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Tuesday, May 10, 2011 - Specialized therapy helps tendonitis patient keep moving and shaking

In the summer of 2010, Linda Nyholm of Oak Ridge began to feel a nagging pain in her right elbow.  She was in the process of moving and was busy packing up one house and unpacking into

Whether it’s painting the walls of her new home or sharing a crab leg dinner with her daughter Tomi, Linda Nyholm is enjoying getting back into her active lifestyle following treatment at Methodist Therapy Services where she received specialized therapy for a stubborn case of tendonitis.

another, and the pain was just what she calls “a low-grade annoyance” that she thought would go away in time.  By August, Linda, who is an office manager for a company in downtown Knoxville, was helping her office move, and as she was packing files and filling boxes, the pain was reaching a new level.

“It got to the point that it was painful all the time,” notes Linda.  “I tried to live with it and just kept resting it.”  But the pain in her elbow continued to get worse, and in mid-October she finally sought help from family practitioner, Toral Pattni, MD. 

Dr. Pattni diagnosed Linda’s pain as tendonitis, an inflammation of a tendon, which causes pain and tenderness just outside a joint, in Linda’s case in her elbow.  Dr. Pattni gave Linda a cortisone shot to help alleviate the pain and reduce swelling in the joint.  The shot didn’t have any effect on Linda’s pain.  She had followed her doctor’s recommendations to ice her elbow, to take ibuprofen regularly, and to avoid repetitive motions like painting the walls of her new house, but there wasn’t any improvement.  After giving the cortisone shot two months to take effect, Linda returned to Dr. Pattni who suggested physical therapy. 

Linda was referred to Methodist Therapy Services where she was assessed by physical therapist, Pauline Looye-Jones who recommended a course of treatment that consisted of traditional therapy using several exercises for her arm, hand and fingers.

In March of 2011, Linda began to work with physical therapist assistant Amy Sloan who helped her exercise her painful right arm and helped her to increase her ability to use her left hand to do certain tasks. 

“I’d lost a lot of strength in my right arm,” remembers Linda who was surprised by the toll that her tendonitis had taken.  She had begun to avoid using that arm due to the pain. 

“I brushed my teeth with my left hand…I couldn’t pick up a full glass of iced tea…opening doors was a challenge, and I was afraid that someone would try to shake my hand.”  Linda’s pain from her tendonitis reached into every aspect of her life. 

In her job as an office manager, she handles files, answers phones, and manages shipping and receiving – it’s an active job that requires her to do a little bit of everything.  “It was a challenge to work around that,” remembers Linda.

It was also a challenge to keep up with her former hobbies.  She and her husband enjoy remodeling houses.  She had a new house and wasn’t able to help with the renovations because of the pain and the doctor’s orders to avoid the damaging repetitive motions that come with such work. 

In therapy, Linda’s PTA, Amy, helped her to regain some of the strength that was lost in her right arm, but the traditional therapy still wasn’t helping to alleviate the pain.

“Amy worked so hard with me,” says Linda. “She would say, ‘If it hurts, don’t do it.’ I still hear her voice in my head when I’m reaching for something.”

However, after five therapy sessions, Linda could feel no difference in her pain level.  She was still taking ibuprofen and icing her elbow, which would even take on a bruised look. She was ready to give up. 

“Maybe I’m impatient,” says Linda, who was diligently following her therapist’s recommendations for home exercises. “I felt like I was trying and I was just so frustrated that the pain was the same.”  

She thought she was going to have to live with the pain, but Pauline, the physical therapist who did Linda’s initial assessment, had other plans. 

She began using an alternative treatment which included massaging, stretching and re-training the group of muscles that includes the neck and shoulders, elbow, forearm and hand.

“The improvement I felt after the first session was amazing and progress since is almost unbelievable,” says Linda.

“The treatment that we used with Linda is the Myokinesthetic System approach,” says Pauline.  “It is a manual therapy approach intended to decrease pain and muscle spasm and increase range of motion, and it can be used on a wide variety of conditions.”

Pauline notes that Linda had a fairly typical case of what’s often called tennis elbow, or more clinically, lateral epicondylitis.

“For Linda, we treated not just her right elbow, but included a total of 82 muscles – 41 on each side – in the neck, shoulder, arm, forearm and hand,” says Pauline. “The simple, safe technique is based on systematically stretching, contracting, and pressing or massaging specific groups of muscles.” 

She also notes that the treatment is relatively comfortable and fairly quick, in Linda’s case, only requiring about a 30 - 40 minute session.

“Often the treatments yield amazing results right away, and sometimes it takes several sessions,” comments Pauline. “Everyone is different, but most people respond favorably to this technique.  For Linda, it was the difference between day and night.”

Linda says she’s had a great experience at Methodist Therapy.  “The staff is wonderful.  They’re very inviting, very helpful and they knew me by name from my first visit.”

She also liked how comfortable the staff made her feel. 

“They don’t make you feel like you’re weird.  You know, people are there for major issues like therapy after a hip replacement, and I’m there because my elbow hurt,” Linda says with a laugh. “But they never made me feel bad.  They said this is real.”

Linda is still careful with her arm and is retraining herself on how to do certain things that can be painful like the way she picks up file folders.  But she says she back to 98 percent of her old self and is enjoying the thrill of doing everyday things without pain like putting her car in drive and cooking.

“To summarize, I no longer take ibuprofen for pain and inflammation, my elbow no longer appears to be bruised, and the pain has diminished to almost nothing.  For the first time in almost a year, I am not afraid to shake someone’s hand!” 

It’s taken time and experimentation with various treatment options, but Linda has learned that when you don’t give up, there is often a solution to your problem and you never know when and how it will come.

“I am actually having pain free days, something just a few weeks ago I would have never thought possible.”