Inside
Physio Professionals Newsletter August 2013
this issue P.1&2
Epicondylitis of the Elbow
P ro f e ssi o n a l D e ve l o p me n t Physio Professionals prides itself in its continuing staff education initiatives.
Epicondylitis of the Elbow: Epicondylitis of the elbow
Staff
Michelle Crew (nee: Peauril) Masters of Physiotherapy Level 3 Sports Physio AIS SHOULDERS / BACK PAIN
Andy Magill B.Sc. Physiotherapy (Hons) Level 1 Sports Physio KNEE / LOWER LIMB
Tim Garrett B. Sc Physiotherapy Level 1 Sports Physio NECK / HEADACHES
Andrew Crew Remedial/Sports Massage Performance Bike Fit Accredited Track and Field / Cycling Coach
Physiotherapy
Epicondylitis is a common repetitive strain injury, where repetitive tendon loading causes micro-tearing and tendonitis, and in advanced cases progressive degeneration due to an inadequate reparative response. Medial epicondylitis, commonly known as golfers elbow, affects the tendons and muscles arising from the common flexor origin, while lateral epicondylitis, or tennis elbow Those presenting with lateral epicondylitis will have a history of affects the tendons and muscles arising from the lateral epicondyle. repeated wrist extension and forearm supination in elbow extension. Sufferers present with discomfort in Although this is a common condition in racquet sports enthusiasts, it is also the forearm, a reduction in functional movement and increased seen is manual labourers who must use tools to fix screws or office pain with specific activities. Onset workers who click a mouse of symptoms may be traumatic, repetitively. however in most cases it is insidious, with symptoms progressing over days, weeks or even months. Accurate subjective and objective examination will allow the Physiotherapist to differentiate between medial and lateral epicondylitis.
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Conversely, medial epicondylitis sufferers will have a history of repeated wrist flexion and forearm pronation in elbow flexion. Throwing and climbing sports are a common cause as well as manual labour involving carrying loads.
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The first step in treatment is relative rest from the aggravating activity and, if indicated, use of anti-inflammatory medication. During this time a Physiotherapist can assist with increasing pain free movement through massage, manual therapy and stretching exercises. A very important aspect at this stage is education. Making sure that individuals understand what Activities of Daily Living (ADL) will aggravate the condition means they can actively manage their condition. E.G. use of a pad under the wrist whilst mousing holds the wrist in a neutral position, dramatically reducing the impact the action has on a lateral epicondylitis. It may also be necessary to use a clasp brace, which when placed around the forearm in the correct way, may allow the user to complete ADL in a pain free manner. A Physiotherapist is ideally placed to decide if this is a necessary measure and can also educate on timely and appropriate use.
Flexion or extension based strengthening exercises will be completed, with the Physiotherapist guiding the patient through the amount of movement desired as the muscles and tendons are progressively stretched and strengthened through their full range. At every stage pain will be monitored and compared to initial presentation of symptoms.
The final stage of treatment involves timely return to the initial aggravating activity. Review of technique and perhaps modification of equipment may be indicated to further reduce the chances of recurrence. E.G. specific drills to improve throwing technique or using a lighter racket may be required.
The second phase of treatment involves targeting the specific soft tissues that may be inflamed and/or weak. It is important to put load through tendons to assist build-up of collagen fibres in the correct direction, and muscles must be strengthened to aid return to full activities and reduce risk of recurrence of the tendonitis.
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