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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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