.

As Physical Therapists, that's our job:
to find out why it's injured, and to fix the cause.

For example, shin pain might be due to a training error or old shoes.
Or, could it be:
  • abnormal foot mobility
  • insufficient hip internal rotation
  • a functional leg length difference
  • referred pain from the low back (neurological), or
  • hitting it repeatedly with a hammer*
It's our job to find out why, to fix the cause, and to provide you the tools to be sure it doesn't happen again; and if not that, then empower you to fix yourself if it does happen again.

And the sad fact is, if you don't figure out the cause, the pain is doomed to continue or return, no matter how many scans, pills, or rests you take. This has become painfully obvious with my own injuries...and it is what drew me to this profession.

diagnostic sleuthing and conquering those roadblocks is what makes going to work each day so fun and rewarding. And, in my humble opinion, that quality of work is what separates Eugene PT from the rest.

(*PTs can also provide therapeutic massage, when indicated!)

Saturday, June 20, 2009

Welcome Relief

Welcome to the official Eugene Physical Therapy weblog! The purpose of this site is two-fold:

, to provide an additional resource of information and insight for past, present and perspective patients. Treatment sessions can be busy, and as much as we'd like to, therapists can't use up your time (and visits and copays) "educating" to the depth and detail as we'd perhaps like. This is an opportunity to provide a bit more information...and for you to comment and ask questions, as well.

I originally developed this idea after discovering another PT-related blog several years ago, while groping for help with yet another running injury. And it was a huge help!

Second, it's a fun way to keep you up to date on what we're up to; one of the great things about Eugene PT is that we've always got "many irons in the fire" around the community (or, "fingers in many pies"?). Moreover, we're constantly trying to learn more -- through coursework or certification -- which means we've got a lot to offer!

Stay tuned...