I went over my 4 Keys (see my book) healthy living questions to which he scored green in food/ water/ supplements and fitness. He scored amber in lifestyle – he was working a little too much. Family life had been fraught with problems until recently, and on the whole, he loved his work. He just couldn’t quite get his life/ work balance right. His mind was amber and at times red, as he found teaching at university stressful, and he also found it difficult to switch off. I intuitively sensed some deeper issues, and it made sense that keeping fit calmed his mind.
“I haven’t injured myself or upped my workouts or done anything to cause these pains; they’ve just crept up on me. My pain is deep and aching, not sharp, and I haven’t done anything to cause it,” he stated, at a loss as to why this was happening to him.
This made me decide to explore his physical body for chronic [neuropathic] pain and to explore the deeper spinal muscles and relevant joints and ligaments. It seemed wise to leave the alternative discipline of shamanic reiki till later. This aspect of healing needs a deeper level of understanding and trust between practitioner and patient.
I could feel that his lower back was tighter on one side This could have been disc irritation, or it could have been his biomechanics; the way he sits and walks, and either a fixed or habitual posture. Telltale signs of collagen lines at the base of his neck and back suggested a thinning of the underlying discs. His buttock was acutely tender. His hamstring was slightly more tense, with sensitivity being increased again over the division of the sciatic nerve at the back of the knee, tight bands in his calf muscles, and a moving tenderness where his ankle flexors wove around his ankle.
This was all pointing to neuropathic changes to his L5 nerve root at the base of his spine. That means the sensitivity of the nerve root due to poor posture or ageing disc, as well as mild peripheral nerve changes, causing small contractures down the limb and his ache.
This type of problem is insidious, and is often a normal part of ageing-related to postural issues, causing disc narrowing, called spondylosis, and subtle changes to nerves, from very mild to severe neuropathy.
The symptoms can be anything from mild stiffness to pins and needles, numbness and various degrees of sharp burning and aching pains, often made worse on exercising.
Edwin needed a combination of treatments and skills to help resolve his problems. Over two treatments I gave him GunnIMS to relieve the deep-seated muscle problems at the base of his neck and back, plus acupuncture, laser, joint mobilisations and deep oscillation. I also used NLP and subtle mind mapping to get his head in the right place.
Ideally, I would have gone on to add shamanic reiki to heal issues in his auric body, balance his chakras, and use key acupuncture points in his fascial plane. However, after two treatments he was physically pain-free and elected to get on with his life.
Welcome back to the series of articles about physiotherapy and tennis elbow (also known as lateral epicondylitis, lateral epicondylosis and lateral epicondylalgia). So far we have covered who is affected by tennis elbow, the anatomy of the elbow and which muscles or tendons are most likely to be injured. This article will try to give an overview of a huge subject: the physiology of tendons and why they get injured, now this is a massive topic in physiotherapy and has been the subject of huge amounts of research (and in fact our knowledge on this topic is still developing) so I will only be touching the surface.
Firstly we need to look at what tendons actually are and why they might get injured in tennis elbow. Simply put a tendon is a piece of connective tissue that joins muscle to bone and is comprised of well organised mostly one directional collagen fibres (Wang et al 2003). Unlike muscles tendons can not contract themselves and are relatively inelastic (with a much lower proportion of elastin – only about 1-2% Jozsa & Kannus 1997). So basically muscles do the contraction and force generation but tendons, because they connect to the bones and are relatively inelastic, transfer that force over to the bones and move our joints. A key fact about tendons is that they generally will have a much lower blood supply than muscles and in turn have a lower metabolic rate which affects their ability to heal and makes an injury to a tendon much slower to recover and heal properly (Abate et al 2009). Furthermore the point at which muscle turns into tendon (the musculo-tendinous junction) is the point which is most often injured and is subject to large mechanical forces (Abate et al 2009).
Okay – how does this affect tennis elbow? Well, as we found out in the last article, extensor carpi radialis brevis (ECRB) is the most commonly injured muscle in tennis elbow and this muscle is most commonly injured at either the musculo-tendinous junction or at the lateral epicondyle (bony bit of the elbow) where the common extensor tendon inserts into the bone. Therefore understanding tendons and how they react and function is key to understanding tennis elbow.
The common extensor tendon as shown above is the continuation of all the extensors of the wrist and fingers and therefore any time you extend your wrist or your fingers to pick anything up it is put under stress. So it isn’t really a surprise that if you do too much of anything like picking things up then this tendon may get irritated and sore and that your physiotherapist will be able to find fairly easily a very sore spot on the lateral epicondyle of your elbow.
Next blog post will look in more detail at the physiology of what happens when the tendon gets injured in tennis elbow and hopefully manage to summarise and simplify decades of research on tendinopathies.
Abate M., Gravare-Silbernagel K., Siljeholm C., Di Iorio A., De Amicis D., Salini V., Werner S., Paganelli R. (2009) Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Research and Therapy 11 (3): 235
Jozsa, L., and Kannus, P., Human Tendons: Anatomy, Physiology, and Pathology. Human Kinetics: Champaign, IL, 1997
Wang J., Jia F., Yang G., Yang S., Campbell B., Stone D., Woo S., (2003) Cyclic Mechanical Stretching of Human Tendon Fibroblasts Increases the Production of Prostaglandin E2 and Levels of Cyclooxygenase Expression: A Novel In Vitro Model Study Connective Tissue Research 44: 128 – 133