Tennis Elbow - Why is my elbow hurting? Lateral epicondylitis (also known as Tennis elbow), is considered an overload injury of the extensor tendons of the forearm where they attach at the lateral epicondyle. It affects up to 3% of the population, and symptoms may persist for up to 1 year in 20% of people. Up to 17% of workers within the highly repetitive hand task industries such as factory workers, admin workers and tradesman, experience lateral epicondylitis. What does it feel like? Lateral elbow pain presents as pain and tenderness over the outside of the elbow when doing activities such as:
- Writing or typing on the computer
- Lifting an object (even as light as a sheet of paper)
- Opening the car door or those horrible pasta sauce jars
- Doing your best to avoid repetitive tasks
- Use the unaffected hand
- Adjusting your work environment (e.g. height of work chair)
- Wearing a brace to disperse load from tendon]
- Tennis elbow is an OVERLOAD injury.
- Don’t do nothing. Learn how to modify your daily tasks to avoid overloading the wrist extensor muscles
- Cortisone injections may be good for a quick fix, but think long term
Tennis Elbow (Lateral Epicondyalgia)If you have tennis elbow you can experience pain when performing gripping tasks or resisted wrist/finger extension. Pain can also be present when your forearm muscles are stretched. There is probably tenderness directly over the lateral epicondyle, the bony bump on the outside of the elbow, and tender points (trigger points) in the forearm muscles. In some cases, you may also experience neck stiffness and tenderness, and possibly also signs of nerve irritation like numbness and tingling. Most elbow movements are pain-free despite the surrounding area being painful.
WHO IS AFFECTED?You don’t have to be a tennis player to suffer from tennis elbow. It is caused by the repetitive movements and the gripping actions common in tennis hence the term ‘tennis’ elbow. However, it may also occur in other activities requiring repetitive gripping actions. Tennis elbow can therefore stem from daily activities such as using scissors, cutting meat, carrying grocery bags, gardening, manual work that involves repetitive turning or lifting of the wrist, such as plumbing, or bricklaying, and typing.
ACUTE VS CHRONICAcute tennis elbow, also known as lateral epicondylitis, is an injury to structures involved in extending (straightening) the wrist and fingers at the site where the forearm muscles attach to the bone via the extensor tendon. It occurs when more force is applied to that area than the normal healthy tissue can handle. For example:
- Unaccustomed hand use such as starting the tennis season,or increasing the frequency or amount of time playing tennis too quickly. Sometimes just a weekend of home DIY may trigger it
- Excessive gripping or wringing activities, possibly a new racket or different grip size
- Poor forearm muscle strength or tight muscles
- Poor technique (this may be a poor tennis shot).
TREATMENTTennis elbow should be diagnosed by a physiotherapist or doctor. A history is taken, and tests performed. Referred pain from the neck and reduced nerve mobility can mimic tennis elbow. The physical therapist must check your neck and clear it from any involvement in your elbow pain. An ultrasound scan or MRI are the best tests to identify tendon damage,but are often not necessary. Physical or manual therapy treatments than can help include:
- Massage therapy to relieve pain and stretch tight muscles and structures
- Manual therapy can mobilise joints in the elbow and around the neck to ensure normal function
- Taping and braces are beneficial in reducing pain in the elbow and supporting the muscles when you return to sport n Ice and ultrasound therapy may be used to reduce inflammation.
- Dry needling can also be effective for pain relief, releasing trigger points in the muscle and promoting tissue healing
- Exercise therapy should be prescribed to strengthen and balance the muscles of the forearm. While stretches help to lengthen tight muscles.
Don’t Let Yourself Be Sidelined by Tennis InjuriesTennis is one of the most popular sports throughout the world, with approximately 75 million participants worldwide. It is a sport that you can play at every age and at every level. Children can start playing from the age of 4, using softer, slower balls and smaller rackets on modified courts to make the game easier and more fun, gradually progressing to regular rackets, balls and courts. Older players can start the sport at any age and can continue playing all their life. Whether you are looking for the competitive club league tennis or a more social game amongst friends, tennis is an excellent sport with loads of health benefits. Tennis is a fun and social (as well as competitive) way to add to your weekly activity goals.
Here are some amazing benefits of participating in regular activities like tennis:1. Increased brain power From alertness to tactical thinking, tennis enhances the neural connections in your brain. Kids who play tennis regularly get better grades at school. 2. Better hand–eye coordination Playing tennis involves regular skills that all contribute to good hand–eye coordination. You can improve your agility, balance, coordination, reaction time and more. This can benefit you in injury prevention where improved balance and agility can help protect against rolling an ankle or tripping and falling often resulting in sprains or Colles fracture of the wrist or worse a hip fracture in older age. 3. Reduced stress Tennis involves physical, mental, social and emotional challenges, which increase your capacity to deal with stress. Or simply running around smashing some balls may help you to blow off some stress too! 4. Strong heart Compared with other sports, tennis players have the lowest incidence of cardiovascular disease. Playing just 3 hours a week will reduce your risk of heart disease by 56%. 5. Higher fitness levels Playing tennis on a regular basis (2–3 times/week), either singles or doubles, meets the global exercise recommendations and leads to increased fitness levels. Tennis is an excellent interval training technique - running, stopping, burst of activity then rest between points or games (which elevates and then lowers heart rate repeatedly through a match) which is proven to be hugely beneficial in improving fitness levels and in cardiovascular conditioning too. The effect is not only seen in elite players but with recreational tennis too. 6. Leaner body Tennis is an excellent and fun way to burn calories and lose weight. An hour of singles play can burn 580–870 calories. A lower body weight has immense benefits in preventing and managing cardiovascular diseases including diabetes, and a lighter frame will reduce loading on your back and joints reducing joint pain and possible arthritis in older age. 7. Strong bones Playing tennis on a regular basis leads to stronger, healthier bones. This effect is strongest in those who play tennis from an early age, but even if you start playing tennis later in life you can benefit from the positive effect on your bones. This is applicable to both women and men combating the development of osteoporosis a.k.a. brittle bones with ageing. 8. Strong leg muscles Playing tennis strengthens your leg muscles, which helps maintain your mobility and independence in old age.
The Secret is Staying Injury FreeBut these health benefits won’t be very fruitful is you are sitting side-lined because of injuries and while some injuries are quick to repair, others can take a couple of weeks and others may be more stubborn, taking 6 weeks or more. What’s more frustrating, and unfortunately very common, is the risk of re-injury. One of the greatest risk factors for an ankle sprain or a muscle strain (tear) is having suffered from a previous sprain or strain. Nearly 2/3rds of tennis injuries are chronic overuse injuries, many of which are caused by poor technique, incorrect equipment use and lack of physical conditioning
Acute injuries, like an ankle sprain or calf strain, although sudden and unpredictable can also be prevented with adequate preparation and appropriate conditioning. Chat to one of our friendly staff for more information on how to prevent common tennis injuries and stay in the game longer!
What is Clinical Pilates and why has it made such an Impact?Clinical Pilates has been shown to reduce the onset, persistence and recurrence of pain by addressing the neuromuscular dysfunction it is associated with. Clinical Pilates is largely concerned with training local spinal and pelvic stabilising muscles to work efficiently throughout functional activity. It is particularly important in the rehabilitation of spinal pain amongst other motor control problems and is associated to what researcher’s term “specific stabilisation exercises” or “motor control exercise”. With the latest research emerging, evidence-based Physiotherapists have re-evaluated their management of low back pain with a shift towards this type of exercise rather than focus on strength and endurance, which is perhaps more appropriate in the advanced stages of rehabilitation. CLINICAL PILATES involves the following components which are particularly helpful to aid in the rehabilitation of low back pain:
- Teaches co-activation of Transversus Abdominis (TA), Pelvic Floor (PF) and Multifidus (MF) muscles
- Teaches correct muscle activation patterns
- Trains local and global stability systems
- Trains neutral stability before end range stability
- Progresses static stability to dynamic
- Direction specific
Osteoarthritis and supplementsOsteoarthritis is a common inflammatory condition characterised by joint pain. See below example. Osteoarthritis affects 2.1 million Australians. The prevalence is higher in women and joint symptoms are experienced by more than 25% of people aged 65 years or older. Osteoarthritis is particularly burdensome, on individuals and on the healthcare system and is the main reason for knee replacement surgery. This is of great concern considering the projected rise in the aging population. In recent years, omega 3 fatty acids (from fish oil), glucosamine and chondroiten have increased in popularity. Research into these and osteoarthritis is showing some promising results, however more research is still needed. Should you take these supplements if you have Osteoarthritis?? You can as there is some worthwhile evidence but it should form only a small part of your management plan. Score your pain on a scale of 1-10 before taking the supplement, then after 3-6 months score your pain again to see if there has been any change. If you are taking chondroitin it is recommended that you take a supplement containing 800mg such as BioOrganics glucosamine 750g and chondroitin 400mg. There is much stronger evidence to show that dietary induced weight loss (>10% of body weight) and physical exercise such as strength training and aerobic exercise can have a moderate to large improvement in pain, function and quality of life. In addition, learning effective pain – coping skills have been shown to have positive outcomes not only for pain but also for function, stiffness and disability.
What is a fall?The World Health Organisation defines a fall as "inadvertently coming to rest on the ground, floor or lower level, excluding intentional change in position to rest in furniture, wall or other objects". Falls in older people cover a wide range of events, including:
- trips on raised obstacles (eg. loose rugs, cords, mats) or uneven surfaces (eg. footpaths, roads)
- slipping on wet or highly polished surfaces
- tumbles and stumbles down steps or stairs
- falling off a ladder or stepladder
- falling over in a shopping centre or while using public transport.
What a fall is not:
- Falls in older people are not accidents. Similarly, falls are not an inevitable or unavoidable part of life. The causes of a fall can usually be identified and the sequence of events leading up to the fall can be predicted and therefore can be prevented. o Unintentional falls continue to be the leading cause of injuries requiring hospitalisation in Australia.
Risk factors for fallsPhysical inactivity
- Physical activity has been shown to be the most promising falls prevention strategy, both as a single intervention and as a part of a multi-factorial approach.
- Research shows that specific exercises such as Tai Chi, balance, gait training and strength building group classes or individualised in-home programs reduce falls risk by 12% and the number of falls by 19%.
- These interventions can also increase the time before a person falls for the first time. A physical activity program should be specific for individuals and include exercise that challenges balance at a moderate to high extent with a attendance twice weekly.
What you can do to prevent a fall ?Physical activity is key to preventing falls and improving well being! A holistic program including:
- Proprioceptive retraining – challenging your body on unstable surfaces such as wobble discs and bosu balls helps to retrain your ability to recognise where your body is in space.
- Strengthening – a full body strength program including lower limb, upper limb and core strengthening will help to mitigate the loss of muscle mass common in the older population.
- Exercises such as squats, bridges, push ups and calf raises are useful examples of this.
Other modifiable risk factors for fallsIncontinence
- Problems with bowel and bladder control can impact on an older person's ability to stay active, healthy and independent.
- Incontinence, urinary frequency and assisted toileting have been identified as falls risk factors for residents in residential aged care facilities.
- Physiotherapy can assist with incontinence.
- Sore, aching or tired feet make it difficult for an older person to stay active and independent, and can affect the way they walk.
- Some types of footwear such as slippers, thongs or scuffs, and wearing socks without shoes can increase the risk of falls
- Low vision, impaired vision, a change to vision or vision affected by medication can increase the risk of an older person falling. Vision impairment ranks sixth in the world's major causes of loss of wellbeing, and the prevalence of vision loss increases with age.
- There is strong evidence that falls risk is increased by medications which act on the central nervous system, such as those used to treat depression, sleep disorders and anxiety.
- For those using these medications to assist with sleep disorders and anxiety related health issues, there is a need for longer term support and use of non-pharmacological alternatives such as relaxation, reducing caffeine intake, increasing physical activity and meditation in the first instance. Home safety
- The relative risk of falls can be reduced by 20% in those with a history of falling by an occupational therapist conducting a thorough home risk assessment and arranging the recommended modifications.
- Tidying up behind you and not leaving objects on the floor can also help to prevent falls.
- Nutrition is an important factor in falls prevention, as frailty results from a loss of muscle mass and strength, neuromuscular impairment, immobilisation and malnutrition.
- Older Australians are at risk of developing nutritional health problems due to reduced energy needs and a decreased ability to absorb nutrients.
Falls can be prevented!Staying healthy and active, maintaining strength and balance, identifying falls risk factors and improving home safety will help to minimise the risk of falling. Talk to your physiotherapist today about minimising your falls risk factors or join our fit for life program.
The popularity of golf has increased substantially over the past few years with an estimated 55 million players worldwide. With increased accessibility and participation rates, the sport of golf offers up a diversity of player profiles, ages and levels of experience. Golf is generally considered to be a moderate risk activity with respect to the development of injury. Up to 80% of all golfing injures are due to overuse with the remainder resulting from trauma or contact. The most common areas for injuries in golfers include:
Low back and trunkInjuries represent the highest incidence of injury affecting up to 1/3 of golfers. Due to the increased rotational forces placed on the spine during the golf swing and the asymmetric nature of the swing, the back is subject to increased forces and potential for injury.
Upper limb injuries are far more common than lower limb injuries.
- Shoulder injuries are usually related to overuse and are due primarily to increased rotary forces (internal and external rotation) at the beginning and at the end of the swing. Common injuries include rotator cuff pathology, AC joint pain and shoulder instability.
- Elbows are the second most frequently injured area. Overuse injuries to the tendons of the medial epicondyle (golfer’s elbow) and lateral epicondyle or (tennis elbow) are common. Interestingly, tennis elbow is 5 times more common than golfer’s elbow among amateur players - likely a result of poor biomechanics such as over-swinging.
- Wrist and hand injuries can result from blunt force with the ground or overuse. Fractures, subluxations and tenosynovitis are most commonly seen.
Lower limb injuries are much less frequent and can be attributed to both the swing as well as the walking loads between holes.
- Hip injuries are often a result of the increased rotational forces placed on the hip during the swing. Soft tissue injuries to the groin and gluteals have been noted, as well as trochanteric bursitis.
- Knee pain is often associated with meniscal injury due to the twisting moments placed on the knee during the swing. Osteoarthritis of the knee can also be aggravated during the swing or when walking.
- Foot and Ankle pain are less common, with ankle sprains and plantar fasciopathy of note.
- The main risk factor associated with injury is a lower handicap (increased proficiency) likely due to the increased hours spent training and playing golf – think overuse and/or over training.
- An age of >50 years old was also observed as in increased risk factor, primarily due to the physiological changes associated with ageing.
- Other factors increasing risk of injury include lack of warming-up, reduced mobility/flexibility and poor physical conditioning.
- Muscular imbalances have also been shown to increase injury risk, particularly during intense play or with high practice hours.
- Collision injuries are most commonly related to contact with golf balls and clubs and in some instances, the golf-cart!
- Poor swing mechanics and incorrect grip and set-up.
- Evidence exists for the implementation of a holistic training program to reduce golf-related injuries.
- Flexibility with specific focus on the shoulder and hip (particularly the hip flexors);
- Mobility particularly of the thoracic spine;
- Core stability to support the large rotational forces of the spine during swing;
- Balance to provide a solid foundation for the swing;
- Resistance exercises with particular focus on large muscle groups and scapular stabilisers.
- An adequate warm-up prior to commencing play e.g. dynamic stretching including trunk rotations and knees to chest.
- Assessment and correction of any muscular asymmetries or range of motion deficits;
- Optimisation of swing biomechanics by a golfing coach.