The Tennis Elbow Conundrum
Tennis elbow, or to give it
its medical term, lateral epicondylitis; is the bane of many people’s lives
regardless of their devotion to tennis. Almost as bothersome is the problematic
golfer’s elbow or medial epicondylitis. Both these injuries are inflammation or
degeneration of the tendons that attach to the medial (inside) or lateral
(outside) parts of the humerus in the elbow joint.
The symptoms of tennis elbow
are pain and tenderness on the outside of your elbow and sometimes in the
muscles on top of your forearm. Tennis elbow usually affects the arm of your
dominant hand because this is the arm you use the most. Symptoms usually
develop gradually. The pain may get worse when you move your wrist or if you
repeat the activity that triggered the pain. The pain may become constant. Your
affected arm may also be more painful when you grip or twist something, such as
turning a door handle or shaking hands.
Tennis elbow is caused by an imbalance
between wrist flexors and extensors, the muscles in your forearm that control
the main movements at the wrist. This imbalance can be brought to the forefront
by a repeated overuse of your arm. Playing tennis three times in a week when
you haven't played for some time is the sort of overuse that could cause tennis
elbow. However, most people who develop tennis elbow haven't been playing
tennis. A range of different activities that involve repeated hand, wrist and
forearm movements is more often the cause. This includes activities like using
a screwdriver, using vibratory work equipment (such as a drill), or even using
a keyboard – particularly relevant these days. Rarely, tendon damage can happen
after a single and often minor incident, such as lifting something heavy or
taking part in an activity which you don't do very often, such as painting and
decorating. These activities can cause a tear in your tendon.
Once diagnosed, this is when the frustration
can begin. There is still no sure fire way to clear up the problem quickly and
stop it returning. The current advice is often, “wait for two years and it will
go away”. This is not what you want to hear when the pain is stopping you not
just from playing sport but being able to complete activities of daily living
without pain. There are treatment options and it is about finding one that
works for you, although you do begin treatment with no guarantee of success.
The first step in establishing a treatment
programme is to determine whether the tendon is thickened or degenerating, this
is crucial in starting you on
the right programme. If your tendon is thickened it needs rest. The thickening
is often due to an influx of fluid to the tendon causing a compressive force
and inflammation, rest and ice are a must to reduce the pressure and thickening.
Often steroid or plasma injections are mentioned at this point but the most
recent research by the top elbow experts currently indicate no significant
benefit from such treatment. This thickened tendon is also known as reactive
If your tendon is degenerating and not
thickened, you must not rest and must begin rebuilding it. The tendon must be
overloaded in order to regain strength. This is achieved with high loads of
eccentric (lengthening) movements at a fast pace. There must be 48 hours of
rest in between loading sessions. Another treatment found to be successful in
some cases is stretching called proprioceptive neuromuscular facilitation (PNF)
which uses a maximal force to cause maximal relaxation; this is used in
conjunction with the loading exercises.
There are several other treatment options
that can be tried such as ultrasound, electrical stimulation, massage and
acupuncture. Often, more then one modality is used at once for the best
results. A new theory behind solving the tennis elbow conundrum is to consider
the whole kinetic chain. This means consider all the joints used in the
movement, not just the elbow. For example, the shoulder, the cervical and
thoracic spine. Research has shown those with elbow problems have benefitted
from addressing deficits with shoulder and spinal movement ranges. A “cervical
glide” (a mobilisation of the cervical vertebrae) has been shown to have a
positive effect on tennis elbow symptoms. We should remember the vast neural
structures that run through the elbow and these come through the spine. Central
sensitisation (a neural affliction) can cause a decreased pain threshold so
should be considered when treating tennis elbow.
Returning to thinking about the whole
kinetic chain, there may be a muscle recruitment problem within the arm or
further down the chain at the shoulder or in the back or the core. Addressing
these issues should they apply can have a good effect on tennis elbow symptoms.
Nathan Hauritz - Dislocated Shoulder
Nathan Hauritz’s place in the Australian World Cup squad was jeopardised by his seemingly innocuous fielding injury. Hauritz is
awaiting scan results to see the extent of the damage, but is facing a lengthy
recovery from a dislocated shoulder.
A dislocated shoulder
is when the head of the humerus is forced out of the glenohumeral socket (made
up of your clavicle and scapula). This is turn can tear or rupture ligaments
and the labrum, which is a cartilage based substance that adds depth to the
shoulder socket. As long as there is no fracture, once the shoulder is
relocated the damage to the bone is over. However, it is the ligaments, labrum
and often also tendons that need time to heal. Shoulder dislocations are
heavily associated with re-injury and therefore an effective rehabilitation
programme is essential to the long term recovery of the joint. A partial
dislocation is known as a subluxation and causes similar damage, but usually
not as serious.
Medical attention should always be immediately sought even
if the shoulder appears to have relocated itself. There are several
complications that could occur if the joint is not further investigated. Once a
doctor has confirmed rehabilitation can begin (this usually follows a period of
rest) strengthening and stabilising exercises can be prescribed. Range of
motion and flexibility exercises are not included until the very end of the
programme and the focus is to re-stabilise the joint and prevent future
This injury is different from an acromio-clavicular joint
sprain which is sometimes also referred to as a shoulder dislocation. Shortened
to “AC” joint, this is where the clavicle (collar bone) meets the scapula on
top of the shoulder. This joint can often become sprung (subluxed) from a fall
and is particularly common in rugby. This causes ligament damage and sometimes
leaves a step deformity in the bones as they don’t always fully re align.
Both injuries require rehabilitation to prevent against
re-injury and complications later in life such as osteo arthritis. If you have
suffered such as injury and need a rehabilitation programme get in touch with
LD Sports Therapy today to discuss the best course for you.
Lee Westwood - Calf Muscle Tear
Lee Westwood has been all over the news this week due to his calf injury. The Ryder Cup victor is on the verge of becoming World Number One but will his injury hinder his current form?
There are several muscles running through the calf but the two most prone to strain injuries are the gastrocnemius and the soleus. The gastrocnemius begins
above the knee attached to the femur and attaches to the achilles tendon. This muscle is most prone to injury as it crosses two joints, the ankle and the knee. The soleus is a deeper muscle, it orginates below the knee and again attaches to the achilles tendon.
What causes a muscle tear?
A muscle tears when it is put under a force it cannot withstand. This can be
more likely to happen when the muscle has not been warmed up properly; when it is fatigued; when there is scar tissue present due to previous injury or when there are predisposing factors such as biomechanical problems. In Lee's case, it is a recurrence of a previous injury and likely to have been affected by fatigue. Muscle tears are graded in seriousness from 1 to 3. A grade 1 tear is a minor strain that can heal as quickly as 2 weeks, with the correct management of the injury. A grade 3 tear means a complete rupture of all fibres and can take up to 6 months to heal, sometimes longer. A grade 2 strain is a midpoint between a strain and a complete rupture when only some fibres are torn.
What are the symptoms of a muscle tear?
It may be possible to identify the specific point when the muscle tore, usually with a grade 3 tear. More often however, the pain is gradual and may not be noticed as soon as it happens. Pain with movement, swelling and loss of flexibility are all indicators there has been a tear in the fibres. Pain and difficulty completing movements are usually what leads to help being sought.
If you think you have suffered a muscle tear, get in touch with LD Sports Therapy today to begin your rehabilitation programme and regain full fitness.
Rafael Nadal - Patella Tendonitis
Rafael Nadal missed the chance to defend his Wimbledon
Champion title in 2009 due to a chronic knee injury. Here, his condition of
patella tendonitis is explained.
The patella tendon connects the kneecap (the patella) to the
shin bone. This is part of the 'extensor mechanism' of the knee, and together
with the quadriceps muscle and the quadriceps tendon, these structures allow
your knee to straighten out, and provide strength for this motion. The patella
tendon, like other tendons, is made of tough string-like bands. These bands are
surrounded by a vascular tissue lining that provides nutrition to the tendon.
What causes patella tendonitis?
Patella tendonitis is the condition that arises when the tendon and the tissues
that surround it, become inflamed and irritated. This is usually due to
overuse, especially from jumping activities. This is the reason patella
tendonitis is often called "jumper's knee." When overuse is the cause
of patella tendonitis, patients are usually active participants of
jumping-types of sports such as basketball or volleyball. Patella tendonitis
may also be seen with sports such as running and football. Also, some patients
develop patella tendonitis after sustaining an acute injury to the tendon, and
not allowing adequate healing. This type of traumatic patella tendonitis is
much less common than overuse syndromes.
What are the symptoms of patella tendonitis?
Patella tendonitis usually causes pain directly over the patella tendon. You
may be able to recreate your symptoms by placing pressure directly on the
inflamed tendon. The other common symptom of patella tendonitis is pain with
activities, especially jumping or kneeling. Less common, but not unusual, is
swelling around the tendon itself. It is more common now to use the term
“tendinopathy” for tendon problems but essentially it is the same condition as
described by the word “tendonitis”.