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ChrisBriggs

Chronic/overuse injuries- how to avoid, manage etc???

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My question up front is this: is there a proper way, a proper form, or some other factor used to avoid or minimize the onset, impact, or severity of chronic overuse injuries? What does everyone else out there do to manage things like this?

 

So a little context. I'm a Physician Assistant in an interventional pain clinic; I'm a prior soldier (Army, infantry and PA as well for total of 15 years), and I've been smithing for about 4 years, although more seriously (consistently, usually 3-6 hours/day, at least 3-4 days/week) over the last 2-3 years. I've begun noticing some chronic aches and pains over the last about 12-18 months. Most specifically my left elbow (I hammer with my left hand). I've got "lateral epicondylitis" or "tennis elbow" that WAS a minor annoyance which was initially fairly responsive to the typical self care techniques I preach day in and day out- rest/avoidance of aggravating activity (the hardest of them all :D), ice, compression, elevation, NSAID (Ibuprofen or similar) use routinely, Tylenol as needed, etc. Currently using basically all of the above plus a compression sleeve a few hours here and there. The pain does seem to respond and decrease by maybe 30% as long as I don't hammer. That only remains an option for so long!!! LOL Now the pain is becoming less responsive, more intense, and when I do hammer (which has been only minimal over the last ~2 weeks) I can only hammer for a few minutes before I'm unwilling to continue worsening the pain. The pain gets bad enough that I find even holding a hammer to be difficult to the point that I've dropped my hammer or lost control of it. Now like I said, I'm a Pain Service Physician Assistant and I know what I would say to my patients ("like it or not you may have to stop doing the aggravating activity") but let us all be honest- that isn't happening. For real. I would truly appreciate any input anyone might have. Thanks a ton!!!!

 

Respectfully,

Chris in Michigan

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I have had to deal with this a couple times over the past couple years. Each time it has resulted from taking on a forging job that would have better been left to a power hammer. I can definitely remember working to the point of fatigue and letting my hammer technique go to pot... elbows out, sprawled posture, etc.

 

The only thing that fixes it is to lay off. Not quit, but you have to let it rest to heal. You don't have to cease from all work, but when you feel the burn, you know you're doing the wrong thing.

 

When it does heal, you have to be constantly mindful of your hammering technique... elbow close to your ribs, vertical swing, etc. Some folks have no problem forging with their thumb on to of the hammer handle, but I do, even though I still catch myself doing it. That loose "handshake" grip will allow the hammer weight and anvil rebound to work together at the fullest potential. (Youtube search "blacksmith hammer technique") When you're trying to force power through sheer arm strength you are going to mess stuff up. Some folks might have no problem with this, but then folks with 20/20 vision don't need glasses.

 

Also, when you do get it healed, do other things to both stretch and strengthen your arms. All of those muscles, ligaments, and tendons work together.

 

I have been to the point that my elbow burnt so bad it was almost crippling. Yesterday I cut and busted firewood for several hour straight. You can get it back; you just have to go easy.

 

Don

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Hi Chris.  Go to a physical therapist for an evaluation.  (Perhaps I should say here in full disclosure that I've been a PT since '95).  A decent one should be able to determine what the true cause is.  Off the top of my head possibilities could be:  poor biomechanics, weak muscles, tight soft tissues, scar tissue from past traumas, is your hammer handle the wrong size causing you to grip too tight....

 

I'm actually dealing with an increasingly frequent lateral epicondylitis type pain on my left (non-hammer) hand that I'm pretty sure is due to scar tissue from multiple blunt traumas over the past few years.  I'm starting to think that I need to find a PT who specializes in deep tissue work.  

Edited by billyO

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We have a thread for that: 

 

Go read it.  Now.  Watch the video.  It's pinned in Shop Safety for a reason!

 

Keeping in mind I wrote my responses to it five years ago, I no longer have to wear the strap every time I forge.  Proper technique, with not even a single slip, is the only way to get out of that hole.  You will also have to just stop for a while.  For me it was a few months.  

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I've sanded myself into a tennis elbow about two years ago, ended up just doing nothing for about 6 months.

The physio gave me some advice to just break up the sanding and just shake out my arms.

 

As far as hammering goes I'm just starting to use correct technique instead of death grip and brute force, going by the general advice here and no glove on my right hand. 

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Have you tried dietary interventions, some foods or eating habits have a big influence on inflammation. 

For me it's sugar and carbs, if I cut them out or do intermittent fasting all my chronic pains go away. 

For my sister it's fruits and veggies containing fructans. 

Different things for different people , but I think there are tests to see what you react to. 

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There was a period of time I had major pains in my left fingers mainly my middle and ring fingers and my left elbow. I figured out it was the really heavy tongs I was using (the only pair I had at the time) and the death grip. Along with fighting to use them for stock too big for the tongs. I started using tong clips and then started buying more tongs and havent had an issue sense. The only problems I've had with my hammer side is cramps in my forearm. I use a light grip on my hammer and once the hammer makes contact with the steel I grip the hammer and lift then it's back to a light grip as the hammer comes back down. Keep your thumb off the back side of the handle also. When we have another forging session together we will work on hammer control and grip methods!

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48 minutes ago, Michael Atkins said:

For me it's sugar and carbs, if I cut them out or do intermittent fasting all my chronic pains go away. 

 

+1

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My two cents on possible causes of elbow pain:

 

Holding the hammer and tongs too tight.

 

Wearing a glove on the hammer hand, which for some folks result in holding the hammer too tight.

 

Too heavy of hammer.

 

Hammer swing that allows the elbow to raise up and out from the side of the body.

 

Anvil too high.

 

Holding onto your hammer and tongs during heats.

 

Thinking you can do a hard physical activity without training up to it.

 

Take with a grain of salt the advice of others, just because it works for them, doesn't mean it will work for you. Not all tennis players get tennis elbow and not all blacksmiths have elbow pain. I've never had elbow pain from blacksmithing, but did from poor body mechanics with the computer mouse.

 

Having said to beware advice: Here's a bit of mine, video yourself and see what's what.

Edited by Gerald Boggs

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23 hours ago, billyO said:

Hi Chris.  Go to a physical therapist for an evaluation. 

10 hours ago, Gerhard Gerber said:

The physio gave me some advice to just break up the sanding and just shake out my arms.

 

Perhaps I should have said, "Go to a good physical therapist."  And what I mean by 'good' is one who will take the necessary time to:

(1) listen to your complaints, ask questions about what is involved with forging (assuming they have no experience themselves),

(2) ask what specific activities cause pain or seem to aggravate your symptoms,

(3) use palpation and passive motions to try to reproduce your symptoms, 

(4) do a thorough physical evaluation checking muscle strength, soft tissue flexibility, joint play of the entire upper extremity (including the fingers, wrist, elbow and shoulder girdle).

When I owned and operated outpatient clinics,  I scheduled an hour for an initial evaluation.  (I also lost 2 positions 15 years ago for refusing to cut this down to 30 minutes).   If they schedule you for a 20-30 minute appointment, find a different PT.

 

 

 

Edited by billyO

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Having the pain of carpal tennel in both my hands, it took me a while to find what worked for me.  My carpal tennel was a result of working at a call center and continuous typing, and a life long obsession of drawing.

 

These days I barely notice it because I changed jobs, limit my drawing, and I approach my blacksmith work much more loosely among a number of other things.  Most of them are in Gerald's list there, which I learned over time working with several people. Hammer shock was a big one for me too, which was the vibration of the hammer after the blow to be felt in the hand, elbow.  Springy hammer handles helped with that. 

 

If you are having that much pain that you cannot hold onto you tools, stop working.  If you do not you can risk nerve damage or something else permanent. You can work without the pain, but you must heal up first.  If it means putting the tools down for a while don't worry the anvil will still be there after you heal up.  You will not have to give up the activity, there are plenty of ways to build a small hammer to work for you if you need to go that route.

 

If I were in your situation, and had that much pain, that I'm losing my grip. Which is not only important for the hobby but for my actual 12hr job, I would seek out a Doctor and get a medical opinion. 

 

 

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1 hour ago, Daniel W said:

I would seek out a Doctor and get a medical opinion. 

 

While generally good advice, Daniel, let's refer back to Chris's original post:

 

On 2/4/2020 at 7:00 AM, ChrisBriggs said:

I'm a Physician Assistant in an interventional pain clinic;

 

Edited by billyO

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Although as my Briggs is as mentioned above, I do not believe that he should diagnose himself.  If anything seeing another physician to see if there is any damage that he is doing to his body and their opinion on treatment. 

 

Chances are, it does not have to come to that, and there is a technique problem. However as I am no doctor, nor have I the chance to see Mr Briggs work, then my opinion would remain the same.  As Mr Briggs has also stated, he has attempted to treat himself and that has not worked.  To me that means the poor technique was worked though, and it got worse.  I read the original post and thought potential injury.

 

All I can say is that it is my opinion to seek out a Doctor to see if you have injured something that even though proper technique could become worse or make a longer recovery time.  You could just simply need a break, take a step back and research a bit, come back to it in a few weeks with good technique and see what happens. But you should never work hurt, although I think "working though pain and bleeding is second to getting the job done." Is posted up in the "10 ways you know when your a blacksmith when . . . ." at my local club.

 

 

 

 

 

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Sorry Daniel, on second reading, I guess my response seemed a bit harsh, it wasn't meant to be.  I was acting on the assumption (which could be the first mistake:unsure:) that he has already consulted a doctor (one of his colleagues) at work.  I mentioned PT because in my 25 years of experience, this is often overlooked by MDs, and a good argument has been made over the years that PTs are more knowledgeable than most doctors (orthopedic surgeons excepted) in musculoskeletal injuries, especially overuse injuries where no specific trauma can be identified.

Edited by billyO

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B) Trust me no offense, we can all give options on how to have a better technique while forging. I have run into another local smith that is my age, works professionally for 8 years, but forges with a lot of pain.  After a 5 minute talk with him, I had found out that he basically used one 3lb hammer for everything, and death gripped it with carpenters grip. He was already in the process of finding out he was having nerve issue, and thought he was going to loose the dexterity in that hand.  I've since lost track of him, but know he is still working. 

 

Please take no offense in my response as well, most of the time I'm unsure if I've saying the correct thing the correct way anyway.

 

I've been finding out as well how some good physically therapy can help over time.  That is a bad story because I tried things on my own that have worked to get rid of my low back pain.  About 3 months back, I was really thinking to see a Doctor over it, I tried very, very light lower body weight training since, and most of that pain is gone.  Something to bring up with the doc during my annual check up.

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Hey all, thanks for the responses. It has been a bit since I was last on here and had the chance to respond. Upon starting to follow up on my initial post I had wanted to thank each of you individually for your advice however there are enough that I don't have time to thank each individually. So I will say "THANKS!" en masse. A couple things, yes, I have seen a doctor, not just diagnosing myself. I have a rule in my house- I don't treat (or diagnose) my family or myself. That goes badly all too often. I did abandon my hammer hand glove (my left as I am a devoted south paw, like, pathologically LOL) several years ago as I realized I was gripping the hammer like I was Lenny. heh... Alan, thanks for the link. I wasn't aware that there was a section on this in the shop safety area. I don't get to get on here often enough to be truly familiar with the site. A lot of you mentioned having to lay off for however long it takes to recover before I get back hammerin'. Yup, I got that part on lock. It's bad enough that I uh, don't really have a choice. I tried just a few minutes the other day as I have laid off for like a month and it was starting to feel a bit better- or so I told me. The pain was rough enough that I was unable to sleep that night in spite of all my attempts, chemical or otherwise. :( Although I'm smart enough to know "right from wrong" in this sense I'm also an alpha male and have always survived and thrived (Army infantry for about 15 years so....use your imagination) by "working through" pain, adversity and so on. But I get older every day and that alpha male mentality seems to haunt me more and more. I can't just muscle through everything. I've been guilty of using brute force, a bigger hammer (figuratively and literally), and generally just mongoloid manners to accomplish things. I started learning this craft without any kind of mentorship, guidance etc. I was doing this without even being aware of this site for like 3 years. So body mechanics, hammer technique etc never even crossed my mind. So here I am, working on those things now. This is the longest post/response I think I've ever made so I believe my free time limit has been reached...time to ghost out for a while. Thanks again all, truly, for all the advice. I've got things to try now beyond just the medical side. THANK YOU!!!!

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Good luck, my brother. 

 

On 2/27/2020 at 10:56 AM, ChrisBriggs said:

But I get older every day and that alpha male mentality seems to haunt me more and more.

(and welcome to upper middle age....)

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I went to an orthopedic surgeon recently about my Achilles, got referred to another physio  for extracorporeal shockwave treatment :ph34r: core strengthening and gait training.

Whatever that little machine does, it works.

Was also pleasantly surprised to find out that PRP treatment is also an option.......not bad for our little 3rd world backwater.  

Co-payment for each visit to the surgeon is just N$1150 :ph34r:

 

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