Mrs K is a 50 year old disability worker who presented with a four month history of right lateral elbow pain(often known as Tennis Elbow) after a manual handling injury at work. She had seen her GP who had arranged an autologous blood injection 2 months ago. This had helped but Mrs K was still on light duties at work. She was also having problems ironing, brushing her teeth and being on the computer for more than 5 minutes.
Examination of Mrs K revealed she had a thoracic scoliosis(curve in the spine) and also restriction in her neck rotation to the right. Routine tests for tennis elbow were all positive, such as grip tests. She could not close a hand exercise gripper at all due to weakness and pain in the elbow. She had stiffness in her cervical and thoracic spines and further scanning revealed a large trigger point in her left inner hamstrings muscle.
Several areas were tested while Mrs K tried to squeeze the hand gripper(as this was a good objective measure of her elbow pain), including her neck and thoracic spine. These improved her ability to squeeze the gripper with reduced pain, but the area that made the biggest difference was releasing the left hamstring, which enabled her to fully close the gripper without pain! We were both astonished!. This happened during her first session and her grip improved in real time as we were releasing the hamstring trigger point.
Mrs K has gone on to achieve a 90% improvement in 3 sessions, even though her Ultrasound scan revealed a partial tendon tear of the common extensor tendon. She has begun a strengthening program and will gradually return to her normal duties.
This case demonstrates the importance of not making assumptions about a client’s presentation, testing the whole musculoskeletal system and throwing out the “recipe book” when it comes to treatment.
