PhysioMonkey

Finally we get to the crux of the matter: what can you do to help yourself?

If you've read the other back articles you'll already know some of the basics.

So from the other articles you already know this (and more):

• Inactivity is generally bad.
• Most back pain will clear up quite quickly.
• It's very likely NOT to be medically concerning.
• Other people can help but they're not going to cure you.
• Using your back, even when it hurts, is NOT likely to injure you although it might be painful.

The single most important message for normal back pain (see "What is" for signs that may suggest something more than normal pain) is this:

Hurt does not equal harm.

So what to do?

I'll start when you first get back pain.

1. Rest it at most for 2 days.  Bed rest is NOT a good cure for back pain.  Neither is sleeping on a board.
2. Go and see a general doctor or get yourself to a physio. 
3. Doctors may prescribe pain killers.  Take them, you're not likely to be taking them for too long.
4. Physios will look at you when you are still, when you move and how you move.
5. Physios should give you exercises that will move/stretch your back and/or teach the correct muscles how to work.
6. You then should do them despite the fact that they may hurt.
7. If you do nothing - nothing will happen.  Actually even if you do nothing your pain may go (most does within 6 weeks remember) but you're going to be far more at risk of recurrent episodes.  Plus if you do nothing you're far more at risk of having chronic back pain, remaining off work, inability to do your hobbies, depression and more - not recommended.
8. If you treat your back as if it's delicate then it WILL be delicate.  If you treat your back like it's normal then you've a good chance that normality will return.
9. When your pain eases don't start treating your back badly again!

Stretching exercises

All of the stretches I'm about to describe are normal movements that a normal back can do, they're not designed to move you beyond your normal movement limit.  They may hurt.  But remember if you do a stretch and feel nothing, then you're not doing it right!

Exercise 1 - Rotation (twisting)

Lie on the floor (better than a bed) on your back with your knees bent and your feet flat.  Roll both knees all the way to one side - NB "all the way" means that the side of one knee should hit the floor.  Your hip WILL lift up, this is supposed to happen.  You might hear a "click" - don't be concerned about this.  Then roll all the way back to the other side so the other knee hits the floor.

This is a fantastic exercise and works well for most people. 

1 addition:  If you have pain predominantly on one side then you can tweak this exercise a little more.  Instead of rolling both ways just roll to the side AWAY from the pain.  Remember to always go away from pain.  Then return to the middle and repeat.  Don't roll towards the painful side until your pain is predominantly central.

Exercise 2 - Side bending

Start standing up.  Try to lean sideways as far as you can.  Try not to go forwards or backwards at all.  As for rotations; if you have pain predominantly on one side then make your sidebends away from that side only.  When or if your pain is mostly central then you can practice both ways.

Exercise 3 - Flexion

Lie on the floor on your back with legs straight.  Pull one knee up as far as you can to your chest.  Return to the start position.  Repeat with the other leg.  Then repeat with both at the same time.

Warning:  This may be aggravating for some problems.  If you start getting pain down the leg(s) during this exercise then stop doing it and move onto the extension exercises.

Exercise 4 - Extension

This is a difficult one for me to put in here.  For many causes of back pain this exercise is useful, very useful on occasion.  Conversely there are problems when this exercise is specifically NOT indicated.  I'll try and explain things as well as I can here but if you're still not sure then send me a mail and ask for clarification for you.  Remember that not all backs are the same!

When NOT to do this

If you are a generally very flexible person normally and your back has been giving you grief, particularly when standing or walking for a long time.  If you're habitually bending your back backwards as part of an act (eg contortionist) or if you're a dancer or gymnast then you'd be better off skipping this exercise and having a look at the "stability" stuff later in the post.

If you're still not sure then get someone to have a look at you as you bend backwards.  If they can see a "hinge" in your back when you bend then avoid this.  I'll try to get photos soon.

So what to do?

Start lying on your front.  Stage 1 of the exercise is to just prop yourself up on your forearms for a bit.  If you can do this for a while then move onto stage 2. 

Stage 2 involves half "press-ups".  Basically you do a press-up but try and leave your hips down on the ground.

With any of these exercises:

• If you start getting pain shooting down your legs then stop.
• If you start getting pins and needles or numbness then stop.
• An ache doesn't give you sufficient reason to stop!

Muscle work

Many of the chiros and physios and all of the doctors I've talked to never mention anything about muscular stability of the spine to their patients and, to my mind, this is commonly the most important factor in many people's recovery from back pain.

The spine is supported by intrinsic and extrinsic factors.  Intrinsic is the structure of the spine- the ligaments, joints etc... The extrinsic factors are the active stabilising mechanisms ie the muscles.

There are a few muscles that contribute but the most important is the transversus abdominis (TA).  You have 2 and they're in your abdomen.  Find them by finding your ASIS's (bony bits at the front of your pelvis at the top of each leg).  Move about an inch in to the middle from there and your TAs are there under the "covering".  The first thing you'll notice is that you may not feel any activity there or even know what to tense up to get them working.  

The TA will switch off if you have an episode of back pain and won't switch on again until you specifically train it.  

This means that the pain may well go away but people tend to have a history of repetitive episodes of the same pains as the poorly supported back caves in again and again.  

Now for the back you have, for the sake of simplicity, 2 kinds of muscle.  Ones that move you and ones that hold you supported.  If you lose the use of the supportive ones (this happens when you get back pain) so the body tries to adapt and overuses the "mover" muscles in a vain attempt to stop the pain happening.  Unfortunately these muscles are not suited for this task so they work even harder in a more vain attempt and so on until they give up in disgust and you get painful muscle spasm.

It's in no way a quick fix but has been demonstrated to help very effectively.  Hodges and Richardson are researchers based in Brisbane, Australia and they showed that a control group given normal exercises generally got better but had a high percentage recurrence rate (IE returning to their doctor with the same problem within a year).  The group that worked TAs as well had a much reduced return rate. Now we know that about 30% of people don't bother doing their exercises; the results could actually be even more hopeful for you if you're willing to put this type of work in.

Now for the hard bit.  I need to teach you the exercises knowing that you might struggle and not being able to see what you're doing to correct your attempts.  

Lie on your back with your knees bent and your feet resting flat on the floor.  This should be comfortable and you will likely have a slight arch in your lower back.  Some folk can easily slip a hand under their back without having to lift off the floor at all but no worries if you can't.  
Try and flatten out this arch in your back and press your lower back to the floor.  This should be a very gentle movement.  Don't change your breathing, no holding your breath.  You should also not use the "6-pack" muscle that you'd use for sit-ups.  If you feel that tense up then it's wrong.

So pull your belly in slightly, squeeze your buttocks together gently and slowly curl your coccyx (tail bone) off the floor, you can also try adding your pelvic floor muscles too (think about what muscles you'd use to slow a flow of urine down mid-flow).  Do not lift your whole lower back off the floor it's more of a slight curl up than a lift.  You should be able to hold this gently and maintain normal breathing or even carry on a normal conversation without struggling.  Another hint is to try and start the exercise at the very end of a breath out.  You're looking to have very little activity going on. If you try too hard other muscles will come and try and help, we're trying to let that NOT happen.  So work gently.

Right I'll leave that there for now.  Have a go and for more info get in touch.  I'll make a guess that either you don't find what you should be tensing or that you think you're doing it right but aren't sure.  Sorry about that but it's difficult to work without "hands-on".  The exercise should not substitute for your current method of keeping a lid on it, bu should complement it.

This last exercise is merely a starter exercise.  If you can't get this working there's no point trying harder ones.  I'll get round to putting harder exercises on the site in the future.

Hope this helps.

(Many thanks to Anwen and Danny for the photos)

Similar Posts

Back Pain - Myths and Truths

Back Pain - What Is?

Back Pain - Treatment 1 - What others can do

[edit: reposted 4/7/06 as new info re anti-inflammatories added] 

Most injuries will be minor and may not even affect your ability to continue with whatever.

Here are some photos from a friend

• Unicycle injury.  This was a basic "turning" of the ankle.  You can see the aftermath being a decent amount of swelling, bruising, some pain and this one caused problems with walking.

• Another unicyle injury.  This was a "leg meets Muni pedals" incident.  Just some cuts with little bleeding.  It didn't need any treatment beyond some ego-massaging oohs and aahhs.

• This was a snakeboard injury.  Eye meets pavement!  Some swelling and bruising. 

Basic Advice

DO get R.I.C.E.

• Rest - Stop putting any pressure on the injured area.  If you've turned your ankle don't go for a 10km joggle.
• Ice - Whack an ice pack on it.  Don't make it too cold and don't leave it on for more than 10 mins.  The old favourite is a bag of frozen peas - be careful with this as modern freezers are far too cold for this purpose.  Wrap the bag in a thin and slightly damp towel - if the dampness starts freezing then it's too cold.  DON'T use ice if you have heart disease.  If you start to get chest pain whilst using ice then stop using the ice and go and see a doctor.
• Compression - Use a compression bandage if you have one.  Good chemists should have them.  These are often referred to as "supports"; they are not.  They simply restrict the amount of swelling.
• Elevation - If possible put the affected bit up above heart level.  Have a lie down.

DON'T do H.A.R.M.

• Heat - People like warmth but these injuries don't.  Heat promotes swelling by opening up the blood vessels in the vicinity of the heat.  Don't do it for these injuries.
• Alcohol - 2 reasons not to drink after an injury.  Firstly; if you get tipsy you're more likely to hurt it more as you drunkenly stumble away from the bar!  Secondly; the alcohol acts as a vasodilator (opens up the blood vessels) so making swelling worse.  (Incidentally this is why rescue dogs in the alps don't carry brandy - it would lead to hypothermia).
• Repeating - if you've just tried something which caused an injury don't do it again.  Does this seem too obvious?
• Massage - firstly this will be painful if someone is putting pressure on an acutely swollen area.  Secondly it also acts as a local heater leading to more swelling.  Thirdly if the tissues are badly injured then it might not take much to damage them further.  This advice relates to acute injury (ie within the first 24-72 hours post-injury)

There has been some controversy about whether NSAIDs (Non-steroidal anti-inflammatories) such as Ibuprofen and Diclofenac should be used after a recent injury.  The positives were that they reduce swelling and hence relieve pain.  The negative was that the swelling is actually rather important to healing so stopping it happen would slow down your recovery time.

Recent evidence is leaning towards the suggestion that taking NSAIDs does not really slow down healing that much.  Here's a quote from "Nonnarcotic Analgesics in Short-term Pain: Musculoskeletal Disorders" by Dr J Markenson in his review of lots of studies about this topic.

Accumulating evidence suggests that they neither delay healing nor interfere with the repair of soft tissue or cartilage following acute injury. Furthermore, in the nongeriatric population, the use of NSAIDs as short-term therapy appears to be associated with neither short-term nor long-term side effects.

This has changed my practice.  I'd previously given the advice to avoid NSAIDs.  Now I'll tell people that there has been controversy but it's leaning towards this view.

Related Posts

One-off Injuries - Major

[Reposted as slight changes throughout.  (Thanks to Dr Helen for the info!)]

Most injuries will be minor BUT major injury can happen even from an apparently minor incident.

[Because of increasing spam comments on this particular article I have now closed the comments section on this article only.  Sorry but if you have comments then please send me an email.  If relevant then I'll publish them on here.  Cheers.  Alan 29/5/06]

The first of the big controversies. 

Warming up is, as we all know, vital to prevent injury and prepare us for action.

Actually; no.  It's bollocks if you excuse my vernacular usage. 

I'll be more specific:  there is NO evidence to show that warming-up reduces your risk of injury.  In fact there is far more evidence to show that it's a complete waste of your time if injury avoidance is the main reason you are doing it.  But it's something that has always been done and everyone still learns and teaches it.

I've seen any number of workshops in tumbling, acro-balance, trapeze and even 3 ball juggling that have included up to 20 minutes of warming up, usually in the form of stretching everything out.  A waste of time for 90% of the participants and it's usually done incorrectly to help the remaining 10%.

Now I'll drop the real bombshell for many of you:

Stretching as a warm-up actually reduces your muscles' ability to respond as well as it could if you hadn't stretched it out.  This means that, not only does this NOT reduce your injury risk, it also drops yours performance level.  It's about a 6% loss of ballistic power.  This doesn't seem a lot but, if you're performing at the far limit of your ability, doing your hardest stuff, it can easily be the difference between success and failure.  It has been described as "the difference between winning a gold medal and not getting onto the podium".

So: so far we have:

• Warm-ups do not reduce your risk of injury.
• Stretching as a warm-up reduces your ability.

So why the hell do we do it?

There ARE benefits to a dynamic (ie not passive stretching) warming up:

• It raises your heart and breathing rates and increases core temperature.
• It gets you "in the zone".
• A set routine is more likely to get you mentally ready.

Therefore a dynamic warm-up is grand for performers.

So how do we reduce our risk of injury?

• Taking care (IE don't be stupid - follow the rules of play).
• General fitness.
• Specific fitness.

I'll talk more about specific fitness.  Sports Scientists and trainers witter on about something called "Specificity of training".  What this basically means is "to get good at something you must practice that thing".  In other words you get fit to run long distances by running a long way a lot of times.  Of course you'll start with a couple of miles only and build up as your body adapts to the new stresses that you're putting it through. Spending hours on a bike (or uni) will not really help you get good at running.  Doing both will make you more generally "fit" but the one doesn't help the other.

Relating that to us:  if you're habitually not going on a trapeze you're likely to hurt something if you try and copy a trained trapeze artist doing something quite difficult.  However much you stretch stuff out before going on the trapeze is immaterial; your body will not be fit enough to deal. 

Think about juggling; when we start to learn 5 balls we are crap at it so we practice more. We don't practise 5 balls as a whim or by accident, we practice it because we know that it's the best way to get better at it.  Getting good at diabolo will not help our 5 ball patterns.

So back to warm-ups

If all you need is injury prevention - get yourself fit to do the task you are aiming for.  The warm-up won't help you suddenly be able to manage something that is novel to you.

If you are performing then you need a dynamic warm-up.

Dynamic warm-up

• Will be different for different skills/purposes and for different people.
• Generally involves getting "geared up" to do the job.
• Increases heart-rate.
• Use a set pattern to get you mentally prepared as well as physically ready.

Examples:

Jugglers

Just crack on with what you want to do.  Many folk feel that starting with easier stuff is preferable to trying your outer-limits stuff.  It's up to you.  Stretching will not stop any injuries.  Not doing stuff for too long or well beyond your physical capability will stop you injuring yourself in the normal course of things. 

For performances try practicing your basic stuff.  Make sure your body will at least manage the more physical parts of the act (eg the contortionist).  Work towards one or two runs of some hard stuff then get yourself out on that stage.

Trapezists

Make sure all your joints are managing everything they'll need to do today.  So do brief shoulder stretches just to see that the range needed is there.  Do some running on the spot or around the gym, star jumps anything to get your blood going and your heart-rate up.  Don't wear yourself out before starting to perform though.

One more thing about warming up

This is an observation after seeing something once or twice at conventions.  The most notable occurance was an acro-balance workshop.  The participants spent 20 minutes doing a wonderful series of stretches as their warm-up.  We now know that this reduced their power and didn't help prevent injury but anyway.  They then sat around (most of them) as the 2 tutors spent 15 minutes talking through and demonstrating things.  The participants were sitting quietly through this period.  At best the warm-up (done wrongly anyway) has now been completely wasted.  In fact there have been studies that show if you warm-up and then sit around doing nothing for a while then you are at MORE risk of injury than if you hadn't bothered with the warm-up in the first place. 

When you warm-up do it right (dynamic not stretchy) and finish the warm-up as close to performance as possible.

"I've heard that the cool-down is more important for reducing injury"

Not exactly true.  If you are going to pick up an injury it will already have happened by the time you get to a cool-down.  

A good cool-down was said to have helped reduce what's known as DOMS (that's "delayed onset muscle soreness). The theory being that DOMS was because of an excess in lactic acid and the massaging effect of stretching helped reduce the levels of lactate.  This is probably rubbish because a few hours after exercise the lactate levels in the tissues have been shown to return to normal levels - hence there should be no pain.  But we know in DOMS that the pain can last for 2 or 3 days.

The next theory stated that the pain was down to "micro-trauma" within the muscles.  This again may not be true but is more likely than theory 1.  A final theory states that the pain is because of the body remodelling itself because of the work you made it do.  

Some research has been done looking into this problem and how it affects sportsmen.  One such paper was Herbert RD and Gabriel M – Effects of stretching before and after exercising on muscle soreness and risk of injury: Systematic review. BMJ 2002:325:468:  This concluded with these lines

“Stretching before and after exercising does not confer protection from muscle soreness and stretching before exercise does not seem to confer a practically useful reduction in the risk of injury.”

There are more studies than that but they tend to say the same thing.  So what to do to avoid post-exercise soreness?  Simple: get yourself fit to do what you want to do.  Practice it a lot and don't go for massive leaps in effort or skill level if that can be avoided.  As you get fitter to do that you'll get fewer problems associated with over-work.  People don't like this solution as it takes longer than stretching pre- or post-exercise does a: to explain and b: to work through to get a good effect.

In brief though: You are more likely to get DOMS after unaccustomed exercise.  Again we are back to specific fitness for the job in question.  Professional trapezists will not have DOMS after doing stuff occasional workshop participants try.

In short:

• Don't bother with stretches as a warm-up.
• Warm-ups should be just that, they're to get you warm and ready to perform.
• Don't expect to suddenly be able to do new and stressful things without some soreness at best.
• Do your stretches daily if you wish to increase flexibility (but don't think they "should" be part of a warm-up).

Now whole books have been written about this and I'm trying to do it in a short form on a web-page.  Hmm?  May not work but we'll have a go. 

Myths:

• Back pain means something serious has happened.

"My back has broken"!  Well yes in a way.  Something has happened that's serious enough for you to have noticed a problem.  It's not likely serious enough to suggest a major medical or physical problem though.  The incidence of serious pathology is about 5% of those incidents of back pain.  By serious pathology I mean anythng from "slipped disc" to spinal tumours.  These are very rare and usually have some specific symptoms in addition to excruciating pain.  We'll come to those later.  Most back pain will get better without recourse to surgery, chemo or scans.

• My doctor says it's just lumbago and he's only given me some tablets.

Firstly, "Lumbago" is just another name for back pain.  It's like going to the doctor with head pain and he "diagnosis" it as "head ache".  Not very helpful.  Now most back pain will go within 6 weeks of onset.  That's why doctors don't bother too much with recent attacks of back pain.  They know things will improve just with time and the drugs are to tide you over.

• I feel I need an x-ray/a scan.

Not necessary in nearly all cases of back pain.  A lumbar spine x-ray is massively more powerful than a chest x-ray.  One study suggested that for every 20000 lumbar x-rays performed there was a new cancer in one of those patients (x-rays are carcinogenic).  The flip side is that a lumbar x-ray very rarely will show anything of note.  Most commonly they show nothing out of the ordinary.  So you're giving yourself a higher risk of cancer for no benefit.

Scans can be useful but they're only necessary if the medics suspect something worrying and also if the result of the scan is likely to affect future management.  In other words why do a scan if your treatment will not be affected by the result?

• I've had back pain so my back will always be "weak".

No no no.  It will remain weak if you ignore it between bouts of pain.  But like any muscles if you train your back support muscles then they will get fitter.  The problem is that most folk don't know how to.  We'll come onto that in the treatment posts.

• Sciatica is worse than back pain.

That's entirely a matter for each individual.  Sciatica is pain in the sciatic nerve, it doesn't always come from the back though.  If it does come from the back it may indeed be "worse" in terms of pain but is still generally dealable with.  Really bad disc problems can cause very nasty referred pain indeed and may need surgery.  That's probably where this myth comes from.

• My chiro/physio/doctor says one of my legs is longer than the other.

Rubbish.  It may well be but unless there's a huge difference you're very unlikely to get symptoms of severe back pain directly attributable to this.  Studies generally show that there is no increased risk of back pain in those with an actual leg length difference within about 2cm.

Note I said "actual leg length difference".  You can get an "apparent leg length difference" which may mean something else and seem to give back pain.  This is likely to be a problem with the joint between your back and pelvis.

• I need ultrasound/TENS/electrotherapy treatment of whatever ilk.

Ultrasound is a complete waste of your time for back pain (and I would argue for just about everything).

TENS is a pain relief modality that may help but is entirely symptom based, ie you'll get rid of pain for a while but you're not dealing with the underlying problem.  The same goes for any other electro modality.

• Don't use heat on it.

Why not?  Commonly the problem is muscle spasm rather than any inflammatory issue.  If it feels like the muscles have spasmed up then heat will help to relax things a little.  Don't make it too hot and don't continue if it's not helpful.

Some folk use ice.  This can work by relieving pain thus cutting down on muscle spasm.  I'd use heat and stretches myself.

• I must rest my back when it hurts.

Possibly the worst advice.  Yes give it a break for a day or so then get using it again.  Start gently and stretch it out.  You shouldn't feel too much pain but you should feel that you are stretching.

• I must sleep on the floor or a plank of wood.

No no no again.  Sleep wherever you find comfortable.  If you can actually get to sleep somewhere then you're getting basically a decent support for your back.  If the base is not appropriate for you you'll really struggle to sleep.

• If I look after my back properly, doing everything correctly, I won't get back pain.

Really not that simple I'm afraid.  1 in 4 of us will get back pain in any given year but some of us who specifically look after our backs will still get some problems with them in just the same way that life-long non-smokers may still get lung cancer.  But you will minimise your chances by looking after yourself.

That'll do for myths although there may well be more that I'll cover at a later date as and when they occur to me. 

So what is the truth?

• The vast majority of back pain is not medically concerning.
• The majority of back pain cases can not be accurately assessed - meaning we don't know exactly what is wrong in the vast majority of cases.  This is not a worrying fact.  In fact the standard term is now either "Mechanical back pain" or even "Non-specific back pain".
• Not knowing what exactly is wrong doesn't mean we can't successfully treat the condition fully.
• Back pain is more commonly lots of little problems with lots of structures rather than one thing gone badly wrong.  This is why we can't often say exactly which structures are the cause of symptoms.
• 95% of back pain episodes will end in less than 6 weeks.
• Your back is very powerful and won't "break" even if you use it whilst your back hurts.
• Your back is supported by some very effective muscles.
• Sadly these muscles pack up when you have episodes of back pain.  They also DON'T automatically come back into use after an episode of back pain, you need to specifically train them.  This, if ignored, is why many people get repetitive episodic back pain.
• Most back pain CAN be treated reasonably well.

Related Posts

What is - Back Pain

Back Pain - Treatment 1 - What others can do for you

Back Pain - Treatment 2 - What you can do

Scenario:

You've been juggling for 4 hours perfecting your 7 club Mill's.  Your wrists have been aching for the last 30 minutes. This has happened for the first time today.  What would you do? 

I have noticed that this sort of problem has been discussed on rec.juggling a few times so I took the liberty of seeing what advice has been offered for just this problem.

rec.juggling answers

1. Rest.
2. Practice other skills for a while.
3. Heat.
4. Ice.
5. Heat and ice alternately.
6. Stretch it out.
7. Go to the gym and build yourself up.
8. Use wrist-weights or power-balls to strengthen yourself.
9. Adjuncts (eg acupuncture, dietary changes etc..)
10. See a professional.
11. Warm-up before exercising.

Let's have a look at these then:

1 - Rest         and

2 - Practice other skills for a while

• Rest - meaning a total break from practice.
• A good idea.
• Practicing other skills may be acceptable as long as the pain doesn't come with the new skill as well.
• You may need to rest for a few days or even longer.
• After a break do not try and return straight to your previous level of activity - work up to it slowly.

3 - Heat

• NOT useful during this acute stage.
• Heat will actually encourage MORE swelling; it is PRO-inflammatory.
• It may feel nice - people tend to prefer the sensation to that of ice.
• There was discussion over whether "wet" or "dry" heat was best: it doesn't matter heat's no use anyway at this stage of an injury.
• If you must use it; don't burn yourself.

4 - Ice

• A good idea.
• It is anti-inflammatory.
• It also acts as an extremely effective local analgesic (pain-killer).
• It needs correct application
• Ideally use crushed ice in a thin towel.
• The old favourite is a bag of frozen peas - please DON'T take a bag of peas straight out of a modern freezer and put them straight onto your skin.  It will burn.
• DON'T use ice if you suffer from angina.
• If you get chest pain whilst using ice - stop using ice and go and see your doctor.  Don't use ice again until you've been checked out.
• Don't leave it on for too long - 10 minutes at a time is enough.

5 - Heat and ice alternately

• The theory is that heat opens up the blood vessels in the area and then the ice shuts them all down again - supposedly acting as a sort of "flush".
• There is no real evidence that this is true.
• Nor is there any evidence that shows this method to be helpful.
• It's certainly not as effective as ice alone.
• Try it if you wish but remember not to burn yourself with either ice or heat.  Follow the cautions above when using ice.

6 - Stretch it out

• Can be useful if done correctly during recovery.
• You're after gentle stretches not "tendon killers".
• Rest is better for very acute (ie recent) problems.
• Stretches should not cause pain and generally should be held for around 30s.

7- Gym work

• Generally a good idea for fitness anyway.
• Make sure you know what you are doing.
• If you don't know - find out!
• If injured - don't exercise to pain and don't expect to perform as well as if you were uninjured.
• Build up slowly - know your limits but keep nudging into them.
• Not recommended for new problems - rest is better.

8 - Wrist weights or power balls

• No non nein nyet nee!!!!!!!!  I can't emphasize this enough.  DON'T DO IT!!!
• Repetitive pain means there is over-loading going on - if you use these you will over-load even more and at a time when the tissues are weaker than normal.  NOT a good idea.
• Even if uninjured, power balls are likely to give you tendon trouble.  Certainly the heavier the ball, the more likely damage is.
• Wrist weights and power balls are more likely to give you neck, shoulder and elbow trouble too.

9 - Adjuncts

• We're in the realm of "whatever floats your boat" now.
• Acupuncture definitely works for pain relief in many folks but remember that you want the problem dealing with, not just pain relief.
• Diet is important.  If you are fit and healthy generally you are at less risk of problems and are likely to be more able to deal with problems if/when they arrive.  So eat well and keep fit.
• You might want to try reflexology, crystal healing, faith healing or whatever.  I have no real clue about their efficacy although I'd like to know. If you have any info please get in touch.  Email addy is in the "About me" bit.

10 - See a professional

• The best advice so far.
• Remember that general doctors tend not to be experts at these sorts of problems.  Make sure you find a specialist (it doesn't have to be a doctor).
• You should never accept "Take these tablets" if it is a long-standing issue.
• There are common problems that may need medical or even surgical intervention.
• Remember that each profession will tend to see their own solutions to any given presentation - so surgeons will want to operate, podiatrists will claim your feet are the cause of all your ailments, rheumatologists will want to inject everything and chiropractors will tell you that your pelvis is twisted (or one leg is longer than the other - at least that's what pretty much all my patients who have seen a chiropractor have told me).  The point is this; you don't have to agree with what they tell you. Think of what bias they have.  In my world I advise people to try the least drastic options first.
• Common musculo-skeletal problems are very commonly mis-diagnosed by general doctors.  About 80% of "tennis elbows" I see are actually neck and neurodynamic problems and NOTHING to do with tendon trouble.  Likewise about 90% of "frozen shoulders" are nothing of the sort.
• Have you had neck pain?  Arm problems are very often neck-related rather than local.
• As Brian would say; "You are ALL individuals".  Your problems are individual too; there is no such thing as a generic problem - a professional should be able to take all the signs and symptoms (often including things you hadn't noticed - unless you're especially body-aware) into account and come up with an individual treatment plan.

11 - Warm-up before exercise

• Now we're into the realm of controversy. 
• I'll leave warm-ups for the next post.

Summary

• Stop doing what causes the pain.
• Use ice as an analgesic (remember the cautions).
• Return to practice in time and start at a lower level than you were.
• If pain returns stop again.
• See a professional healthcare person at any point in this pattern.
• Use gentle stretches as part of a daily routine to help recovery.

Related Posts

What is - Tendinopathy

What is - R.S.I.

Warm-ups and Cool-downs