Q&A Time! Help Explain Peripheral Sensitivity and Swelling in Elbow Case

Pain Science Education may be getting easier with practice and the more variety of patients you see, but what about using it for a chronic condition with actual physical signs of inflammation? That's today's Q&A Time!

"Today I was covering for another therapist and I was treating one of her patients who was presenting with tendinitis in her arm that has been going on for over 5 months. This patient was very frustrated that she wasn’t getting better and was concerned that she will never get better because she keeps re-injuring herself. She does repetitive work on a computer and continues to have noticeable swelling in her wrist/forearm. I explained to her that pain does not equal tissue damage and that pain persists because of heightened sensitivity. However, I had difficulty finding a way to explain why the inflammation is so persistent. I am wondering if you could help me by explaining how/why inflammation persists in these situations, and if you have a good analogy for explaining this to patients.

Thank you for your help and for keeping up the fantastic blog.
- Lauren"

Thanks Lauren, if you're lucky, a patient will get any analogy, story, or metaphor you tell them about pain not often correlating well to tissue damage. However, when there are actual physical signs of inflammation, redness, swelling, warmth, it is hard to use the pain as an output explanation solely.

There are some key points that need to be made in this case

pain is a neuroimmune response, not just a sensation as a warning sign
since the immune system is involved, actual chemical inflammatory mediators can cause peripheral sensitization in the area of perceived threat
this manifests itself as swelling/redness/tenderness, whether or not physical trauma or repetitive trauma is actually occuring

In the patient's case, the repetitive strain of the job is actually causing peripheral sensitivity, possibility contributing to some central sensitivity as well, You can see how this is quite the loop.

I don't know how she presents otherwise, but something needs to be done to remove her peripheral sensitivity like

light IASTM along the radial nerve for lateral epicondylalgia like complaints, or ulnar nerve for medial
neurodynamic sliders for the applicable nerve
cervical retraction and SB to the involved side to mediate and centralize the complaints - especially if there is a loss of cervical mobility to the involved side
a HEP performed often enough to give variability throughout her day to keep her window of improvement open
possible KT taping along the path of the peripheral nerve for continued novel input as she performs her ADLs and work activities

Required reading!

I hope this explanation helps. You should read Therapeutic Neuroscience Education if you have not by now!

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Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...