The web of muscle, ligament and bone

Thursday, 10 March 2022

This morning I went to my an evaluation by a physical therapist. For several months I’ve had a small spot of pain – about the size of the tip of my little finger – dwelling in my right elbow. It makes itself known only occasionally, but when it does it does so with considerable force: a sharp, hot, shot of pain. Normally it happens when my arm is extended and my fingers grip something with a bit of force. Though, if I’ve irritated it, the spot can flare up during seeming innocuous activities.

Generally, an episode is induced by some vigorous activity involving frequent gripping and grasping and holding. Gardening, especially digging with a trowel and pulling weeds by hand, is the usual and most evident culprit. More recently, an episode was triggered by reassembling a recalcitrant bookcase, which required a lot of squeezing and holding heavy things with one hand. After this most recent insult, rather than resolving after a couple of weeks, the pain lingered, wanning and then, without any clear incitement, waxing again. Eventually, after it failed to resolve during the quiescent period of my recuperation from surgery, I decided I should deal with it. I consulted with my doctor – who having done an x-ray that showed nothing structurally amiss – referred me to a physical therapist

I must say that I do like physical therapy. I like it because the examination and evaluation is so transparent. There are no x-rays that produce ghostly white shadows, no blood work that produces mysterious BUN/Creatinine ratios, no machines that hum or buzz and give forth a number. Instead it’s a very human, very one on one interaction: raise you arm like this – does that hurt? Where? How about this? Hold your arm out and I will press on it – try not to move it. Squeeze as tightly as you can; good, now hold your arm this way and squeeze again. After a while, it is clear that the therapist understands what will produce discomfort, and what will not, and then she can give an account and provide any number of confirming demonstrations: it is these two muscles, and they attach to the ligament here, which is right where the pain is.

And it is also nice because often the problem is part of a larger system. The thigh bone is connected to the knee bone, and the kneedmay be in unhappy because of the thigh. In my case, my elbow ligament is irritated because my arm has been overcompensating for weakness in my right shoulder. The shoulder had, indeed, been the subject of a previous series of visits, and I thought I’d gotten it back to about 95% of where it shoulder. I had diligently continued my shoulder exercises, until August, when my diagnosis of prostate cancer distracted me from my exercise regime, and that lapse – followed by continued inactivity during my recovery from surgery – coincides with the failure of the elbow pain to resolve. It all fits together. Very satisfying, and oddly comforting to have a narrative that makes sense of it all and connects it to things I already knew about. While I’m not keen on having the problem, I like it when things make sense.

And, since today marks the day when I can resume activities like lifting more than 10 pounds, and doing things that will exercise my abdomen and core, I can begin a concerted effort to address the problem. Ideally, not only will I come out of this having resolved the elbow issue, but I will be able to get a bit more guidance in getting my shoulders (which, truthfully, I’d thought were back to 95%), and my core (which has needed more work) back into shape.

So, I will update my exercise guide, adding the initial set of hand and wrist excercises (intended to placate the irritated tendon), to my Kegel exercises (for my prostate recovery), and my eccentric heel drops (to protect my achilles tendon for when I start running again). Interestingly, one of the exercises I will do for the elbow is a cousin of the eccentric heel drop: both involve an assisted lift of the joint spanned by the tendon, followed by a controlled drop of it which will strengthen muscles that will ultimately take stress off the tendon. So it all fits together nicely. Everything is connected, both physically and metaphorically.

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