Lateral Epicondylalgia

[alophysio]

Hi Marty10,

NSAIDs and injections...

...well, if there are signs of inflammation, treat them - heat, swelling, pain, redness, loss of function...

As for injections, i am fairly confident there is research that suggests a short term benefit in terms of pain but longer term results in the same group leading to decreased improvement overall.

If you were treating someone who strained their elbow on the weekend, you are probably looking at some form of inflammation. If you are treating someone with a 6 month history of elbow pain, you are probably treating something that is not inflammation.

In the end, we are trying to break a cycle and gradually expose the injury to load to assist in repair - i am fairly pragmatic about such things...especially having suffered from LE myself...i only ask that the patients know about WHY they are getting a treatment etc.

Cheers

[mulberry]

bill vicenzino missed one thing in his assessment; the myofascial assessment developed from physiotherapist luigi stecco and his wife carla stecco who is an orthopaedic surgeon. the technique is called myofascial manipulation and is based on the meridain channels of traditional chinese medicine. luigi refers to painful sites and centres of perception; arease that your are aware of pain and states the lesions of the myofascial meridian; meridian channel, usually are juxtapositioned near the centre of perception (CP), the lesion site is called the centre of coodination (CC) and usuallu is found where the monarticular and polyarticular muscles converge there line of tension along the myofascial plane.

for example;

lateral epicondylagia is the centre of perception of the elbow. to identify the centre of coordination look at the muscles attached to the lateral epicondyle.
the monoarticular muscles is the aconeus and supinator and brachialus
polyarticular muscles are the wrist extensors/ thumb extensors abductors and the muscles that attach onto the lateral intermuscular septum such as triceps and biceps brachii
the centre of coodination will be the area of convergence of the tension of monarticular and polyarticular muscles either proximally or distally from the area.
the distal site of supinator over the interosseous membrane and the origin of thumb extensor / abductor. also beneath the wirst extensors.

or

the distal site of aconeus and the interface between brachioradialus

or the origin of brachialus and the interface between triceps or biceps brachii

the CC wil be tender on palpation and refer pain like a active trigger point.

i also quickly run along the path of the affected myofascial meridian to identify lesions; active and latent trigger points then treat the active trigger point and re asssess. if there is still residual weakness i then will treat the latent trigger pint as well if still there after the release of the active trigger point. 90 percent of the time the latent trigger point will resolve with active trigger point trreatment

for example

the large intestine meridian is made up of the soft tissue that passes over the lateral epicondyle. i will palpate over the length of the large intestine and its opposite the heart meridian to identify lesions to treat in the segments juxta positioned to the painful site; active trigger points, if there are no active trigger points i will then assess the next segment above or below until i find the active trigger point along the length of the myofascial meridians; large intestine and heart

[estherderu]

Hi Mulberry,

very interesting.
Can you give us some references to read about this technique you speak of?
You might know I have spoken about the meridians in relation to musculoskeletal problems and epicondylitis before (from the bindegewebs/meridian corner) and am always interested in knowing more, especially regarding the science behind any given method or technique.

Thanking you in advance.

Esther