Broken Elbow - Pain Relief vs. ROM

[Toss that Yeyo and Run]

I have a friend who broke her elbow a year ago. She's also a massage therapist & was out of work for 2 months. However, she's been working a full schedule ever since & is diligent about her therapy. She stretches her arm numerous times per day to maintain her range of motion. Last week, she went on vacation & didn't stretch. She noticed 2 things: she lost some range of motion, but she also lost the dull pain she's been experiencing in her elbow for the past year. This week, she's done a little experiment, to see if she can massage with the limited ROM. It turns out she can: both swedish/deep tissue & Thai massage. So, her question for me was, "I love not having any pain in my elbow. Am I making a mistake to give up a little ROM for pain relief?"

What do you think?

 

[S P]

If it were me, I'd take the decrease in my ROM over pain any day. It's the quality of the life, not the quantity of it as my cancer survivors remind me.... is her quality of life better without the pain than with? Is she able to do what she wants without the stretches? Does the limited ROM maintain itself at that limited level or does it decrease? I'd pick limitation any day over constant pain.

Reasoning is this: 25 plus years ago I fractured my R calcaneus, talus, cuboid and 4th and 5th metatarsals plus tearing ligaments and damaging tendons in a jump off a bucking horse [another verrrry long story]. After 11 1/2 months of PT I could walk [was told my R foot would never be usable for walking again] and climb stairs etc. Pointing my toes was do-able as was flexing the ankle. Any side to side movement was extremely limited UNLESS I spent a minimum of an hour a day massaging and manipulating and drawing letters in the air with my toes........ just got fed up with the bother of it all and the pain that the manipulations and "exercises" caused me. Yep, it can be inconvenient to have my foot not do what it should when I plant it to turn abruptly, but, that inconvenience is waaaaay more minor than the constant pain and aggravation the daily maintenance work was creating.

A R pisiform fracture actually made it easier for me to do CST pelvic diaphragm release because it left my wrist at a slightly [less than 1 degree] angle than my L wrist so it's actually verrrry comfortable to slip my R hand under a sacrum and leave it there for as long as the release takes [up to 13 mins for one clt.] A R elbow fracture changed the ROM slightly as well. Does it impinge on my being able to do the work I love, nope. Just learned to do what needs to be done in conjunction with the way my body works or doesn't work.


One thought, has this gal had anyone work with her doing OrthoBionomy? Sometimes it can help undo some of the problems caused by scarring, etc. to increase slightly a limited ROM... just a thought.


PS - all the fractures I have had [with the exception of 3 toes that I dropped an 80 lb cedar log on] are related to the horse racing stable ex-hubby and I had ages ago - just in case y'all were wondering who was beating the crap out of my body.... LOL

 

[Aditya]

I broke my elbow back in 2000. It took me a few years to get full ROM back with stretching almost daily. As for strength in it I never got that back fully, I was a server before and after,could carry trays with no problem prior but after couldn't do it all that much with just one hand.
My pain is seldom these days.

Like Anastasia, I have broken several bones over my lifetime (all major ones on my R side) and I am limited sometimes in what I can do. You learn to adjust. I couldn't learn to adjust to pain.

 

[rare pokemon hunter]

I agree!!! Giving up a *little* ROM for pain relief makes good sense to me! If the stretches caused pain still after a year, I'd be quick to give them up.

 

[Khaled]

My first question is what stretching method was she using? She may not have to give up full ROM in order to remain pain-free.

 

[gh_alban27]

Thanks to everyone for your replies! I'll pass your experiences & support along to my friend. Isn't it amazing how our bodies can adapt?

My first question is what stretching method was she using? She may not have to give up full ROM in order to remain pain-free.

Jason, I believe she does static stretching. The loss of ROM is in extension. Would you recommend AIS instead? Since the problem isn't a tight muscle, but rather a joint that's been reshaped by injury, would AIS make a difference? If you think so, I can suggest she try it.

 

[Dink]

I don't think there is anything wrong with giving up a little ROM for pain relief, but the big question is: if she gives up the ROM now, will she continue over the years to give up more and more to keep getting that "pain relief"? It's a hard question to answer. Has she had a good amount of work applied to her extensors near the elbow. Many times I have noticed with clients who have fractured this region... especially the two who have recieved plates, that those muscles need to be stripped out.

Just a different take on it, I guess.

 

[link]

Has she had a good amount of work applied to her extensors near the elbow?

Yes, definitely. She's had lots of excellent bodywork to support her healing process, including detailed stripping to the extensors. I don't think the extensors are a current problem, because performing massage therapy (which tightens all of her forearm muscles) causes her no pain. It's only when she stretches to full ROM that her elbow hurts.

The big question is: if she gives up the ROM now, will she continue over the years to give up more and more to keep getting that "pain relief"?

Good question. Anastasia, with your injuries, did you find the restricted ROM stayed stable, or continued to decrease over the years?

 

[Ace]

My first question is what stretching method was she using? She may not have to give up full ROM in order to remain pain-free.

Jason, I believe she does static stretching. The loss of ROM is in extension. Would you recommend AIS instead? Since the problem isn't a tight muscle, but rather a joint that's been reshaped by injury, would AIS make a difference? If you think so, I can suggest she try it.

If it's a matter of very minor bone remodeling, then it may be possible for her to regain some of the lost ROM. At the very least, with AIS she should be able to retain more of her remaining ROM without so much pain.

There are several issues I have with typical static stretching methods:

1. Most people try to stretch too intensely, when less is often more.
2. The long holds increase risk of stretching ligaments.
3. The long holds trigger the myotatic stretch reflex, causing the muscle to try shortening even as you hold the stretch.
4. Stretch positions are ischemic, so circulation is temporarily reduced in the target tissues while holding the stretch, possibly irritating sensitive tissues.
5. On its own, static flexibility doesn't translate well into dynamic mobility, since the body hasn't been trained to really use the ROM.

I like AIS because it addresses all of the above concerns, is effective, and is gentle enough for anyone. If she can learn to perform the techniques correctly, she may be pleasantly surprised with the results.

 

[John de Witt]

BTW, for anyone not in the "know", Blisss & JasonE are talking about Active Isloated Stretching, or so I assume.

Stretching USA w/seminars & events on the upper right hand corner of themain page and products such as DVD's and books can be found in the "Products" section.

While I'm adding tidbits, I just ran across a review about Arron Mattes books where there were "two other good books" mentioned in said review were by Paul Blakely ( I don't know anything about him, but thought I should add it all the same... just in case):

Paul Blakey, formerly an international ballet dancer and now a practicing osteopath...

• The Muscle Book
• Stretching Without Pain

Blisss,

Some years ago, a Feldenkrais Practitioner spoke of how Feldenkrais can help those who would like strategies to deal with movement limitations. Possibly another place for your frend to look.

~pueppi~