Tennis Elbow and Other Repetitive Strain Injuries
Physical Therapy Keeps 'Wounded Warrior' On Top Of Game
By Marge Dwyer
Beth Israel Deaconess Medical Center Correspondent
It's ironic that Dudley Blodget, who loves playing tennis and works for Tenacity, a nonprofit that builds life skills in Boston youth through tennis, occasionally has been sidelined by repetitive injuries from tennis and other sports.
"I'm like a wounded warrior. I've never been the sturdy athlete I wanted to be," says the 65-year-old Winchester, MA, resident. Injured ankles, calf muscles, hamstring pulls, a torn rotator cuff…the list goes on. Today, however, Blodget regularly plays squash, racquetball, and his favorite, platform tennis, played with a paddle. "It doesn't matter if it's snowing outside, I can still play tennis."
What keeps him in the game? Physical therapist Mark Dynan, Supervisor of Rehabilitation Services at Beth Israel Deaconess Healthcare in Lexington, MA, who Blodget has seen for 10 years, is one "secret weapon."
"Mark's great. He's helped me stay in the game," Blodget explains. Dynan helped him rehabilitate after rotator cuff (shoulder) surgery last March. "By June I could golf, September play light tennis, and by October, platform tennis," Blodget says.
"Dudley is like many who spend the work day sitting at a computer and then race to the tennis courts, do no real warm up, play aggressively and get injured," Dynan says. He's taught Blodget to avoid injury by warming up with five minutes of light jogging or cycling followed by gentle stretches to make sure muscles are flexible.
"Most overuse injuries come from doing too much, too fast and not pacing yourself, or from doing too much of one activity," Dynan explains. A classic example is the sedentary person who hasn't exercised all winter and at the first sign of spring starts running two miles a day every day instead of gradually increasing their running. Older people are even more vulnerable; injuries are more likely when you are 45 than 25 if you haven't been doing any regular preventive care.
Common Repetitive Injuries
Common repetitive injuries include:
- Achilles tendinopathy , resulting from calf muscles stressed during soccer, running, jumping and other sports. "We used to call this Achilles tendonitis thinking that the inflamed tendon was the problem, but we now know that degenerative changes can occur that, if untreated, can become chronic," Dynan says.
- Iliotibial band (ITB) syndrome , a leading cause of knee pain in runners. Tissue connecting the pelvis, hip and knee tightens and increases friction on the outside of the knee. Although knee pain is the symptom, impaired alignment at the hip or foot can lead to the band tightening.
- Shoulder impingement , common in sports with overhead movement, like tennis, volleyball, swimming and baseball. Weak or overused rotator cuff muscles are the culprit. Poor posture also can contribute. Sitting often with shoulders rounded causes muscles to weaken and can change the resting position of the shoulder blade. The resulting altered shoulder mechanics can lead to a painful "pinching" with overhead activities.
- Tennis elbow , resulting from overuse of tendons in the forearm. "It's the repetitive gripping and overuse of the forearm muscles that leads to injury and degeneration of the tendons," Dynan says. While anti-inflammatory medications and rest can help temporarily, the problem doesn't go away because the tendon has degenerated. Appropriate measures to strengthen the healed tendon adequately before resuming the activity must be done to prevent recurrence.
Three Simple Steps To Help Avoid Overuse Injuries
Dynan points to three simple steps that can help avoid overuse injuries:
- See the physical therapist for an assessment before you get injured rather than after. If you have flat feet or high arches, are knock-kneed or bowlegged, have a curved spine or uneven legs, you probably don't know it until you're assessed. "It is usually these unknown postural impairments or muscle imbalances that make us susceptible to 'overuse' in the first place," he says.
- Warm up correctly. Do five minutes of cycling or walking, and a series of pain-free stretches for 20-30 seconds each with no bouncing that can stress tissues.
- After activity, cool down with, say, a five minute walk and mild stretching.
An injury doesn't mean you must give up the activity. "A physical therapist will work with you to identify your 'imbalances' and make the weak muscles stronger. Gradually you can go back to the sport," he says.
Dynan also has helped Blodget's wife, Pam Budner, stay active, despite tendonitis and other injuries in her leg from ballet and modern dance years ago. "Imagine a piece of celery. The inner ribs are pulled apart and frayed. A tear makes it painful to walk. That was me," she says, referring to a tear in a tendon on the inside of her foot. Dynan helped her regain motion and flexibility last year after knee surgery. How she walked from years of chronic foot problems had affected both her knee and her hip. Although Budner went to him to recover from knee surgery, he looked at the entire picture in order to help her recover. "He gave me exercises to put my hip in alignment. Now I have less stress on my knees, hip and ankle," she says.
At 60, Budner stretches daily for 45-minutes, goes to the gym several times a week and takes twice weekly yoga classes. She does the physical therapy exercises daily. "I look at these as lifelong exercises - like brushing my teeth. I do them every day to keep free of pain," she says.
Schedule an Appointment with Rehabilitation Services
To schedule an appointment with the experts at Rehabilitation Services at Beth Israel Deaconess Healthcare Lexington, 482 Bedford Street, call (781) 528-2510.
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted March 2010