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Physical Therapy for Tennis Elbow

By Physical Therapy, Rehabilitation, Tennis


What is Tennis Elbow?

Tennis elbow is one of the most common upper body orthopedic injuries, especially when it becomes warmer outside and people pick up a new recreational activity. Although the name implies that this condition only occurs in tennis players, this is not always true! It is more common in tennis or racquet sports athletes, but it can also occur in anyone who performs repetitive arm motions through their job, recreational, or home activities.

Tennis elbow, or lateral epicondylitis, refers to pain on the outside (lateral) part of your elbow, often made worse with increased activity. The lateral epicondyle is the end of the humerus bone (upper arm bone), and your forearm muscles that extend your wrist and fingers (extensor muscles) attach to this bone. The tendon of these forearm muscles, called the common extensor tendon, can become inflamed with overuse. If left untreated, the pain can become worse over time.

Lateral Epicondylitis is the inflammation or irritation of the common extensor tendon, causing pain in the forearm or outside part of the elbow.

What Causes Tennis Elbow?


Typically, lateral epicondylitis is caused by repetitive overuse and overstretching of your forearm extensor muscles. The most common muscle affected is the extensor carpi radialis brevis (ECRB). When the forearm extensor muscles become overworked, they can develop trigger points or knots in the muscle. These knots are due to the build up of lactic acid and lack of stretching post activity. Trigger points can refer pain and cause weakness in the muscle. The more knots that develop and the tighter the extensor muscles become, the more that the tendon can become irritated.

This excess strain can result in tiny tears in the tendon where it attaches to the lateral epicondyle. This causes acute inflammation in the tendon, often leading to an increase in pain.

If left untreated, lateral epicondylitis can become a chronic condition and get worse over time. Due to the overuse, scar tissue can develop and thicken the tendon. At this stage, there are typically no inflammatory cells, and we call this condition Lateral Epicondylalgia.

Other Causes

  • Starting a new activity 
    • Rock climbing, tennis, water sports, CrossFit
  • Going too hard too fast
  • Improper technique or equipment while playing racquet sports
  • Prolonged use of hand or wrist
  • Typing or mousework at a computer
  • Painters, plumbers, machine operators
  • Excessive gripping or twisting activities
  • Lifting heavy objects
  • Forceful activities
  • Unknown
  • The pain can begin randomly, and we call this insidious onset

Signs and Symptoms of Tennis Elbow

  • Usually starts out gradually and become worse over time
  • Pain and tenderness on the outside part of your elbow
  • Pain may radiate into your forearm or wrist
  • Pain or weakness with gripping activities
  • Weakness or cramping in the forearm with recreational activities
  • Difficulty with opening a jar
  • Pain when lifting a heavy object or child
  • Stiffness in the elbow

Tips for managing pain if you think you may have lateral epicondylitis

  • Modify your activities
    • This includes taking a rest break from tennis, lifting, or any other activity that is painful
    • Remember, tendons take time to heal! Taking a few weeks off after the pain begins is typically recommended for a tendinitis injury
  • Try ice or anti-inflammatory medications
  • Perform stretches for your forearm, especially before and after increased activity
    • You can watch our video where we instruct on these specific exercises.
  • Massage your forearm muscles
    • You can use your opposite hand to massage the muscles on the back of your forearm
    • You could also use a handheld massage gun to gently loosen these muscles
  • Applying a compressive brace on your forearm
    • This helps release the amount of tension on the tendon on your lateral epicondyle

What happens if my pain doesn’t improve?

Physical Therapy for Tennis Elbow

If your pain lasts longer than a few weeks and doesn’t seem to be improving, it may be time to try Physical Therapy for tennis elbow!

Lateral epicondylitis is not always a one size fits all condition. There can be other factors contributing to your pain including numbness/tingling in the forearm, pain on the inside part of your elbow (medial epicondylitis/golfer’s elbow), and possibly shoulder and/or wrist pain. Our Physical Therapists will evaluate your elbow and determine the best plan and treatment approach specifically for you.

Don’t forget, you can refer yourself to Physical Therapy!

What Can I Expect during a PT Session? 

  • Pain Management: Your PT will help determine which movements cause your pain and help you avoid them in the beginning of treatment to decrease your symptoms.
  • Range of Motion and Stretching Exercises: Often your wrist and elbow motion becomes limited due to pain. Your PT will prescribe you stretches for the muscles around your elbow to help regain your mobility and allow you to move with less pain.
  • Strengthening Exercises: The forearm extensors and flexor muscles are typically weakened which makes it challenging to perform your daily activities such as gripping, typing, and lifting. Your PT will give you strengthening exercises for your weakened muscles in the forearm and hand to reduce the strain in your elbow.
  • Manual Therapy: Hands-on treatment also assists in loosening your tight forearm muscles and improving the stiffness in your elbow joint. Dry needling is also an effective approach for relieving lateral elbow pain!

You will receive a home exercise program that was designed specifically for you, and your PT will regularly check in with your exercises to make sure they are still beneficial for you. After you graduate from PT, these exercises will be your tool to help prevent future episodes of elbow pain.


Lateral elbow pain is very common, and our physical therapists are specifically trained to help relieve your symptoms. Regardless if you have had elbow pain for years or just started experiencing this pain recently, we can assist in alleviating your pain!

If you’re experiencing pain in your elbow, please contact us by using the form below and we can get you scheduled with one of our dedicated physical therapists!

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Physical Therapy for Low Back Pain

By Health, Low Back, Physical Therapy, Rehabilitation, Spine


Low Back Pain

Out of all of the orthopedic conditions that Physical Therapists treat, low back pain is the most common. Low back pain can occur whether you are young or old, and it can last a few days or be off and on for years. It can be aggravated by a single event such as bending over, a car accident, or the pain can sneak up gradually over time.

Because low back pain can present many different ways, it is not a one size fits all condition. There can be issues with the joints in your spine, and this can cause stiffness in the bones in your low back. You could also be experiencing low back pain with possibly some weakness or numbness and tingling in your lower leg. Your low back could be taking too much of the load during activities due to weakness in your core and hip muscles. Whatever the cause, Physical Therapy for low back pain can help you return you back to function!

What Causes Low Back Pain?

As mentioned above, there are MANY different causes of low back pain. Here is a brief overview of the most common causes.

Common Causes:

  • Disc and Nerve-related Conditions:
    • Herniated Disc
    • Lumbar Radiculopathy
    • Sciatica
    • Degenerative Conditions: common over the age of 50
    • Lumbar Spinal Stenosis
    • Degenerative Disc Disease
    • Osteoarthritis
    • Facet Joint Syndrome
    • Osteoporosis
    • Spondylolisthesis
    • Myofascial Conditions: common in individuals 20-50 years old
    • Muscle Strain or Spasm
    • Ligament Sprain
    • Hypermobility
    • Instability
  • More Serious Conditions:
    • Fractures
    • Cancer
    • Kidney Disease
    • Infection

Signs and Symptoms of Low Back Pain

Your pain might be in the center of your low back right above your belt line, it could be off to one side, or it could even begin to radiate down into your buttock region. The pain area could be a pin-point location or span across a larger region. Symptoms could vary between sharp or stabbing pain, throbbing pain, a dull ache, or shooting pain. The pain could be constant or come and go depending on the time of day or your activity level. You might not even be experiencing pain, but rather you feel more stiffness and an uncomfortable feeling in your low back.

The time limit and how frequently you experience your symptoms also helps define your low back pain. The main three categories of pain are:

  1. Acute Low Back Pain (pain that has lasted less than 3 months)
  2. Chronic Low Back Pain (pain that has lasted more than 3 months)
  3. Recurrent Low Back Pain (multiple periods of 3 month episodes of acute low back pain that comes and goes)

*If you are experiencing any symptoms that are more severe such as loss of bowel or bladder, progressive and severe weakness in both legs, decreased sensation in your groin area, or unexplained weight loss, please see your doctor immediately.

Tips for Managing Your Back Pain

Acute Low Back Pain

Typically resting for a short period of time can help calm down your symptoms initially. Ice can be used any time your back becomes hot and inflamed, such as after a fall or after a sudden movement that caused a sharp pain. Heat is commonly used after a car accident or repetitive activities that cause your back to ache and throb afterwards. Sometimes alternating heat and ice or using creams such as IcyHot or Biofreeze can also help you find some relief.

The most important thing to remember is that resting for a little bit after injuring your back is okay, but bed rest for multiple days is not recommended! The longer you stay inactive, the tighter your muscles and joints can become, and this can cause you more low back pain. Especially if you have been involved in a car accident, it is essential to keep moving!

If you recently aggravated your low back, it is also best to avoid prolonged positions such as sitting or staying in a crouched position for a long period of time. Additionally, attempt to avoid any heavy lifting or repetitive squatting movements until your pain begins to decrease.

If you have been suffering with low back pain for more than two weeks and cannot find any relief, it may be time to consult your doctor or refer yourself to Physical Therapy.

Recurrent or Chronic Low Back Pain

Perhaps you have been suffering with low back pain for years and have tried multiple different treatment options with no relief. Clearly something is causing your pain to keep coming back, and Physical Therapists are trained to come up with solutions to allow you to have more pain-free days.

Physical Therapy for Low Back Pain

In the majority of cases, low back pain can be successfully treated conservatively through Physical Therapy. During your first session, your PT will ask you multiple questions so he/she can figure out what is the underlying issue of your pain. These questions could include:

  • What movements cause your pain?
  • Is your pain worse in the morning or at night?
  • Does your pain get gradually worse during the day or is it caused by a single movement?
  • Do you have numbness or tingling down your leg or in your foot?
  • When did your symptoms begin?
  • Have you tried any other treatments before today?

The initial goal of PT is figuring out which movements cause your pain and avoiding them in the beginning of treatment to decrease your symptoms. Your PT can then find stretches or positions that feel good and help alleviate your low back pain. Once your pain decreases, you can begin performing your regular activities again. Typically strengthening exercises for your core and hip muscles is also necessary to reduce the strain in your low back muscles. Manual therapy (hands-on treatment) also assists in loosening your tight muscles and improving the stiffness in your back joints. Dry needling is also an effective approach for relieving low back pain!

You will receive a home exercise program that was designed specifically for you, and your PT will regularly check in with your exercises to make sure they are still beneficial for you. After you graduate from PT, these exercises will be your tool to help prevent future episodes of low back pain.


There are numerous treatment options for low back pain including injections, pain medications, chiropractor, massage, or possibly even surgery. If you have tried any of these treatments but nothing has helped, give PT a try! We see patients every day with low back pain, and we would love to help alleviate your pain!

If you’re experiencing Low Back pain, please contact us by using the form below and we can get you scheduled with one of our dedicated physical therapists!

Benefits of Physical Therapy for the Aging Population

By Aging, Health, Rehabilitation


A man with a beard and mustache smiling for the camera.

Guest Blogger Steven Griffin, DPT

It’s a fact of life: as we age, our bodies are not quite as resilient as they used to be. Strength, endurance, flexibility, cardiovascular and pulmonary function, bone and joint health, and other physical functions begin to decline. You may have noticed that you or someone you know is having difficulty walking, bending over, lifting objects, climbing stairs, or other daily activities due to pain, weakness, or inflexibility. However, aging does not necessarily translate into dysfunction throughout our daily lives. The effects of aging can be slowed, and one of the best ways to combat these effects is through regular exercise and body maintenance.

The benefits of exercise are numerous for all ages. Some of those major benefits are as follows: 

  1. Cardiovascular health: Stressing the heart through exercise improves circulation, activity endurance, lung function, and energy levels.
  2. Muscle strength and endurance: Our muscles, even as we get older, adapt to the stresses they are subjected to. Improving strength and endurance through exercise can translate into easing daily activities like walking, standing up from a chair, picking things off the ground, and lifting heavy objects.
  3. Reducing musculoskeletal pains: Pain can arise when muscles, joints, nerves, or other structures aren’t working the way they are supposed to. Specific exercise to address body impairments related to these structures can help prevent or reduce pain.
  4. Social wellness: Going to exercise classes, the gym, playing sports, or just walking with a group is a good way to interact with your family and friends which plays a huge role in mental and emotional health.

Although these are some of the major benefits, they are by no means the only benefits of exercising. When I work with clients, I often hear them say things like “I’m too old to do that” or “I just have to accept the fact that I’m getting old.” I believe this is the wrong mindset. As an expert on the human body, I know that exercising can help slow the aging process. I often respond to those clients claims with the following: You don’t stop doing physical activity because you got old, you got old because you stopped doing physical activity.

Now, where does physical therapy come into this? What if you are having pain that is preventing you from exercising? What if you want to exercise but you aren’t sure what you should be doing? Physical therapists are extensively trained in both pain management and exercise programming. If you are suffering from pain, weakness, difficulty with daily activities, low energy levels, or any combination of these, then you should consider making an appointment at Druid Hills Physical Therapy. A highly skilled physical therapist on staff will evaluate your needs and select the appropriate interventions based on their findings.

These are your golden years. Don’t let the fact that you are getting older get in the way of living the life that you want to live. You may find that you are capable of things that you previously thought were only possible for the much younger version of yourself. Make your appointment today, and start your journey towards a more active and enjoyable life!

A man and a little girl in the water.

Dry Needling: How and Why It Works

By Health, Outpatient Surgery, Rehabilitation, Surgery

A man with a beard and mustache smiling for the camera.

Guest Blogger Steven Griffin, DPT

Why Dry Needling Works

We’ve all been there at some time or another. You’ve been staring at the computer for hours, slumped over in your chair and shoulders up to your ears, carrying all of the stress from the impending deadline at work or the test that you have to take tomorrow. You’ve noticed that a headache is starting to come on, but you shrug it off, attesting it to simply staring at a screen for too long. The only problem is that it doesn’t go away once you leave the computer, and you feel like you have tons of “knots†or “kinks†in the top of your shoulders and into your neck that need to be worked out.

Not a desk kind of person? Maybe you decided to break out the tennis racket for the weekend because the weather was so nice. You had a blast, but when you wake up Monday morning, you notice this dull aching pain that is radiating from your shoulder blade into your upper arm that you can’t quite pinpoint. You may even notice a feeling of tightness in the shoulder, or possibly even some tenderness if you poke around.

In either of these scenarios, it’s likely that your pain is being caused by myofascial trigger points. These trigger points are those painful “knots†in the muscles and can be caused by many things, like poor posture during standing, sitting, or sleeping; over-exertion; direct trauma; or protective spasms. Regardless of how they come about, trigger points can be a nagging source of pain and tightness for many people, and sometimes simply stretching isn’t enough to oust them.

Fortunately, there are treatments–in combination with proper movement–that can help alleviate the issue. One of these is trigger point dry needling. Dry needling involves the use of a very thin needle that directly enters into the trigger point. This causes a cascade of biochemical events in the muscle fiber and allows it to release, reducing pain.

What exactly happens in the trigger point during dry needling that causes it to release? The research isn’t conclusive, but the three main theories are:

  1. Increased neurotransmitter activity at the muscle causes prolonged contraction which causes sensitization of the tissues and therefore pain. Needling to the area increases the pH in the muscle fiber and decreases neurotransmitter activity, which then decreases the  muscle contraction and the pain.
  2. Prolonged muscle contraction causes decreased blood flow, which causes decreased tissue healing and therefore increased pain. Needling to the trigger point improves blood flow and, with it, tissue healing and pain.
  3. Sustained muscle contraction puts pressure on nerves which causes pain. Needling to the area helps release the contraction and therefore decreases pressure on nerves and decreases pain.

There’s nothing like a little science to get you amped up, is there?

You may be saying to yourself, “This definitely sounds like something that may help me, but where can I have it done? What can I expect?†Luckily for you, there are physical therapists who have had years of experience studying and treating the human body, as well as countless hours of practice with dry needling. Druid Hills Physical Therapy has an expert dry needling therapist on staff.

When having the procedure performed, you can expect a deep aching feeling  or pressure, and you may even feel the muscle twitch. That twitch response is the muscle fiber letting go of the sustained contraction that has you feeling your pain. Side effects are rare, but the two most common are muscle soreness (which should just feel like a workout type soreness) and minor bruising.

If you are suffering from trigger point pain, then dry needling can help you. Your physical therapist is an expert in analyzing movement and performing a comprehensive treatment of the musculoskeletal system. A combination of dry needling, other appropriate manual therapy techniques, and specific exercise should have you feeling much better in no time!

Call To Book An Appointment!