What is it? Epicondylitis is inflammation of the bony parts on either side of the elbow where some tendons of muscles attach. The lateral epicondyle is where the wrist extensor muscles attach, and inflammation here is called lateral epicondylitis or “tennis elbow”. The medial epicondyle is where the wrist flexor muscles attach, and inflammation here is called medial epicondylitis, or “golfer’s elbow”.

How did I get it? You don’t have to play one of these sports to experience an injury that causes inflammation at the elbow. Epicondylitis can happen due to repetitive forceful wrist motion, or from trying to keep the wrist stable against an external force, or due to a traumatic injury.

How do I know if I have it? You can tell you have “tennis elbow” if it hurts to touch the lateral epicondyle, and the pain increases when you extend your wrist against resistance. You can tell you have “golfer’s elbow” if it hurts to touch the medial epicondyle, and the pain increases when you flex your wrist against resistance. Your physician can check these maneuvers for you if you are not sure.

How do I treat it? The first and most conservative treatment is rest – take a break from the activity that caused the epicondylitis. You can use ice or heat for 10 minutes three times a day. A counterforce brace to the forearm can be used to decrease the tug of the muscles on the elbow. A counterforce brace is the strap that you sometimes see on athletes encircling their forearm just below the elbow, which you can typically get at your local pharmacy. There are some over-the-counter remedies you can try such as topical Arnica gel, Traumeel ointment, or a Salonpas patch to help decrease pain and swelling.

What if I still have pain? Then, it is time to see your physician. Your physician will perform a physical exam to rule out other diagnoses and to confirm lateral or medial epicondylitis. Your physician may want to order an x-ray to rule out an avulsion of the epicondyle, which is when a little piece of bone gets pulled away with the tendon during a forceful movement. An injection at the location where the wrist muscle tendons attach to the elbow can help decrease the pain. I recommend not injecting steroids because they can weaken the tendon making it more likely to rupture. I prefer to inject natural pain-inhibiting substances like Sarapin and local anesthetics. I also like to use Kinesio tape over the forearm and elbow in a pattern that inhibits the wrist extensor or flexor muscles while the area is healing.

What if it has been more than 2 months, and I still have elbow pain? Then, your body has not fully healed the injury and might need some assistance to do so. Prolotherapy is a series of injections of a safe, proliferative solution to the spots where the muscles and ligaments attach to bones. Prolotherapy stimulates your body to lay down more collagen, strengthening the tendons and ligaments of the elbow, fixing the problem.

My elbow is all better. Can I go back to my activities? How do I prevent myself from getting epicondylitis again? The best thing to prevent future bouts of lateral or medial epicondylitis is a stretching and strengthening program for your wrist flexor and extensor muscles. Start with isometric strengthening, which is when you flex or extend your wrist against resistance without moving it. You should be able to see the muscles in your forearm contracting. You can stretch the wrist flexors and extensors by using your opposite hand to gently push your hand into further flexion or extension than you can achieve on your own and hold for a count of ten. Your physician can teach you these maneuvers or refer you to a physical therapist. Once your elbow is pain-free, strong, and limber, then you can return to your activities.

Contact Dr. Boston at the Akasha Center for Integrative Medicine if you are interested in being evaluated and treated for elbow pain.  The Akasha Center is located at 520 Arizona Ave, Santa Monica, CA 90401.  (310)-451-8880

Sacroiliac joint (SIJ) pain is more common than you think. What is the SIJ? Well, you know those dimples you have at the top of your buttocks, one on the left and one on the right? That is the location of the top of the sacroiliac joints. Imagine an upside-down triangle starting at those dimples down to your butt crack…that is the path of the SIJ’s. The sacroiliac joints connect the pelvis (iliac bones) to the sacrum (the lowest portion of the spinal column), and transfer force and weight between the upper body and the lower body.

These joints have some mobility which increases in women after childbirth. The ligaments holding the pelvis tight are relaxed during pregnancy by a hormone called relaxin. Sometimes the increased SIJ mobility continues indefinitely after the baby is born, and never gets back to the pre-childbearing level of tautness. The SIJ’s are true synovial-lined joints that can swell just like any other arthritic joint. They can cause a radiating pain that starts in the buttock and radiates down the back of the leg, resembling sciatica. In fact, some practitioners believe that most cases of “sciatica” are actually due to SIJ dysfunction.

You ask yourself, “Do I have SIJ pain? Is that what my low back pain is?” To find out whether your low back/buttock pain is due to SIJ dysfunction, your doctor can do some physical exam maneuvers that will stress the SIJ, which if your usual pain is reproduced or increased, makes it likely to be SIJ dysfunction. Imaging techniques such as x-ray or MRI are not always necessary, but can show arthritic changes, inflammation, or sclerosis.

Why do I have SIJ pain? You might have increased mobility at the SIJ due to ligament laxity, inflammation of the joint due to synovitis, arthritis of the joint due to wear and tear (sports, gymnastics, trauma), spondylitis due to an inherited condition, or sclerosis of the joint due to degenerative changes.

What can be done? SIJ dysfunction is a condition that typically has flairs and remissions. There are many treatments that are useful in managing SIJ dysfunction. The first and foremost treatment is prevention (prevention of SIJ pain or prevention of worsening of SIJ pain). This includes maintaining a healthy body weight, because carrying extra weight on the bones of your lumbosacral spine and pelvis is a recipe for pain. Maintaining good nutrition and hydration to keep the bones, joints, ligaments, and tendons of the SIJ region healthy is also necessary. If you have the weight, nutrient, and hydration pieces squared away, but still have SIJ pain, then it is time to institute a targeted exercise program for strengthening and stretching, and some treatment modalities.

Exercises to limber up and strengthen the buttock, low back, hip, and hamstring muscles can be taught to you by a physiatrist, physical therapist or qualified personal trainer. The gluteus maximus, gluteus medius, piriformis, and quadratus lumborum muscles attach in proximity to the SIJ. Targeting these muscles can help to stabilize the SIJ. While you are strengthening the region, it might help to have your physician or physical therapist to use kinesiology tape in a crossing-over fan pattern over the SIJ region to provide proprioceptive feedback.

As strange as it sounds, you can also have your physician or acupuncturist try using a press-tack tiny acupuncture needle on your ear at the lumbosacral site. Some patients find the ear acupuncture treatment extremely helpful at decreasing SIJ pain during flairs. Full acupuncture sessions might also help to bring relief from SIJ pain.

Lastly, there are injections that can be done for SIJ pain. Traditionally, steroids were used when injecting the SIJ to decrease inflammation in the joint, but studies have now revealed that steroids can damage cartilage and cause negative side effects. I prefer to inject natural anti-inflammatory substances into the SIJ to decrease pain and inflammation. If a person has chronic or repeated SIJ pain, then Prolotherapy is a more definitive, longer-lasting treatment. Prolotherapy is injecting a safe, proliferative substance to the whole SIJ region where the ligaments attach to the bones to promote healing of the involved ligaments. After a series of Prolotherapy injections, a person can typically expect to have lasting pain relief unless they reinjure their SIJ at another time.

Dr. Boston treats patients for SIJ pain with a comprehensive approach.  You can contact her at The Akasha Center for Integrative Medicine, located at 520 Arizona Ave, Santa Monica, California,  310-451-8880