Care for the pregnant woman and her babyRock layer's elbow
By Dr. Peter Loescher
Three years ago I decided that it was time to plant a vegetable garden. As I started digging to loosen up the ground, I found that I had chosen to cultivate a minefield of subterranean rocks and boulders.
Over the next three springs, I dug and pried and moved rocks and planted squash and peas around the immovables.
Then, last summer, I just got fed up with the big rocks, so I went out and got myself a Kubota tractor. Complete with bucket, backhoe and tow chain, I was armed for battle against the igneous enemy.
I unearthed more tonnage of stone in one day than I had in the previous three years combined, which left me with one problem – what to do with all of these rocks.
Well, it didn’t take long to be inspired by all of the beautiful stone walls around me, so I decided that if the early settlers could do it, then so could I.
With a how-to book and a crowbar borrowed from my neighbor, I set out to turn 20 tons of unearthed stones into a work of art. I wanted to be as pure as possible in my construction, and I committed in my mind to only use the tractor for rocks that I absolutely could not move by hand or with non-motorized tools.
What I developed, along with a deep respect for the settlers and farmers who built the stone walls that traverse our landscape, is a serious case of rock layer’s elbow.
Although this condition is known more commonly as tennis elbow, I can count on one hand the number of times in 10 years of medical practice that I have seen it caused by playing tennis.
The medical books will tell you that it is caused by hitting the tennis backhand with poor form or with a grip that is too small or strings that are too tight, but around here that is the exception rather than the rule. Maybe it is because the tennis season is in Vermont is too short to induce any type of chronic condition, but there are many more cases induced by shoveling snow, chopping and stacking firewood, gardening, walking dogs on leashes, holding small children and excessive “mousing” and keyboarding than by playing tennis.
Ten times more common than its kissing cousin, golfer’s elbow, tennis elbow’s classic symptom is pain at the bone on the outside of the elbow (the same side as the thumb with the palm up). This bone is the attachment site for the tendon that extends the wrist. Small tears to this tendon at its attachment site lead over time first to inflammation, and then to chronic degenerative scarring and thickening, which both weakens the tendon and causes pain. The worse it gets, the more easily pain is provoked. Once you cannot pick up your morning coffee cup without pain, it is well past time to visit your doctor.
Treatment for tennis elbow can take many forms. Avoiding painful activities is critical to allow healing to begin. If the extensor tendon must be used, then a tennis elbow strap can be helpful to tether the tendon downstream from its attachment site and take some of the pressure off the tender area.
Anti-inflammatory measures (ice after activity and before bed and ibuprofen) can be helpful. Proper sleep position is important – keep the elbow away from the body and avoid flexing it beyond 90 degrees. Physical or occupational therapy can be helpful as well.
Stretching and strengthening exercises are necessary to keep the condition from coming back. Cortisone shots can quickly make a sore elbow feel better, but should not be used too often in the same location.
And a new and exciting treatment for tennis elbow that is not getting better with these other techniques is called platelet rich plasma therapy.
In this treatment, blood is drawn from the patient and the platelets are concentrated and injected back into the area of injury. The platelets recruit the body’s own healing cells to promote a vigorous healing response. It is a relatively new treatment concept, but studies to date have shown it to be very effective for this condition.
Finally, surgery is an option if nothing else is working.
As for my stone wall: I am caught between a rock and a hard place. I need to let the elbow heal, but I need to get the rocks in place. My borrowed book also has a pithy truth that is haunting me: “There is no such thing as a half finished stone wall. It is either a stone wall or a pile of rocks.”
Maybe it’s time to fire up the Kubota.
Dr. Peter Loescher is a sports medicine specialist at Gifford Medical Center’s Sharon Health Center and Sports Medicine Clinic. He’s since finished the stone wall.
Past health columns
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Read about the winter blues >>
Read about the preventing flu in children >>
Read about ACL tears in women and girls >>
Read about childhood immunizations >>