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:

• Fracture
• Something More Sinister

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.