Massage & Bodywork

SEPTEMBER | OCTOBER 2019

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Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 95 a certain position. Computer users who spend much time operating a mouse develop epicondylitis for this reason. It's not so much that there is a repetitive wrist extension movement as much as the wrist extensors and flexors are both in a chronic degree of isometric activity when holding and manipulating the mouse. Because both muscle groups, flexors and extensors, are overused at the same time, it is common to develop either medial or lateral epicondylitis from long periods using a computer mouse. Other factors play a role in developing epicondylitis. Body mass index, history of rotator cuff disease, de Quervain's tenosynovitis, carpal tunnel syndrome, and a history of smoking are all correlated with a higher incidence of lateral epicondylitis. It may be that some of these factors developed from the same mechanical stressors and just happened to occur simultaneously. The relationship between these corresponding factors is an important distinction. Just because those conditions occur together doesn't mean that one of them caused the other. The name of this condition, epicondylitis, would indicate that there is a primary inflammatory component because of its suffix, -itis. The original theories of epicondylitis suggested that it resulted from micro- tearing and inflammatory reactions within the extensor tendons. However, further investigations with increasingly sophisticated diagnostic instruments over the last several decades have revealed that epicondylitis, like most chronic overuse tendon disorders, is not an inflammatory condition caused by fiber tearing. Instead, the primary dysfunction appears to be collagen degeneration within the tendon. 2 We have a better understanding of the actual physiology of tendon breakdown in these conditions now, but still don't have a good understanding of why the collagen degeneration occurs. There may still be some minor inflammatory activity at certain stages of the problem. However, framing the condition as one of fiber tearing and inflammation Eccentric load on the wrist extensors. Lateral epicondylitis can become a debilitating condition, and because it is often related to occupational injuries, the condition can provoke significant anxiety. encourages a problematic treatment strategy. One of the primary treatment methods for reducing inflammation in soft tissues is corticosteroid injections. Unfortunately, corticosteroids have detrimental effects on long-term collagen synthesis within soft tissues and are a known factor in tendon weakening. The corticosteroid injections are effective at pain relief, which gives them the impression of healing the condition, but are detrimental in the long run. Jill Cook, one of the most prolific researchers into tendon pathology, authored a paper along with her colleagues in 2009 that presented a new model for chronic tendon dysfunction such as epicondylitis. 3 In this paper, they propose that tendon dysfunction exists on a continuum consisting of three essential stages of breakdown: reactive tendinopathy, tendon disrepair (failed healing), and degenerative tendinopathy. Each of these different stages has different physiological characteristics and responses to treatment. One reason that many overuse tendon pathology treatments seem effective is that one treatment is applied to conditions that are at different stages of the continuum. How different treatment strategies match up with the tendon dysfunction continuum is explained further in the treatment section below. As with other soft-tissue pathologies, there is not a direct correlation between the amount of pain and the level of tissue degeneration/damage to the tendon. In some cases, there is a significant degree of tissue damage/degeneration 2

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