Ms C consulted us recently with a 3 year history of R Tennis Elbow, after having undergone 4 cortisone injections. Ultrasound scans showed a partial thickness tear in her extensor tendon.
She was extremely frustrated and had stopped her personal training, Pilates and cycling due to elbow pain. She also had difficulty with carrying groceries, using her computer for more than 15min without pain, stirring a pot and even pouring a jug of milk.On assessment, Ms C’s main signs were that she had a thoracic scoliosis(curve in the spine), and stiffness in the joints around T4-6 (thoracic spine) due to postural imbalance. She also had guarding and tension within the subscapularis, pec major and infraspinatus muscles, and segmental dysfunction (stiffness to palpation assessment) in L4 from the front of her spine (palpated through the abdomen). She had poor grip strength and other standard tests for Tennis Elbow were all positive. She also had positive neurodynamic tests.
Treatment consisted of a range of techniques to address musculoskeletal imbalance, correct posture and educate Ms C on the causes of her dysfunction. It was revealed that her primary contributing factor was her thoracic spine around T4 ,which was rotated to the right.
Her grip strength improved very quickly, and she returned to personal training and Pilates within 4 weeks. She was able to use her arm more normally and her sense of positivity had returned.
Most of Ms C’s treatment was not directed to her elbow but to the other factors that had caused it to become painful, namely postural and biomechanical imbalances.
This highlights the value of a thorough whole body assessment in solving musculoskeletal problems, and was a very satisfying result to have achieved form a clinician’s perspective.
