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June 2018

Tennis Elbow: not just for Tennis Players

Tennis Elbow: not just for Tennis Players 640 472 Jennifer Lane

Tennis Elbow, also called lateral epicondylitis, is inflammation of the wrist extensor tendons where it attaches at the elbow. More specifically, the tendons involved are the Extensor Carpi Radialis and Extensor Digitorum. For years, tennis elbow has been called tendonitis (which means acute inflammation), but upon examination, there is very little inflammation in the tendon due to the chronic nature of the disorder. A more accurate term is tendonopathy or tendonosis.

Tennis players are not the only ones who suffer from this. Anyone who performs repeated movements with their wrist (computer programmers, musicians, carpenters) can have tennis elbow. Traditionally, physical therapy treatment of tennis elbow has included cross friction massage to the tendon, modalities such as ultrasound or electrical stimulation, bracing and therapeutic exercise. More recently, research has shown that the prescription of therapeutic eccentric exercises is a very effective way in treating tendinopathies. Eccentric exercises effectively lengthen the muscle-tendon complex, remodeling the tendon and increasing the tensile strength of the painful tendon.

So, what does PT look like for my patients who have tennis elbow? First thing is to make corrections to posture and body mechanics to take undo stress off the wrist extensor tendons. Second, the use of ice or heat still is effective in reducing some of the pain and soreness that people experience. And finally the teaching people therapeutic eccentric exercises to do on a daily basis at home or at work will effectively help reduce pain and facilitate proper healing of the tendon.

Want more info on the research behind this? Keep reading…

Chronic Ankle Instability: Why does my ankle constantly give out on me?

Chronic Ankle Instability: Why does my ankle constantly give out on me? 635 405 Jennifer Lane

Ankle sprains are the most common musculoskeletal injury in physically active people. Chronic ankle instability can arise from repeated acute lateral ankle sprains. Lateral ankle sprains are incurred when your ankle rolls outward. The ligaments are strained or torn causing pain and instability. Research shows that individuals who sustain an ankle injury are more susceptible to re-injury which can result in a string of long-term issues. Chronic Ankle Instability, or CAI, is a term used to describe patients who have experienced prolonged functional deficits and report subjectively that their ankle is unstable. Over time, these people are less physically active, which can lead to decreased health-related quality of life and increased risk of developing ankle osteoarthritis as compared to healthy individuals.

What is the cause of this long-term ankle instability? Studies have shown that when given functional performance tests, individuals with a history of CAI tested as well as people without ankle pathology. But when asked how their ankle felt, the subjects who had CAI reported feelings of instability while performing the tests. So, what is the root of the issue? I would suggest that after suffering an ankle injury, proprioception is affected. Proprioception is the ability to know where your body or limbs are in space without consciously controlling it or looking at it. Proprioception helps you make minor adjustments in joints to stay balanced (piicture, standing on a moving train without falling). If you can’t sense properly where your ankle is, it is more likely that you will roll it again. For more info, read “Assessing Outcomes in People with Chronic Ankle Instability” in Journal of Orthopaedic & Sports Physical Therapy.

What should you do if you have rolled your ankle once or multiple times? See a PT who can prescribe appropriate balance and stability exercise, use Kinesiotape and who can check for proper ankle mobility, strength and flexibility.

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