LD Sports Therapy - "sports injury specialists"

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 tendinopathy.

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.

If you are suffering with tennis or golfer’s elbow, get in touch with Laura today to see how LD Sports Therapy can help you to go from this...


To this...

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 dislocation. 

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”.

If you, like Rafa are suffering, get in touch with Laura today to begin your treatment and rehabilitation.