Case Presentation: Patient presents with bilateral epicondylitis after performing crawling during an exercise class.
The right side was worse when we were looking at the bilateral epicondylitis. There was pain onset following a high volume crawling exercise class. Pain present for six weeks prior to the session and was unresponsive to other treatments. The pain occurred straight on arm loading which radiated to a small degree into the… And also was radiated with bicep curls. The findings were, there was pain on finger extension and wrist extension, as well as straight arm, long head biceps loading. There was slight dissymmetry to the left, and as well as into the shoulder.
Jessica Sears presents her thoughts on this case presentation.
Looking at it, we see what the activities that she’s going with as being the cause of it, but it’s looking at what she does in her day to day. What’s her work? Is she in an office environment? Does she have to use her upper limbs more? Depending on what she does, when you’re at desk work or computer work, some postures go with that. But the activities that she’s been doing have probably been the main cause of it. We try and limit those activities, but it’s hard to take back. When it comes to treatment-wise, kind of a little bit as Emily was pointing to, I’d look at the front and back arm fascial lines. See what is jammed and probably what isn’t moving properly, to maybe go down to those areas.
We involve the neck, we involve the shoulder, we go down to the elbow, and try to see where the lines aren’t moving properly. Try to work the fascial aspect of it first. When it comes to the neck, we can do some cranial circles, see if that doesn’t create a release to any of the tissue as well, to get everything involved in it. When it does come to the shoulder and neck, we involve the soft tissue, so we go with a little bit of a trigger point release, see what that can create, or if it can create more movement. Chances are we will find some hypertonicity. So we will mix in some Swedish massage, a little bit of effleurage, petrissage, some friction is in there. Muscle stripping. Chances are a lot of the rotator cuff muscles are mixed into it. There was some teres, so we kinda look at all the rotator cuff muscles, just to make sure that they’re not the cause of it, and the teres has just flared up because of that. Once we can free up the shoulder, we can kind of… Shoulder and neck, we go down to the main issue, and see how flexors and extensors are moving, or not moving. We can do some active release in there. A lot of muscle stripping. A lot of effleurage, trying to just get everything flowing and moving properly. And after that, it’s kinda up to them.
We go a little bit with the strength, depending on how the movement is. After that, we can start with a little bit of contract/relax. I do like the stress ball for the epicondylitis, so maybe depending on how the movement is at the clinic, we may start with a towel just to get the slow contract/relax. If the stress ball is a little bit too much, the towel will be the main one for the first week, and hopefully, the stress ball will go in. After that, it’s kind of like a give-and-take of how the day-to-day activity is playing with the treatment. You can only do so much, but they do return to their flare-up stage every time that they return to their activity. So it’s playing with the give-and-take of what the patient can give you, depending on their environment and how much they can put aside for a little while.
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Jessica Sears Bsc Kin, RMT, SMT (C)
Jessica graduated with a Bachelors of Science in Kinesiology in 2003 and in 2005, she graduated from the Kiné Concept Maritimes Inc. School in Massage Therapy. Since then, she worked nine years at Champlain Physiotherapy, as a Kinesiologist and Massage Therapist and recently has moved her clinic to Protherapy. She has been selected as Team Therapist with Team Atlantic, for the National Women’s Under 18 Hockey Championship in 2011, Team Canada-Atlantic for the World Under 17 Hockey Challenge in 2013 and 2014. Currently Jessica is the Vice President for the Canadian Sport Massage Therapists Association.