Fixing Tennis Elbow and Knee Pain with Clinical Thai Bodywork

Amy Carr of TimeOut Chicago magazine came in a few weeks ago for a treatment. She's a tennis player, and wanted help with a persistent pain issue that has been bothering her for almost a year. Her pain was diagnosed as tennis elbow, or lateral epicondylitis, and she had seen several practitioners since last March without getting much relief.

Her report on our session appears in the current (Feb. 5, 2009) issue of TimeOut Chicago, and to quote an excerpt, "Combining his knowledge of anatomy and Western medicine with Thai massage techniques, Duff gives my aching tennis elbow more relief than a year of cortisone shots and chiropractic visits..." Which makes me sounds like a genius, but in truth, cases like this are relatively easy to address by anyone with the right training. We empower our students to have "miracle cures" like this in every Clinical Thai Bodywork class we teach.

It's all about your worldview. Allopathic western practitioners almost invariably assume that pain near a joint (for example, elbow, knee, lumbar vertebrae) is due to injury, dysfunction in the joint, or a mysterious onset of inflammation (tendonitis) in the tendons and ligaments that cross the joint. This often mistaken attitude about joint pain is what leads to the 3 common and frequently ineffective therapies that we hear in a litany from our clients: anti-inflammatory medications, cortisone shots and surgery. While we consider our western medical system to be firmly based in science, one wonders what scientific reasoning is at work in the face of a great deal of evidence that these approaches usually don't work to actually relieve pain.

A simple but profound paradigm shift is what makes cases like this easy to solve. The key is that muscle tissues themselves are in most cases the source of at least some of the pain, if not all of it.

Of course, when we need surgical repair, western medicine is brilliant -- and I do not intend in any way to underestimate the incredible skill and sophistication of modern medicine when it is appropriately applied. The issue comes from our allopathic injury-centric model, which assumes that all pain must derive from injury or degeneration within joints, nerves or connective tissues. Sometimes joints do need repair. But many times joints may show some evidence of arthritis, degeneration or injury, and the surgery fails to resolve the pain. This is because nobody treated the tender points and taut fibers in muscles that cross the joint and refer pain there.

Thai medicine is based on an energetic view of the body. Health and proper function comes from the free flow of energy (Lom) through energetic conduits (Sen). Thai practitioners use compression along the sen lines in combination with various stretches, and we pay close attention to hard, ropy fibers and local tenderness, as this is an indication of imbalance.

I became fascinated early in my career with similarities in practice between certain asian approaches to bodywork and the field of myofascial trigger point therapy, which was developed entirely in the west by medical doctors. While the conception of the body was vastly different in the two systems, the approaches in practice to resolving pain were often quite similar. Out of this early research, I developed a modality that I now call Clinical Thai Bodywork.

Trigger point therapy "discovered" that tender points in muscles can cause referred pain -- generally in parts of the body distant from the tender point itself. Often the pain can be quite severe and feel like it's around or deep in a joint. So it's not surprising that the medical establishment is led to assume that structural injury to the joint itself is causing the pain. One of the mantras we use is "don't chase the pain" -- in other words, the pain is usually not where the problem is.

The approach we use is to investigate and treat the stagnant tender points in muscles that are referring pain to another part of the body. These relationships are predictable and were carefully mapped over decades of clinical practice by Dr. Janet Travell and Dr. David Simons, who wrote the definitive medical textbooks on trigger points.

For example, the complaint commonly identified as tennis elbow is usually caused by a small muscle in the forearm called the supinator, which is a major actor in stabilizing the racquet head each time the ball is hit during tennis. If this muscle gets acutely or chronically overloaded, it develops a point of local metabolic stagnation (trigger point) that sends pain to the outside of the elbow joint -- however the pain can only be addressed by treating the supinator muscle itself.

In Thai terms, we would find tenderness in the sen lines that radiate from the joint and focus on that area during treatment -- which consists of various forms of compression and stretching. A trigger point therapist would know that the supinator muscle is commonly responsible for this ailment and would locate tenderness in the muscle itself. In CTB, I bring the western anatomical knowledge and insights from trigger point therapy to the elegant treatment system of Thai massage. The result is a treatment modality that is not only extremely effective at treating pain, but is actually beneficial for the therapist as well.

Ironically, Drs. Travell and Simons' incredible body of work is not commonly taught in medical school -- this truly is the Great Mystery to me. Consequently, millions of patients each year with myofascially induced pain are prescribed anti-inflammatories, given cortisone shots and unnecessary surgeries, only to find that their pain is still there (at which point it is called "intractible"). Tennis elbow is one of hundreds of conditions with which I could tell a similar story.

On Feb. 27, 2009, we will be teaching another Clinical Thai Bodywork weekend workshop at the school -- on knee, groin and thigh pain. I'm sure you know friends and clients who have struggled with knee pain -- sadly, this is another case where enormous amounts are spent annually on useless procedures. If you are a massage therapist or yoga teacher or know of someone who wants to more reliably address pain, you can find out more about Clinical Thai Bodywork and the rest of our Thai massage training program at www.thaimassageschool.net.