Chronic Strains

We are realizing that chronic strains, sprains and tendinitis ("pulled ligaments") are different than acute ones, and respond differently to different kinds of treatment.

Common examples of these include strains of the forearm tendons ("tennis elbow"), the ligament below the kneecap, or subpatellar tendon ("jumper's knee) and shoulder or rotator cuff strains ("pitcher's shoulder").  By acute, we mean new.  By chronic, we mean that the pain has been going on for 6-8 weeks or longer.

When you overwork or suddenly strain a tendon, tendon fibers are actually torn and damaged at a microscopic level.  (Injuries in which the tendon is actually torn through or completely ruptured would be a totally different discussion.)  Your body responds to this injury by increasing blood flow to the area to prevent infection and by shortening the muscle and tendon ("spasming") to prevent further injury.

This is why when an injury is new, it helps to put ice on it (this reduces blood flow to the area, and thus reduces swelling and inflammation) and to take anti-inflammatory pain relievers such as ibuprofen or naproxen (because they reduce pain, and also reduce inflammation which  causes pain).  Avoiding painful activity also helps here, because you are allowing the injured area to rest and heal.

On the other hand (sorry, no pun), when the pain has been present for over 6-8 weeks, it turns out that this model is no longer accurate.

We used to think that this was how tendinitis worked all the way through its course.  However, it turns out that as time goes on, inflammation and swelling  are replaced by separation of collagen or connective tissue fibers and development of new blood vessels (neovascularization).  This explains why you can reach a point where anti-inflammatory pain medicines, cortisone injections and surgeries no longer help to relieve the pain.

Happily, this is where physical therapy really comes into its own.  A professional physical therapist can help you to re-stretch the injured tendons and re-strengthen muscles that support it.  While it's more time consuming than taking pills or getting a shot, it works better than any other treatment including surgery for tendon strains of over 6-8 weeks in duration.

We are very fortunate here to have plenty of highly skilled and effective physical therapists in a wide variety of locations near most people's home or work.

So, bear in mind that if your strained your shoulder or your elbow and it won't seem to go away and medication stopped helping, it may be time to re-assess the situation and consider getting a physical therapist involved in getting you back  to form!