Mechanical or Inflammatory Pain?

Do you have Mechanical or Inflammatory Pain?

Never thought I would need a corticosteroid injection for elbow pain but after picking up some heavy luggage on one of my many trips, I developed a searing pain just above my elbow.  I tried the rest, ice, heat combination but every time I hit a golf ball or lifted anything it would flair up again.  So I contacted one of our local orthopedic surgeons and after a lengthy exam with x-ray’s etc he determined I had a case of golfer’s elbow, which is an inflammation of the tendon by the elbow of the trail arm.  The suggestion was a corticosteroid injection and a brace which lead me to ask the following question.  “ Doc, will this cure the problem or is it just to cover up the pain”  and the response was “the answer is a little more complex and needs some background to explain fully”. My doctor proceeded to explain the difference between Mechanical and Inflammatory Pain and this is what he said.

One of the determinants in diagnosis and treatment of orthopedic problems is the concept of mechanical versus inflammatory pain.

Mechanical Pain arises when either normal tissue is confronted with abnormal stress, or abnormal tissue (usually shortened) is confronted with normal stress. Pain is the result, but once the mechanical stimulus is removed, the pain abates quickly. For example if someone pinched your skin. It hurts, but if you were only pinched once, and not terribly hard, then the pain goes away quickly.

Inflammatory pain, on the other hand, does not abate quickly. It can be initially caused by a mechanical stimulus, but the body’s inflammatory response has been elicited to initiate clean-up and healing.

Inflammatory problems can many times be caused or aggravated by mechanical forces. Referring to the pinching example - someone pinches you once and it hurts, then you’re fine. However, if someone pinches you hard, and does so thirty or forty times in a row it’s likely that the area will stay red and hurt for a while. It might even swell and bruise.

Inflammatory pain responds well to inflammatory treatment - namely anti-inflammatories. They can take the form of non-steroidal anti-inflammatories (NSAIDs), the form of corticosteroids, or physical modalities like cold packs, electrical stimulation, or compression. Most people are familiar with NSAIDs, such as Motrin, Naprosyn, Celebrex, etc. Anti-inflammatories (without getting into a long discussion on inflammation) also exhibit pain relieving effects.

Mechanical pain responds well to mechanical treatment. Mechanical treatment is targeted to a specific tissue, tissue group, or area, and is meant to change a mechanical property of that tissue. For example, increasing the resting length of a muscle is a mechanical treatment. The point may be to assist the healing of that particular muscle from an injury, or to reduce the amount of force encountered by another injured tissue as a result of tightness in that muscle. For instance, we commonly will stretch the hamstrings in order to reduce pain in the knee.

If a mechanical problem has led to an inflammatory problem - such as the problem with your elbow - treating the inflammation may make the problem go away, but do nothing to address the underlying mechanical problem. Mechanical treatment, on the other hand, can address the underlying mechanical problem, and allow the inflamed area to heal faster, and help to prevent recurrence.

That is why some patients in therapy may end up receiving an anti-inflammatory treatment - like a corticosteroid injection, and most (the smart ones) will come back to therapy and finish their course of treatment.

Back to the original question - we will give you the injection and will continue manual therapy until everything is taken care of this will give us the best possible outcome. Had the injection pain is gone and continuing rehab and wearing a brace when I play golf.  It is 100% better than it was before the shot.

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