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Your Serve
By
Victoria L. Magown,
CMTPT, LMT and George S. Pellegrino, LMT, CMTPT
With the beautiful weather we have experienced this early spring,
people are beginning to engage in more outdoor activities, including
sports. At MyoRehab, the Tennis Elbow season has begun early.
Lisa was determined to beat her perennial rival at tennis and began
practicing for long hours as soon as the weather allowed. Her
dedication to the sport improved her scores at first, but ultimately she
was unable to play due to pain in the right lateral elbow.
Before tennis season began, Lisa was an avid skier. Although she
first noticed her elbow pain while skiing, she didn't give it a second
thought. She just waited for it to go away. She didn't realize that
sports injuries were usually cumulative and not the result of one
incident.
When Lisa came to MyoRehab for what she called her "Tennis Elbow", we
did an in-depth evaluation and discovered that she had been previously
treated with steroid injections at the site of the pain. This seemed to
provide temporary relief, but neither the injections nor other therapies
helped to permanently relieve Lisa's pain. Although tennis was her main
concern, her elbow began hurting with normal activities such as typing
at the computer, unscrewing jars and spring-cleaning chores.
 Range
of Motion testing and palpation of the muscles in Lisa's forearm told us
the main culprit was Trigger Point activity. A Myofascial Trigger Point
is a hypersensitive point in a muscle that when stimulated, produces
pain that is referred in a predicable pattern usually away from the
Trigger Point.
In Illustration "A", the supinator muscle pain pattern matched most of
Lisa's Tennis Elbow pain. Using a tennis racquet with the elbow locked
in full extension, places this muscle at risk for injury. This was not
the only muscle injured by Lisa's sports' activities.
When palpating the forearm, we noticed Trigger Points in a long muscle
that attaches above the elbow where Lisa indicated she had pain and also
in the wrist just above the thumb. This muscle, the brachioradialis,
Illustration "B", produces pain at the thumb. Lisa originally thought
this was irrelevant, and failed to mention it. To a Myofascial Trigger
Point Therapist, specific pain patterns are the signatures of the
muscles causing them.
The extensor carpi radialis longus also plays a role in contributing
pain to the lateral elbow and the back of the hand just above the thumb
and index finger, Illustration "C". When we tested this muscle, it too
had active Trigger Points.
During each treatment, we reviewed specific actions that caused Lisa's
injury. Understanding the "whys" of Lisa's pain gave us the insight to
prevent it from reoccurring after successful treatment. These
activities are referred to as perpetuating factors in that they
perpetuate the injury. If they are not identified and modified, the
return of the pain is only a matter of time.
When Lisa demonstrated her backhand for us, we noticed the head of the
racquet was dropped. This can overload all of the above muscles and
develop active Trigger Points in them. We also discovered that the grip
was too big for Lisa's hand. This kept the extensor carpi radialis
longus and brachioradialis muscles over active in an attempt to
compensate. This was the perfect excuse for her to buy a new racquet.
We encouraged her to take tennis lessons to improve her form.
After successfully inactivating the Trigger Points in the muscles
involved, we gave Lisa a specific Home Exercise Program to retrain the
muscles and keep them pain free. We heard through the grapevine that
Lisa’s game has improved so much that her perennial rival wants to know
the secret of her success. Lisa said “After I even the score a bit, if
he’s real nice, I’ll tell him!”
Have a sport's injury that keeps costing you points? Give us a call at MyoRehab
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