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Physical Therapy for the Elbow

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?

Overuse

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.

Conclusion

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!

Your Sleeping Positions Are Making You Tight and Sore

By Uncategorized

Guest Blogger Steven Griffin, DPT

Do you often feel restless during the night and wake up with neck, shoulder, back, or hip pain? Do you feel like you can’t find a comfortable position? Have you tried multiple pillows or even a new mattress and still have the same old problems?

Sleeping is critically important to our functioning as human beings. Consistent disturbances in sleep can be the source of many issues, including but not limited to: mood, concentration, and memory issues, weakened immunity, increased risk for heart disease, high blood pressure, or diabetes, and decreased tissue growth and repair. A good night’s sleep is of dire importance for us to stay healthy.

Poor sleep quality can be caused by a number of factors. Emotional or mental stress can cause one to lie awake or toss and turn for hours. A poor sleeping environment such as too much light or noise can prohibit us from feeling rested. But what often gets overlooked is that how we position ourselves in bed can also impact the quality of our sleep. Improper positioning can stress muscles, ligaments, tendons, and other tissues. Furthermore, as humans, our bodies do not like to be in one position for long periods. This is why we often get the urge to stand up and stretch when sitting and why we find ourselves shifting around when we have been standing. However, we do not have much conscious control of our positioning while sleeping. Many times, waking up stiff or tight is a result of subjecting tissues to non-neutral positions all night long.
In general, there are three types of sleepers – back, side, and stomach sleepers. Although you might employ a combination of these, most people have a preferred position. Each position can present its own unique issues, but there are strategies to prevent these issues from having a lasting effect on your body and improve your sleep quality. The following paragraphs will cover what can cause problems in each position, and how you can combat these problems or prevent them from occurring altogether.

Back Sleepers
Ultimately, sleeping on your back with everything in a straight line is the best option if done correctly because all of your joints and muscles are in an anatomically neutral position. But, most people aren’t comfortable sleeping like a corpse, so there are issues that can arise with back sleeping.

Problem #1: You have too much pillow support. Having an extremely fluffy pillow or even more than one pillow can put the neck into excessive flexion, setting you up for tight muscles and possible disc issues. It’s also likely that if you work a desk job, you have been sitting in this position all day–so you’re living your entire life in this position, which will almost undoubtedly lead to neck pain.
Solution #1: Get a flatter pillow or remove excess pillows. This will reverse the excess flexion in the neck and optimize cervical muscle length.

Problem #2: You have too much extension in your lower back. Lying with your legs out straight often creates a significant amount of arch in your lower back, which over time stresses the joints of the spine and cause shortening of spinal musculature. This can lead to low back pain or stiffness.
Solution #2: Put a pillow or a wedge under your knees. This will reduce the arch in your back, keeping it in a more neutral position all night.

Problem #3: Your sheets are tucked too tightly over your body. This will force your feet into a point all night long, leading to tightness in the calves–which may predispose you to things like plantar fasciitis or cramping.
Solution #3: It might seem obvious, but untuck your sheets at the side and/or the bottom. This will reduce the pressure on your feet and allow them more room to move around under the covers.

Side Sleepers
Many people, including myself, prefer to sleep on their side. This position is usually fine as long as you have a supportive mattress and pillow, but there are still problems that can arise when sleeping on your side.

Problem #1: You do not have enough pillow support. In contrast to having too much when on your back, many people do not use enough support when on their side. This is especially true for people with broad shoulders, as the relatively larger distance from the mattress to their head is larger. Without proper pillow support, the neck will be forced into a side bend towards the pillow, and prolonged positioning like this is very likely to lead to some neck stiffness down the road.
Solution #1: Increase your pillow support by doubling up your current pillow, adding a second pillow, or buying a more supportive pillow so that your neck is as neutral as possible.

Problem #2: You sleep with your bottom hand under your head. Cradling your head in your hand may feel nice at the time, but this puts your shoulder in relative internal rotation all night long. This problem is compounded by the fact that most of us sit with our shoulders rounded forward much of our day, so sleeping this way ensures we rarely move out of this position. In addition to the internal rotation, this can also produce compression through the shoulder joint, and these two in combination can cause issues like impingement.
Solution #2: Put your arm under the pillow instead of under your head. This is a compromise in which you still get the cradling feeling but decrease the internal rotation of your shoulder. Also consider rolling back slightly to decrease some of the compression directly through the shoulder joint.

Problem #3: You sleep curled up in the fetal position, causing increased hip flexion and internal rotation. If you sit a lot at your job, this excessive hip flexion is likely one that you spend too much time in every day. This increases tightness in the hip flexors and stresses the gluteal muscles, which can ultimately lead to back pain, bursitis, or gluteal tendonitis.
Solution #3: Bring your knees down and sleep with a pillow between your knees. This will decrease the amount of hip flexion and bring your hips into a more neutral position.

Stomach Sleepers
This is typically not a position I recommend people sleep in because of the effect on the neck and the lower back. But, if you must, please consider the following potential problems and their solutions.

Problem #1: Your head is in excessive rotation. Because suffocating yourself in the pillow clearly isn’t an option, you have to rotate your head to almost its end range when sleeping on your stomach in order to breathe. Imagine sitting like this all day and how stiff and sore you would get. This position places a tremendous amount of stress on the joints and muscles in the neck, and can often lead to soreness or a “crick” in the neck.
Solution #1: Place a pillow under the arm towards which you are turned. This creates a decrease in the relative rotation of the neck by rotating the rest of the trunk towards that side as well.

Problem #2: If you like to sleep with your hands under your head, then your shoulders are in excessive elevation and internal rotation. This shortens muscle groups that are already tight in most people and can lead to stiffness of the neck and pain in the shoulders.
Solution #2: Unfortunately, there isn’t a great solution to this problem if you want to stay on your stomach. If you’re willing to compromise, then you can flip onto your back and sleep with your hands under your head. This will put your shoulders in more external rotation and also take the excessive rotation out of your neck as well.

Problem #3: You have too much extension in your lower back. This occurs because of the elevation of your head and neck on a pillow relative to the rest of your body. This excessive extension causes prolonged compression of the lumbar vertebral joints and shortening of the paraspinal muscles, which can lead to back pain.
Solution #3: Remove the pillow and sleep without support. This will reduce the amount of extension in both the lower back and the neck and decrease the pressure on the vertebral joints. Conversely, you can place a pillow under your hips to better align your lower back with your neck.

I bet you didn’t know there were so many ways to sleep incorrectly, did you? I often find with my clients that if they are having trouble progressing as quickly as they would like to in their recovery, how they sleep can be a missing piece of the puzzle. Since we spend so much time in bed and many people are not aware of their positioning during this time, it is always worth a look to assess and improve your positioning throughout the night. This can help you achieve a better night’s sleep and feel better throughout your day.

Osteoarthritis: What Does It Mean and How Can Physical Therapy Help?

By Uncategorized

Guest Blogger Steven Griffin, DPT

Physical Therapy for Osteoarthritis

Have you been suffering from joint pain for a few days, months, or even years? Does this pain feel like an aching sensation that might get sharp with certain activities? Do you notice some creaking or cracking in joints as you move them? These are some common descriptions of symptoms in those who are experiencing arthritic pain.

Osteoarthritis (OA) is the condition in which the cartilage lining the ends of bones begin to wear down. This is a natural and unavoidable part of the aging process, and the amount of U.S. adults with OA in the hand, hip, or knee is over 20 million (Neogi). Many people with OA experience pain, a sensation of pressure or grinding in their affected joints, decreased range of motion, strength, and an inability to perform some of their daily activities.

Many of my clients who are over the age of 50 come in after seeing their physician and tell me that they were diagnosed with arthritis in a painful joint after their MD looked at the X-rays. The truth is, most people at that age have some visible degenerative changes on imaging in many, if not all, of their joints. Whether or not they experience pain, or if arthritis is actually the source of the pain, is another story entirely. There have been many studies that conclude that asymptomatic individuals can have abnormal findings on X-rays or MRIs, as well as other studies indicating that symptomatic individuals can have completely normal findings on imaging. Although this is another topic of discussion, it is important to rule out other causes of pain, such as acute pain from an accident, muscle pain, referred pain from another body structure, or even pain that is tied to emotional stress. Once you have ruled out other causes and have combined imaging with other objective tests that point to OA, then it is much more likely that OA is the source of your pain.

Understanding how osteoarthritis causes pain is important in understanding how physical therapy can be useful for treatment. Decreased cartilage on the articulating areas of a joint cause abnormal pressure on bone tissue. This can lead to decreased blood flow, growth of bone spurs, development of microfractures, and a state of fairly constant bone repair and remodeling. This state of constant repair often results in  a continued cycle of inflammation within the joint, which ultimately leads to an over-excitability of pain receptors. Oftentimes pain will occur during daily activities involving use of the affected joint, so people will in turn avoid the activity, making them weaker and eventually unable to perform the activity. This cycle is then repeated and over time, people may notice they are unable to do simple things like stand up out of a chair or climb stairs without severe pain.

I often get the question, “How is PT going to help my arthritis? I thought cartilage doesn’t grow back.” No, articular cartilage does not regenerate, and unfortunately, physical therapists do not have a magic cartilage wand. What PT does do, however, is help you determine the sources of your pain, reduce inflammation in the affected joint, and address modifiable risk factors. I educate my patients about the appropriate levels of activity for their individual goals, work to improve their strength and flexibility, and address faulty movement patterns that put their joints at increased risk. Another important focus is modifying certain activities or positions to make them more efficient or manageable for a specific impairment. Finally, there are several manual therapy techniques that I perform to help reduce overall pain, such as joint mobilization, soft tissue massage, dry needling, and more.

If you have been diagnosed with pain related to OA, it is important for you to know what the appropriate actions are to take so that you can reduce its effects on your daily life. A skilled physical therapist can help you reduce pain and determine which of your modifiable risk factors can be improved. From that point, the two of you can conceive a plan moving forward to keep you living the life that you want without the fear of constant pain.  

 

Data obtained from the following article:

Neogi, Tuhina, and Yuqing Zhang. “Epidemiology of OA.” Advances in Pediatrics, U.S. National Library of Medicine, Feb. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3545412/. 

 

Runners: Forget R&R – How About Some S&S?

By Uncategorized

Guest Blogger Steven Griffin, DPT

Strength and Stability Training for Runners

If you are a runner, one of the worst feelings in the world is sustaining an injury while training for a big race. An even worse feeling is having this injury slow your time down significantly or even knock you out of the race all together. Overuse injuries are notorious in the endurance athlete population, particularly in runners. One of the reasons for this is that many runners do not incorporate any kind of exercise variety into their training program. Coupled with the very high volume of activity, the lack of cross-training predisposes these athletes to many different kinds of overuse injuries that can turn chronic if the underlying issues are not addressed.

One common strategy that runners use when dealing with overuse injuries is R&R, or rest and relaxation. While R&R has its place, I often implore my runners to try what I call S&S, or strength and stability training. This type of cross-training can have numerous benefits for runners, including improving form, multiplanar strength, tissue resiliency, and kinesthetic awareness.

To understand how S&S training can help you, you must first understand the basics of how most overuse injuries affect your body. High-volume training coupled with subtle weaknesses in certain muscle groups can cause a breakdown in your running form. These weaknesses often occur in some of the stabilizing muscles such as the gluteal muscles or the muscles that support the arch of the foot. In the short term, you may not notice the effects of form breakdown, but over tens of thousands of steps, even a slight decrease in your running economy causes increased pressure and demand on your muscles, tendons, joints, and bones. Complicating matters is that many athletes will train through the injury, resulting in increased tissue damage, increased chance to develop a chronic injury, overall prolonged recovery time, and more missed training days in the long term.

S&S is also critical for runners who always feel tight; no matter how much you stretch your tight muscles, they never seem to loosen up. This is likely because your muscles aren’t physiologically shorter, but that your muscle weaknesses are causing instability in certain joints. Your body is a master at protecting itself against what it perceives as potential threats to its well-being, and so it uses the muscles that directly affect that joint as a “protective spasm,” keeping the joint from moving or shifting in various ways. If this is your issue, correcting these weaknesses is likely the underlying solution to your chronic tightness.

Incorporating strength and stability into your training has numerous benefits, including, but not limited to, the following:

  1. It improves strength and endurance of stabilizing muscles in the lower extremities. This will in turn improve overall running economy and take pressure off of tissues that compensate for weaknesses in these areas.
  2. It subjects tendons and bones to increased loading. This will improve tendon strength and bone density, decreasing risk for common running injuries like tendonitis or stress fractures.
  3. It improves proprioception, or the ability to sense where different body parts are in space. This helps running economy and also can prevent acute injuries like ankle sprains.
  4. It also improves overall function in daily activities not related to running, such as squatting, lifting objects, climbing stairs, etc.

S&S training comes in many different varieties. If you are considering incorporating this into your routine, then you may choose to try weight lifting, yoga, Pilates, body weight training, resistance band exercises, functional training, TRX classes — the list goes on! If you can implement a large variety, that will only magnify the benefits that you get.

If you are a runner suffering from an overuse injury, then you should consider seeing a physical therapist at Druid Hills PT. Your therapist can determine the sources of your injury, analyze your running form, and advise you on the appropriate cross-training strategies based on your individual needs and goals. And if you are not currently injured, consider implementing some S&S training to prevent future injury and help you reach your running goals.

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