What to Do When Injury Recovery Takes Longer Than You Expected
The bad pain started in my right arm soon after dinner. By the next morning, it hurt for me to make a fist. I was on the chronic-injury ride.
One of my sons and I had been bull raking from a skiff near an island in Narragansett Bay, scratching up baskets of wild hard-shell clams on a winter day. Bull raking, a method of manually harvesting shellfish with a metal rake and basket attached to a long aluminum pole, can be hard work. On this afternoon, early in 2019, we were working in 16 to 20 feet of water, and the rake was angled beneath us at the end of a 40-foot pole. I dragged it through the silt-and-gravel sediment by squeezing my hands over and rhythmically pulling on a metal T-handle, cutting furrows as we drifted downtide.
The ritual went on for hours. I’d jerk the rake for about five minutes, until the basket felt full, then retrieve the rake to the surface and dump its contents on a sorting table, where my son picked through the catch while I sent the rake back over the side. The rake was heavy. The tide was strong. We filled buckets with clams.
A twinge of foreshadowing
I had felt a twinge in my right forearm early on, when the rake hung up on a submerged rock and I pulled too sharply. I opted to ignore it, to do nothing beyond adjusting my form to compensate for the light pain. This, of course, was a mistake—a familiar case of someone being too eager, and too foolish, to call it quits when it hurt.
We headed home before sunset, riding the skiff over the darkening waves. That night, after eating a small mountain of steamed littlenecks, I sat by the woodstove as new sensations set in. The bundle of muscles in my right forearm felt creaky and strained. This did not alarm me. I assumed I had sprained or torn something early in the day. But the pain was migrating, following the muscles up to a point on the outer side of my forearm, just beneath the elbow.
This new pain sang out louder throughout the night, seemingly worse by the hour. When I woke in the morning, my other arm ached, too. I did not yet know it, but I was suffering from microtears where my wrist extensor tendons attach to the outside of my elbow, a condition commonly called tennis elbow. I was in for a rough 15 months.
I told myself one thing. Pain said another.
I’d like to say I got smart fast. I didn’t. I went about much of my recovery wrong. Having endured many minor injuries, I thought I knew what to expect. Rest, I told myself. If I gave the arms a break for a week or so, to allow time for healing, I figured I’d be back soon. A week passed. The pain was no less. Then a month. I bull raked only a few times and not for long. It hurt too much. I told myself I just needed a little more recovery time.
By then pain had found dozens of routes into my days. Lifting a large cast-iron skillet by its handle was borderline impossible; I relied on a two-handed carry. Clutching and hauling firewood between my fingers and thumb? I learned to lift logs from beneath, palm up, in a scooping motion. Holding a broom or a mop? Lashing a dock line around a cleat? Using vice grips, a bolt cutter, or pliers? Grasping a gallon jug by the handle and pouring a glass?
For weeks, then for months, routine motions demanded forethought about my body position and slow, deliberate movements. I developed a habit many people with pain or disability know: I’d anticipate what would hurt, then feign normalcy while trying to do it. Even shaking hands could make me want to wince. (I found ways to avoid this foundational social ritual, usually by preemptively offering another form of greeting. This was before COVID-19, when many people stopped extending hands altogether.)
After three months, all I had to show for my new cautions was lost muscle tone and a list of physical chores that had grown long. It got worse. As spring arrived, the injury was having other effects. Not being able to use my arms was undermining my confidence and making me feel weak, which in a literal sense I was.
Many activities I depend on for mental health—swinging a splitting maul, doing pullups or dumbbell exercises, raking clams—aggravated my condition. Frustrated, eager, determined, unwise, I’d sometimes choose to do as I pleased no matter the pain, telling myself I was checking to see if I had recovered. On occasion I’d push through—a few pullups here, a few swings of the maul there—only to discover that soon after, the throbbing would begin again and sometimes feel worse.
I was losing more than strength
I was 54 years old. I began to see in my nonrecovery the unwelcome proof that the relentless grip of aging and a new brittleness were upon me. I wondered: Might I never heal? My injuries and pain were much less than what many people suffer, yet I was losing some sense of self.
At last I decided to visit a hand surgeon to find out what was going on. The doctor, Ben Phillips, M.D., M.P.H., of Ortho Rhode Island, is an athlete and weightlifter. He interviewed me as he examined my arms, asking what had happened and what motions and activities still hurt. He reviewed my grip strength. My left hand was weaker than ever yet stronger than my right, my dominant hand. He formally diagnosed my condition as tendinosis. I was, it seemed, a classic case.
Although the name of my condition implies otherwise, and the swing of a tennis or squash racket as it moves backward certainly extends the wrist and causes forearm and elbow strain in the dominant arm, few of Dr. Phillips’s patients come to him with injuries suffered in racket sports. His patients, he said, are often contractors, including building framers, whose job requires them to apply their arms to load-bearing chores at odd angles, or to wield tools in tight spaces and awkward positions. Dr. Phillips said he also frequently treats farmers, landscapers, groundskeepers, gardeners, and commercial fishermen, including quahoggers like me.
What he said next was heavy to hear: You may need a year to heal.
Many extensor muscles in the forearm, Dr. Phillips said, come together in a small landing point at the outside of the elbow. This bundle is a nexus for moving the wrist, aiding in grip, using fingers—the interrelated actions that allow our lower arms and hands to be unrivaled tools. My pain was the result of microtears in my tendons, leading to a chronic degenerative process where the musculature is anchored to the bone, and it was being triggered by much of what I did. This was no pulled muscle. Dr. Phillips told me the tendon was frayed.
Patience and consistency are the toughest medicines to take
What to do? Dr. Phillips did not want to start with surgery or steroids. He recommended a regimen of self-care: regular icing and rest as well as topical anti-inflammatory cream, and he suggested over-the-counter anti-inflammatory medicines, like Aleve, to bring the swelling down.
When I asked about traditional anti-inflammatory treatments, like turmeric, Dr. Phillips said he had patients who’d reported success with turmeric and that if I was inclined to try it, he considered it worthwhile. He cautioned me to avoid further damage to the right arm and to protect the left. “It does heal, but like anything else it heals by not using it,” he said. My goal, he added, was to get enough relief that I could start physical therapy later, to stretch and strengthen my forearms, and to learn motions that would help me avoid injury again.
Like most any injured person, I hoped for the feel-good story, the happy arc. But the payoff was a long time coming. At home I began consuming huge amounts of turmeric, heaping spoonfuls into green smoothies, rolling fish fillets and vegetables in a turmeric-ginger rub, drinking fresh-brewed turmeric tea by the pint.
I also began trying self-massage, kneading my forearms with the thumb of my opposite hand and feeling the small pockets of fascial adhesions, almost like packing bubbles, in my flesh.
Little changed. For a while I was discouraged. After about eight months, however, the pain started subsiding—first slowly, then remarkably. I started bull raking regularly the following winter, albeit in shallower water, using a 20-foot rake instead of a 40-foot one. Some days my arms ached after, but not with the intense pain I remembered.
Was it all the turmeric? I did get better while loaded with the stuff. I also have to admit I have no idea whether this was pure coincidence or a partial cause.
As I recovered, Dr. Phillips referred me to Lori Lind, a certified hand therapist and occupational therapist at his practice, who in two sessions refined my self-massage technique and taught me forearm stretches that brought more relief. Lind also taught me cupping therapy. The pulling motion of this treatment, as opposed to the pushing and kneading motions in finger and thumb massage, reduced my forearm tautness and pain even more.
Eighteen months after the initial injury, I was functional again—without surgery, steroids, or pharmaceutical help. When I spoke with Dr. Phillips about the turnaround, he shared a philosophy I realized he’d applied to me.
“I like to give patients the opportunity to be part of their own care,” he said. “This is more empowering, which I think is good.” He chuckled, profiling me in a way that shed light on my long journey. “Commercial fishermen and landscapers, they are my best patients and my worst patients,” he said. “They are motivated to get better, but they don’t know how to stop.” My next step is to get back to a gym.
This article originally appeared in the October 2020 issue of Men's Health.
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