Do you have elbow pain?

Elbow pain can have many causes.

Golfers elbow, tennis elbow are the common names for lateral and medial epicondylitis. Which is caused by irritation of the common flexor or extensor tendons of the forearm. This irritation is usually caused by the eccentric contraction which is the motion of an active muscle while it is lengthening under load.

What can you do for epicondylitis?

You can use braces. This is a temporary solution to your elbow pain. It does feel good to have this brace compressing your elbow. If you get some relief from using one of these braces, it is a great tool to use so that you are not aggravating the elbow. But it will not fix the problem.

Using Ice and heat can also be useful for reducing pain and inflammation in the elbow. The research suggests that the most benefit from both ice and heat is about 20 minutes. I suggest alternating between ice and heat. Using an ice cube or freezing water in a small paper cup and using that to massage the elbow using it until it it nice and numb, then using a hot pack or heating pad to heat the elbow up. What does this do to the elbow? The ice constricts the blood vessels and causes some tightening of muscles, pushing inflammation out into the bloodstream and then the heat dilates the blood vessels and moves the inflammation away from the elbow.

Muscle work is also useful when addressing elbow pain. Because muscles are the ones doing the work, they can also be the ones causing the problem. Working on them only makes sense. Using self massage, instrument assisted massage, and massage therapy to reduce pain and prepare the soft tissues to be able to work and strengthen the areas that need to be stronger.

Using a FlexBar to strengthen the muscles in the forearm is going to help fix the problem so that this does not become a chronic issue. The exercise is fairly simple: 1. Hold Flexbar in the involved (hurt) hand maximum wrist extension. 2. Grab the other end of the FlexBar with the Uninvolved hand (uninjured) hand. 3. Twist Bar with non-involved wrist while holding the involved wrist in extension. 4. Bring arms in front of the body with elbows in extension while maintaining the twist. 5. Slowly allow Flex bar to untwist by allowing involved wrist to move into flexion.

What else is there that can help?

Deep tissue laser therapy can help reduce the inflammation in the elbow and reduce the pain. This is safer than taking NSAIDs and it is able to focus the anti inflammation benefits to the elbow more that taking the NSAIDs which once in the system are all over the body. Deep tissue laser works by stimulating the mitochondria of the cell to increase ATP production and bringing heat deep into the body more that the use of a hot pack or heating pad.

If you have any questions about lateral or medial epicondylitis please contact us at Vector Spine and Sport. We are located in the Old Farm Professional Plaza in Millcreek Utah.

Plantar Fasciitis

What is plantar fasciitis?

It is one of the most common causes of heel pain according to the Mayo clinic. It involves inflammation of the plantar fascia, which is a band of thick tissue that runs across the bottom of the foot connecting your toes to your heel and turning into the achilles tendon and calf muscles.

Plantar fasciitis commonly causes a stabbing pain that normally occurs with the first steps in the morning. After getting up and moving more, the pain will normally decrease. But it may return after standing for long periods of time or going from sitting to standing. It is more common in runners, other risk factors are being overweight, inadequate foot support, standing for long periods of time, dancing or ballistic jumping activities.

Complications

If ignored plantar fasciitis could result in chronic heel pain that hinders or changes your regular activities. Changing the way you walk to minimize your foot pain could lead to foot, knee hip and or back pain as compensation.

Treatment options

Orthotics- You might be able to find relief by having custom made or fitted arch supports (orthotics) to help disperse pressure through your feet more evenly. In the office we offer Foot levelers orthotics.

Deep tissue laser therapy- Laser therapy is a non-invasive, drug-free, and surgery-free way to treat the body and decrease pain & inflammation. It is a technologically advanced treatment that uses light energy to accelerate your body’s own natural healing processes to help speed recovery.

Lightforce class IV laser

Exercises- Using specific exercises to strengthen the foot can help long term in correcting the biomechanical problems in the foot. One of the main causes of plantar fasciitis is weak foot muscles, causing the arch to collapse which increases tension and irritation to the plantar fascia.

Extracorporeal shock wave therapy- This procedure uses sound waves directed at the area of heel pain to stimulate healing. It shows excellent
results, reducing the swelling and pain in the treated area.

TRT shockwave

Injections- Steroid medications injected into the tender areas may provide a temporary pain relief, but it is NOT a good long term option due to the risks associated with multiple injections such as weakening of the plantar fascia and bones of the foot. platelet rich plasma (PRP) under ultrasound guidance, could be another option with less risks of tissue rupture.

Soft tissue therapy- This can be done multiple ways. There is massage therapy, Instrument assisted soft tissue mobilization, Cupping etc. This works by reducing scar tissue.

Opioid epidemic. What alternatives are out there?


According to the CDC on Drug Abuse, every day, more than 130 people in the United States die after overdosing on opioids (1). The abuse of this classification is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and prevention estimate the prescription opioid misuse alone in the US is around $78.5 Billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement (2). Roughly 21-29% of patients prescribed opiods for chronic pain misuse them (4). of those between 8-12% develop a opioid use disorder.

10 Alternatives to opioids

Chiropractic care

Chiropractors are specialists focused on neruomuscular disorders, who emphasize manual manipulation of the spine and extremities. Studies have shown to be effective at decreasing pain and improving physical function (5).

Acupuncture

Acupuncture is the Chinese practice that involves and experienced practitioner using hair thin needles into the skin at specific points in the body. Through this they are correcting imbalances in the nervous system and muscles. In the Archives of Internal Medicine a review found that acupuncture relieved pain by about 50% in patients (6).

Physical Therapy

A physical therapist specializes in physical medicine and rehabilitation. They may be able to create an exercise program that helps you improve the function of your body mechanics and decrease your pain.

Massage Therapy

Massage therapy is a great tool in combination with chiropractic, acutpuncture and physical therapy wheather it be acute injury such as a car accident or sports injury or chronic problems like low back pain, neck pain etc.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) can help people practice “acceptance theory”, which can lead to behavioral changes and perceptions, and increase patient confidence and self-efficacy for pain management. In a review published in the American Psychologist found that CBT had small to moderate effect on decreasing pain when compares to patients usual treatment, this option was suggested to be best applied in conjunction with a primary care setting (7).

Steroid injections

Seroid injections are a commonly given pain and inflamation releaver associated with certain joints and conditions. Although fequently used, the long term effects are not well established. The short term effects are are established and show a significant reduction in pain and inflamation, but there is a increased risk of bone thinning with the use of some steroid injections (8).

Non-steroidal anti-inflammatory drugs

NSAIDs are the common drugs wich include asprin and ibuprofen. They are used to reduce inflammation as well as lower fevers. Many NSAIDs can be bought OTC, which means they are easy to obtain and relativly inexpensive. But like all drugs should be taken with care and not for extended periods of time due to the increased risk for heart attack and stroke, as well as gastrointestinal bleeding or other problems.

Diet and life style

Diet and life style are one of the most common ways to self-manage chronic and acute pain. The activities very from person to person as to what will work, you need to find what is going to be best for you and what you enjoy. From power lifting, dance, yoga, to running or even going for a walk around the block. The more we move and the better we eat, the better we will feel, it’s as simple as that eat right, move right, feel right (11).

Electrical Stimulation

Electrical nerve stimulation can provide short-term pain relief, especially for various types of muscle pain, by sending low-voltage electrical signals from a small device to the painful area through pads attached to the skin. While researchers aren’t sure why it works, they think it may either interrupt the nerve signals to the brain or stimulate the production of “feel good” endorphins, the body’s natural painkillers (9).

CBD oil

CBD oils are todays go to for many conditions. They are useful in reducing inflamation, relaxing muscles and reducing pain.

In practice I have come across a variety of treatments for acute and chonic pain. If you are in pain see one or more of the specialist listed above you can usually find one in your area that offers a free consultation to see if you are a good candidite for their approach to conditions. There is hope out there you might have to get out of your comfort zone, but that is where growth tends to happen.

1.CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://wonder.cdc.gov.

2. Florence CS, Zhou C, Luo F, Xu L. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Med Care. 2016;54(10):901-906. doi:10.1097/MLR.0000000000000625.

3. “Trends in Opioid Analgesic Abuse and Mortality in the United States | NEJM.” New England Journal of Medicine, Richard C. Dart, M.D., Ph.D., Hilary L. Surratt, Ph.D., Theodore J. Cicero, Ph.D., Mark W. Parrino, M.P.A., S. Geoff Severtson, Ph.D., Becki Bucher-Bartelson, Ph.D., and Jody L. Green, Ph.D www.nejm.org/doi/full/10.1056/NEJMsa1406143.

4. Center for Behavioral Health Statistics and Quality (CBHSQ). 2017 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018.

5. Goertz, C. M., Long, C. R., Hondras, M. A., Petri, R., Delgado, R., Lawrence, D. J., . . . Meeker, W. C. (2013, April 15). Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: Results of a pragmatic randomized comparative effectiveness study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23060056

6. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. 2012;172(19):1444–1453. doi:10.1001/archinternmed.2012.3654

7. https://www.apa.org/pubs/journals/releases/amp-a0035747.pdf

8. Bicket, M. C., Gupta, A., Brown, C. H., & Cohen, S. P. (2013, October 01). Epidural Injections for Spinal Pain:A Systematic Review and Meta-analysis Evaluating the “Control” Injections in Randomized Controlled Trials. Retrieved from http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1918146

9. M., S., B., A., A., & G. (n.d.). Analgesic effects of transcutaneous electrical nerve stimulation (TENS) in patients with fibromyalgia: A systematic review. Retrieved March 04, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/30029964

10. Joseph, L. H., Hancharoenkul, B., Sitilertpisan, P., Pirunsan, U., & Paungmali, A. (2018). Effects of Massage as a Combination Therapy with Lumbopelvic Stability Exercises as Compared to Standard Massage Therapy in Low Back Pain: a Randomized Cross-Over Study. International journal of therapeutic massage & bodywork11(4), 16-22.

11. Hoon, E. A., Gill, T. K., Pham, C., Gray, J., & Beilby, J. (2015). A population analysis of self-management and health-related quality of life for chronic musculoskeletal conditions. Health expectations : an international journal of public participation in health care and health policy20(1), 24-34.

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