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Tennis elbow, cartoonists and central sensitisation

By David Butler Uncategorized 29 Jul 2016


Forward thinking cartoonist

This is my favourite cartoon – I’ve had it pinned on my bookshelf for 30 years after a patient gave it to me. At that time, I was pondering the role of central sensitisation in many common pain states. The cartoon (Tribune Media Services 1986) reminded me that some artists were questioning our concepts of sensitisation before many scientists and clinicians.


The elbow journey

As a new grad, I used to think that tennis elbow (lateral elbow pain) was an elbow problem experienced by tennis players. Then a year or so later, I discovered that golfers can get it too! As I grew professionally, I realised that elbow pain could be referred from the neck, and that multiple problems within the radial and musculocutaneous nerves and their roots could also cause a lateral elbow pain that copped a diagnosis of tennis elbow. But it didn’t stop there. We now know that the neuroimmune representation of the elbow in the brain can become perturbed and a diagnosis of tennis elbow might emerge. The person may or may not have anything to do with tennis.


A leaf from the artists’ book

Good artists always question the norm. Perhaps we could take a leaf out of their book and pause once in a while to consider why we do what we do. I’m quite the fan of the Australian cartoonist, Michael Leunig – this image below comes from a much larger art work hanging at NOI headquarters. It’s great when metaphors for the body can connect back to nature.




Have you seen any other examples of artists being a bit bold and ahead of the time in the world of pain and science?


– David Butler


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