Dr. Mukesh Vyas

All tennis elbow and golfer’s elbow are both injuries to the elbow joint that are caused due to overuse. Technically, they are both considered to be forms of epicondylitis. This refers to an inflammation of the tendons attached to the elbow. Another similarity between them is that they are not restricted to athletes. However, they are not synonymous. The main difference between the two conditions lies in the part of the elbow that is affected.

Tennis elbow:
This condition is also known as lateral epicondylitis. It is most commonly diagnosed amongst patients between the age of 30 to 50 years. The tendons affected by this condition are located on the lateral or outer side of the elbow. Thus, it is marked by inflammation of the outer areas of the forearm and elbow due to repetitive actions by the wrist and forearm. The condition is commonly known as tennis elbow because a forehand or backhand stroke exerts the muscles that cause this inflammation. Cooks, carpenters, plumbers and painters are most susceptible to this condition. Seasonal activities such as gardening or raking can also trigger tennis elbow.

Symptoms of tennis elbow:
A pain that radiates from the outer elbow to the wrist and forearm is a characteristic symptom of this condition. This pain may be felt as a constant ache or only experienced while performing certain activities. In addition, the forearm might feel weak and patients may complain of having a weak grip.

Golfer’s elbow:
Golfer’s elbow is also known as medial epicondylitis. This condition affects the tendons on the medial or inside of the elbow. It is characterized by pain and irritation on the inside elbow and arm. Any action that requires repetitive flexing and twisting of the wrist can cause this condition. Thus, golfers are at a high risk of suffering from it. Medial epicondylitis can also be caused by shovelling, gardening or throwing a ball. Carpenters, weightlifters and painters often find themselves experiencing pain associated with this condition.

Symptoms of golfer’s elbow:
A pain on the inner side of the elbow is the main symptom associated with golfer’s elbow. This pain usually radiates downwards to the forearm. It may be experienced when lifting the hand or when twisting the forearm, such as when making a fist. The elbow may also be slightly swollen and feel tender. In addition, patients may experience a tingling sensation in the ring and little finger. If left untreated for a long time, it could cause elbow stiffness as well as weakness in the wrist.

Being flexible is not always about doing splits or doing some random bending. It is about achieving a level of mobility that will not hold you back from doing whatever you are able to do. Most people think that stretching or flexing your muscles and body as the first method to defend you from pain. But if stretching and flexing can be done correctly, it can lengthen one's muscles and give one relief from pains and aches. Stretching is also done to increase the functional range of one's joints and muscles. There are various ways by which one can stretch their muscles. However, the question which looms over here is which is the correct procedure and which is the wrong one.

The wrong vs the right way: Before discussing about the correct way, let us talk about the various wrong ways in which stretching can be done. The first rule is that if stretching is causing you pain or if it is hurting you, then you are probably taking it too far. A muscle needs to relax as much as possible, if it needs to stretch. If one is stretching so hard that he or she cannot relax then the muscle will not lengthen. Stretching should never be painful.

One should also avoid stretching for an insufficient length of time. Only a few seconds of stretching will not hold the therapeutic effects of stretching.

The following methods are few of the correct ways to stretch:

• Always start with the warm muscles. Warm your muscles by doing some aerobic movement or by applying heat with the help of a warm bath.
• After warming your muscles, monitor your level of discomfort. Let it go once you feel pain.
• Hold any stretch for at least 30 seconds.
• Stretching the correct muscle: There are muscles, which need to be stretched and there are muscles, which should not be. So getting to know the correct muscles to be stretched is as important as knowing the correct procedure to stretch your muscles. Every muscle, which does not hurt should not be stretched. There are different types of muscles that cause pain like stiff, tight, short muscles and long muscles. Muscles that are tight should only be subjected to stretching. Stretching muscles that are too long is not a good idea.
• Using physiotherapists: Most people who cannot determine which muscle should be stretched and which should not be, should consult a physiotherapist. Physiotherapists can quickly and easily diagnose muscular issues. They will also show ways to stretch which are most effective for particular needs.
• Stretching should be made a part of one's life. It is a way by which one can become their healthiest self and avoid muscular imbalances.

Knee injury can occur from the direct blow as well as through stretching and twisting injuries. At times the ligament that holds the knee in place gets stressed and results in sprains. Depending on the extent of the ligament and fibre damage, the sprains are graded. Then there are knee injuries that are caused by overuse of it. These injuries cause harm to the tendons and the muscles. Since the knee is interconnected to a lot of other structures, any damage to the knee can have serious repercussion to other connected bones and ligaments.

What are the risk factors?

• Muscle imbalance leading to hamstring spasm.
• Imbalance of the thigh muscle leading to injury of the knee.
• Pregnant women and people who are overweight are at increased risk of knee injury

Signs and symptoms of a knee injury:

Knee injuries that are serious in nature can result in instant swelling along with difficulty in bending it. People may find it difficult to bear any sort of weight whatsoever. Joint pain, swelling, inflammation of the muscles are some of the other symptoms of injury to the knee. Pain, instability, locking of the knee can be felt while walking fast or climbing stairs.

When to contact a doctor?

Any knee injury should be instantly reported to a doctor. Signs such as deformity, loss of sensation, cold ankle, swelling of knee etc. Are signs of a knee injury. A doctor should be consulted, if home remedies such as rest, elevation, compression and ice treatment fail to fetch any fruitful results. If the swollen area has become warm and red and accompanies fever, it is a sign to visit the doctor.

How is a knee injury diagnosed by a doctor?

A doctor starts the diagnosis with medical history along with physical exam of the patient. Doctor first does a thorough inspection of the nerve and blood supply of the area. The next step of the diagnosis includes palpation. This is a step where the doctor tries to find out the exact location of the pain and tries to correlate the same with the injury location. The doctor might also stress the ligament in order to find out if they are fine. Other imagery tests such as x-ray and mri are performed to find out the exact location of the injury.

Treatment available:

The nature of the injury decides the treatment plan. In many cases, the injured area is suggested to be kept at rest or moved in the specific direction as per the direction of a physiotherapist. For serious injuries with a tendon or ligament injury, a reconstructive surgery is necessary to get the knee to the original condition. The type of surgical procedure depends on the kind of injury one have faced.

An overloaded backpack or wearing one improperly can lead to a poor posture, stress on the soft tissue in the neck and the back, and unnecessary strain on muscles and joints.

Fibromyalgia is a musculoskeletal disorder that is characterized by pain in the muscles and the joints. This disorder leads to the development of multiple tender points on the body, wherein, a very small amount of pressure applied might result in pain. In some cases, social isolation and depression may occur as a result of this disorder.

The symptoms of fibromyalgia are:
1. You will have difficulties in sleeping at night
2. You may experience mental problems and cognitive dysfunction
3. Light and noise sensitivity
4. Irritable bowel syndrome
5. A numb feeling on your hands and feet
6. Chronic headaches
7. You may experience painful periods
8. Restless legs syndrome
9. You may be depressed

The muscles of the body tend to feel overworked, even though you may not have exercised. You may also experience deep throbbing pain and burning sensation in the muscles. In addition, it may cause symptoms similar to osteoarthritis and bursitis. You are at a higher risk of being affected by fibromyalgia if you have a family history of this particular disease.

Some other causes of this disease are:
1. Certain infections and illness may lead to fibromyalgia
2. Car accidents
3. Any repetitive motion

The treatments for this disorder include:

Sleep management: optimal levels of sleep at night help in improving symptoms of fibromyalgia. Don’t drink coffee or consume spicy foods before going to bed as these have the ability to interfere with your sleep cycles.
Medications: the doctor may prescribe medications to manage the pain. Taking anti-depressants may be necessary if you suffer from depression.
Other therapies: massage treatments help in easing the symptoms of fibromyalgia. You may continue with your exercise regimen after consulting the doctor. Relaxation techniques like mediation may help improving your mental health. You may also be asked to include various food supplements to make sure your body receives the necessary nutrients in the right amounts.

Myth 1: pain is always caused by an underlying tissue damage

Fact 1: There need not be a tissue damage for pain to occur. In majority of the cases mere postural deviations, muscle tightness, inadequate joint range and reduced neural mobility, decreased soft tissue (fascia) flexibility can cause pain.

Myth 2: Degenerative changes in the joint (as seen in the x-ray and mri) is the primary cause of pain.

Fact 2: Movement dysfunctions like loss of the intrinsic joint play movements and adverse neural tension cause most of the pain, rather than degeneration.

Myth 3: Pain should not be treated based on radiological (x-ray, mri) reports.

Fact 3: Pain should be treated based on patient history and physical assessment. Radiological or laboratory investigations should be used only to rule out any potential red flag (harmful) pathologies. Ex; tuberculosisspine, inflammatory arthropathy, fracture, dislocation etc.

Myth 4: Treatment should be given exactly in the area of pain.

Fact 4:  In most instances the cause of pain is present in an area distant to the site of actual pain and hence the treatment should focus on removing the cause of pain rather than alleviating the symptoms in the area of pain. Ex: most of the knee pain is caused by a dysfunction in low back (lumbar) and hip (pelvis) regions.

Myth 5: The painful joint should not be moved and weight should not be transferred through the joint.

Fact 5.  Normal movement within the painless range is mandatory for the recovery and graded protective loading of the affected structures is vital for the re- modeling of the collagen in the soft tissues and functional recovery.

Myth 6: Pain is a disease and hence it should be treated. 

Fact6:  Pain is only a symptom of an underlying disease or a dysfunction and hence when the cause of pain is treated pain vanishes by itself.

Herniated disks or bone spurts in the vertebrae of the neck may become the reason behind severe neck pan. They sometimes take too much space and compress the nerves branching out from the spinal cord.