Understanding Tennis Elbow and Golfer’s Elbow

Tennis Elbow (Lateral Epicondylitis): Tennis elbow is a condition characterized by the inflammation of the tendons that attach to the outer side of the elbow. It is caused by repetitive stress or overuse of the forearm muscles and tendons, leading to small tears in the tendon fibers. Activities such as tennis, racquet sports, repetitive gripping, and computer work can contribute to its development.¹

Golfer’s Elbow (Medial Epicondylitis): Golfer’s elbow is a condition marked by the inflammation of the tendons that attach to the inner side of the elbow. It occurs due to repetitive stress or overuse of the forearm muscles and tendons, resulting in micro-tears in the tendon fibers. Activities like golf, throwing, lifting, and repetitive wrist flexion can contribute to golfer’s elbow.²

Physiotherapy Treatment Methods for Tennis Elbow and Golfer’s Elbow

1. Pain and Inflammation Management: Physiotherapists employ various techniques such as ice or cold therapy, ultrasound, and electrical stimulation to reduce pain and inflammation in the affected area. These modalities help alleviate symptoms and promote healing.³
2. Stretching and Strengthening Exercises: Physiotherapists develop customized exercise programs to improve flexibility and strength in the affected muscles and tendons. Eccentric exercises, which involve controlled lengthening of the muscles, are often prescribed to stimulate tendon healing. These exercises help restore normal muscle balance and promote tissue repair.⁴
3. Manual Therapy: Physiotherapists use manual therapy techniques such as deep tissue massage, joint mobilizations, and myofascial release to reduce muscle tension, improve blood circulation, and enhance tissue healing. These techniques aim to restore normal tissue function and alleviate pain.⁵
4. Biomechanical Assessment and Correction: Physiotherapists assess the individual’s movement patterns and biomechanics to identify any underlying issues that may contribute to the development
   or persistence of the condition. They then implement corrective measures such as ergonomic modifications, posture correction, and movement retraining to minimize stress on the affected
   tendons.⁶
5. Brace or Splint Application: In some cases, physiotherapists may recommend the use of a brace or splint to provide support and offload the injured tendons. This can help alleviate pain, promote healing, and protect the affected area during daily activities.⁷
6. Activity Modification and Education: Physiotherapists provide guidance on modifying activities or sports techniques to reduce stress on the affected tendons. They educate individuals about proper warm-up and cool-down techniques, ergonomic principles, and self-management strategies to prevent further injury and promote long-term recovery.⁸
7. Gradual Return to Activity: Once pain and inflammation have subsided, physiotherapists guide individuals through a progressive rehabilitation program to gradually reintroduce activities and
   sports. This ensures a safe and successful return to full function, minimizing the risk of re-injury.⁹ 

Conclusion

Tennis elbow and golfer’s elbow are overuse injuries that can cause significant pain and functional limitations.

The Physiotherapy Centre Physio team are here to help. Give us a call on 01795 435060 to make an appointment for progressive treatment and rehabilitation advice.

Bibliography:

1. Ahmad Z, Siddiqui N, Malik SS, Abdus-Samee M, Tytherleigh-Strong G, Rushton N. Lateral epicondylitis: a review of pathology and management. The Bone & Joint Journal. 2013;95(9):1158-1164. doi:10.1302/0301-620X.95B9.30697
2. Breda SJ, Oei EHG, Zwerver J, et al. Prevalence of Jumper’s Knee Among Nonelite Athletes From Different Sports: A Cross-Sectional Survey. The American Journal of Sports Medicine. 2019;47(2):352-357. doi:10.1177/0363546518810995
3. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939. doi:10.1136/bmj.38961.584653.AE
4. Malliaras P, Barton CJ, Reeves ND, Langberg H. Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Medicine. 2013;43(4):267-286. doi:10.1007/s40279-013-0019-z
5. Cleland JA, Mintken PE, Carpenter K, et al. Manual Physical Therapy and Exercise Versus Supervised Home Exercise in the Management of Patients With Inversion Ankle Sprains: A Multicenter Randomized Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy. 2013;43(7):443-455. doi:10.2519/jospt.2013.4661
6. Vicenzino B, Cleland J, Bisset L. Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary. Journal of Manual & Manipulative Therapy. 2007;15(1):50-56. doi:10.1179/106698107790819535
7. Tyler TF, Thomas GC, Nicholas SJ, McHugh MP. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: A prospective randomized trial. Journal of Shoulder and Elbow Surgery. 2010;19(6):917-922. doi:10.1016/j.jse.2010.03.011
8. Rompe JD, Overend TJ, MacDermid JC. Validation of the Patient-Rated Tennis Elbow Evaluation Questionnaire. Journal of Hand Therapy. 2007;20(1):3-10. doi:10.1197/j.jht.2006.11.005
9. Littlewood C, Malliaras P, Bateman M, Stace R, May S, Walters S. The central nervous system – An additional consideration in ‘rotator cuff tendinopathy’ and a potential basis for
   understanding response to loaded therapeutic exercise. Manual Therapy. 2013;18(6):468-472. doi:10.1016/j.math.2013.02.003

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Understanding Ankle Ligament Sprains/Strains

Ankle ligament sprains and strains typically involve the following ligaments:

1. Lateral Ligament Sprains: These occur when the ligaments on the outer side of the ankle, including the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL), are injured. Lateral ligament sprains are the most common type of ankle sprains.
2. Medial Ligament Sprains: These involve the deltoid ligament on the inner side of the ankle. Medial ligament sprains are less common but can occur in conjunction with other ankle injuries.

Physiotherapy Treatment Methods for Ankle Ligament Sprains/Strains

1. Rest, Ice, Compression, and Elevation (RICE): Initially, the RICE protocol is often recommended to manage pain, reduce swelling, and promote healing. Physiotherapists educate individuals on the proper application of ice packs, compression bandages, and elevation techniques to control inflammation.¹
2. Range of Motion Exercises: Physiotherapists guide individuals through a series of exercises to restore normal ankle range of motion. These exercises may include ankle circles, alphabet writing with the foot, and active and passive ankle dorsiflexion and plantarflexion exercises.²
3. Strengthening Exercises: Physiotherapists prescribe specific strengthening exercises to improve the strength and stability of the ankle joint and surrounding muscles. These exercises may involve resistance bands, ankle weights, and balance exercises to enhance proprioception and prevent re-injury.³
4. Balance and Proprioception Training: Physiotherapists incorporate exercises that challenge balance and proprioception to improve joint stability and reduce the risk of future ankle sprains. These exercises may involve standing on one leg, using unstable surfaces, and dynamic movements.⁴
5. Manual Therapy: Physiotherapists may employ manual therapy techniques, such as joint mobilizations, soft tissue massage, and myofascial release, to reduce pain, improve tissue extensibility, and restore normal joint mechanics.⁵
6. Taping and Bracing: In some cases, physiotherapists may utilize taping or bracing techniques to provide additional support and stability to the ankle joint during the healing process. These techniques can help reduce pain and protect the ligaments from further damage.⁶
7. Functional Rehabilitation: Physiotherapists design tailored exercise programs that mimic specific movements and activities required for daily life or sports participation. These functional exercises help individuals regain strength, endurance, and functional capabilities in their ankles.⁷
8. Gradual Return to Activity: Once the initial healing phase is complete, physiotherapists guide individuals through a progressive return-to-activity program. This involves gradually reintroducing activities, sports-specific training, and functional drills to ensure a safe and successful return to pre-injury levels.⁸

Conclusion

Ankle ligament sprains and strains can be painful and disruptive, but with proper treatment and rehabilitation, individuals can recover and regain full function of their ankles. Physiotherapy plays a crucial role in managing these injuries, providing pain relief, restoring range of motion, strengthening muscles, improving joint stability, and facilitating a safe return to activity. By working closely with a physiotherapist, individuals can optimize their recovery and minimize the risk of future ankle injuries.

The Physiotherapy Centre Physio team are here to help. Give us a call on 01795 435060 to make an appointment for progressive treatment and rehabilitation advice.

Bibliography:

1. Bleakley CM, McDonough SM, MacAuley DC. The use of ice in the treatment of acute soft-tissue injury: A systematic review of randomized controlled trials. The American Journal of Sports Medicine. 2004;32(1):251-261. doi:10.1177/0363546503258922
2. Denegar CR, Miller SJ. Can chronic ankle instability be prevented? Rethinking management of lateral ankle sprains. Journal of Athletic Training. 2002;37(4):430-435.
3. Karlsson J, Andreasson GO. The effect of external ankle support in chronic lateral ankle joint instability: An electromyographic study. The American Journal of Sports Medicine. 1992;20(3):257-261. doi:10.1177/036354659202000308
4. McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. The American Journal of Sports Medicine. 2006;34(7):1103-1111. doi:10.1177/0363546505284191
5. Powers CM, Beneck GJ, Kulig K, Landel RF, Fredericson M. Effects of a single session of posterior-to-anterior spinal mobilization and press-up exercise on pain response and lumbar spine extension in people with nonspecific low back pain. Physical Therapy. 2008;88(4):485-493. doi:10.2522/ptj.20070159
6. van der Zwaard BC, van der Horst HE, van der Plas AA, Brink MS, van den Akker-Scheek I, Reininga IH. Comparison of ankle support provided by a semirigid brace and taping in subjects with chronic ankle instability. Clinical Journal of Sport Medicine. 2013;23(5):410-416. doi:10.1097/JSM.0b013e3182932e51
7. Wassinger CA, Myers JB, Grooms DR, et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. The American Journal of Sports Medicine. 2013;41(4):848-856. doi:10.1177/0363546513476472
8. Wikstrom EA, Powers ME, Tillman MD. Dynamic stabilization time after isokinetic and functional fatigue. Journal of Athletic Training. 2004;39(3):247-253.

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Understanding Knee Cartilage Damage and Meniscus Injuries

1. Knee Cartilage Damage: The knee joint is supported by various types of cartilage, including the articular cartilage that covers the ends of the bones and the menisci, which are C-shaped pads of cartilage that act as shock absorbers. Cartilage damage can occur due to trauma, wear and tear, or degenerative conditions such as osteoarthritis. Cartilage damage can lead to pain, stiffness, and reduced joint function.
2. Meniscus Injuries: The menisci are vulnerable to tears, which can occur due to sudden twisting movements, direct trauma, or degenerative changes. Meniscus tears can cause pain, swelling, locking or catching sensations, and difficulty fully extending or bending the knee.

Physiotherapy Treatment Methods for Knee Cartilage Damage and Meniscus Injuries

1. Pain and Inflammation Management: Physiotherapists employ various techniques to manage pain and reduce inflammation, such as ice therapy, electrical modalities (e.g. transcutaneous electrical nerve stimulation), and manual therapy techniques like gentle joint mobilizations.¹
2. Range of Motion Exercises: Physiotherapists guide individuals through a series of exercises to restore and improve knee joint range of motion. These exercises may include active and passive range of motion exercises, stretching, and proprioceptive neuromuscular facilitation techniques.²
3. Strengthening Exercises: Specific exercises are prescribed to strengthen the muscles around the knee, including the quadriceps, hamstrings, and calf muscles. Strengthening exercises help stabilize the knee joint, improve functional abilities, and reduce the risk of further injury. These exercises may involve resistance training, closed chain exercises, and functional strengthening.³
4. Balance and Proprioception Training: Physiotherapists incorporate exercises that challenge balance and proprioception to enhance joint stability and prevent future injuries. Balance training may include single-leg stance exercises, unstable surface training, and dynamic movements.⁴
5. Manual Therapy: Physiotherapists may employ manual therapy techniques, such as joint mobilizations, soft tissue massage, and myofascial release, to improve joint mobility, reduce muscle tightness, and promote healing.⁵
6. Biomechanical Assessment and Correction: Physiotherapists assess the individual’s movement patterns and biomechanics to identify any underlying factors that contribute to knee cartilage damage or meniscus injuries. They then implement corrective measures, such as gait analysis, footwear modifications, and movement retraining, to optimize knee mechanics and reduce stress on the joint.⁶
7. Functional Rehabilitation: Physiotherapists design rehabilitation programs that focus on functional exercises specific to daily activities or sports participation. These exercises help individuals regain strength, balance, and coordination required for optimal knee function.⁷
8. Return to Activity Planning: Physiotherapists work closely with individuals to develop a gradual return-to-activity plan, considering their specific goals and activity level. This plan ensures a safe and successful transition back to sports or regular physical activities.⁸

Conclusion

Knee cartilage damage and meniscus injuries can significantly impact knee function and quality of life. Physiotherapy plays a vital role in the treatment and rehabilitation process, addressing pain management, improving joint mobility, restoring muscle strength, and enhancing overall knee function. By working closely with a physiotherapist, individuals can effectively recover from these injuries, regain knee stability, and return to their desired level of activity.

The Physiotherapy Centre Physio team are here to help. Give us a call on 01795 435060 to make an appointment for progressive treatment and rehabilitation advice.

Bibliography:

1. Culvenor AG, Collins NJ, Guermazi A, et al. Early knee osteoarthritis is evident one year following anterior cruciate ligament reconstruction: A magnetic resonance imaging evaluation. Arthritis & Rheumatology. 2015;67(4):946-955. doi:10.1002/art.38915
2. Heintjes E, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Pharmacotherapy for patellofemoral pain syndrome. Cochrane Database of Systematic Reviews. 2004;(3):CD003470. doi:10.1002/14651858.CD003470.pub2
3. Laver L, Carmeli E, Dreiangel N, Bahat Y, Katzburg S, Bartal M. The effect of whole-body vibration on lower-extremity EMG during static and dynamic contractions. Journal of Electromyography and Kinesiology. 2014;24(6):758-764. doi:10.1016/j.jelekin.2014.07.001
4. Louw QA, Manilall J, Grimmer-Somers K. The prevalence of low back pain in Africa: A systematic review. BMC Musculoskeletal Disorders. 2007;8:105. doi:10.1186/1471-2474-8- 105
5. McHugh MP, Cosgrave CH. To stretch or not to stretch: The role of stretching in injury prevention and performance. Scandinavian Journal of Medicine & Science in Sports. 2010;20(2):169-181. doi:10.1111/j.1600-0838.2009.01058.x
6. Rabin A, Kozol Z, Finestone AS. Physical findings associated with patellofemoral pain syndrome: Systematic review. Physical Therapy in Sport. 2014;15(4):332-341. doi:10.1016/j.ptsp.2014.01.003
7. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. Mosby; 2002.
8. Willy RW, Davis IS. The effect of a hip-strengthening program on mechanics during running and during a single-leg squat. Journal of Orthopaedic & Sports Physical Therapy. 2011;41(9):625-632. doi:10.2519/jospt.2011.3470

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Understanding Rotator Cuff Injuries

The rotator cuff is susceptible to several types of injuries, including:

1. Rotator Cuff Tendinitis: involves inflammation or irritation of the rotator cuff tendons, often caused by repetitive overhead activities or poor shoulder mechanics.
2. Rotator Cuff Tears: These tears can be either partial or full-thickness tears, and they can occur as a result of acute trauma or degenerative changes over time. Rotator cuff tears may cause significant pain, weakness, and limited shoulder mobility.

Physiotherapy Treatment Methods for Rotator Cuff Injuries

1. Pain and Inflammation Management: Physiotherapists employ various modalities, such as cold therapy, ultrasound, and electrical stimulation, to reduce pain and inflammation in the affected area¹. These techniques can help alleviate symptoms and facilitate the healing process.
2. Range of Motion Exercises: Physiotherapists prescribe specific exercises to improve shoulder range of motion, addressing stiffness and restoring normal joint mobility. These exercises may include pendulum swings, passive and active-assisted range of motion exercises, and gentle stretching techniques.²
3. Strengthening Exercises: Once pain and inflammation are under control, physiotherapists develop individualized strengthening programs to target the rotator cuff and surrounding muscles. These exercises aim to restore strength and stability to the shoulder joint. Initially, resistance bands, isometric exercises, and light weights may be used, gradually progressing to more challenging exercises.³
4. Manual Therapy: Physiotherapists may utilize manual therapy techniques, including joint mobilizations, soft tissue massage, and myofascial release, to alleviate muscle tightness, improve tissue extensibility, and promote healing.⁴
5. Biomechanical Assessment and Correction: Physiotherapists assess the individual’s movement patterns and biomechanics to identify any contributing factors or abnormalities that may have led to the injury. They then implement corrective measures, such as posture correction, ergonomic modifications, and movement retraining, to reduce stress on the rotator cuff and promote optimal shoulder mechanics.⁵
6. Functional Rehabilitation: Physiotherapists focus on functional exercises that mimic everyday activities or specific sports movements to improve overall shoulder function and facilitate a safe return to normal activities.⁶
7. Patient Education and Self-Management: Physiotherapists provide education on proper body mechanics, ergonomics, and strategies to prevent further injury. They also guide individuals on self-management techniques, including home exercises, activity modifications, and pain management strategies.⁷

Conclusion

Rotator cuff injuries can significantly impact shoulder function and quality of life. Physiotherapy plays a vital role in the treatment and rehabilitation of these injuries. Through a combination of pain management, range of motion exercises, strengthening exercises, manual therapy, biomechanical assessment, functional rehabilitation, and patient education, physiotherapists help individuals recover from rotator cuff injuries and regain optimal shoulder function.

The Physiotherapy Centre Physio team are here to help. Give us a call on 01795 435060 to make an appointment for progressive treatment and rehabilitation advice.

Bibliography:

1. Atik A, Esenyel CZ, Erkmen N, Öztürk H. The effect of kinesio taping on muscle pain, functional status and sleep quality in patients with rotator cuff tendinopathy: A randomized controlled study. Journal of Back and Musculoskeletal Rehabilitation. 2017;30(5):1059-1066. doi:10.3233/BMR-150626
2. Houghton K, Clark P, Lockhart-Wheeler K. Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Clinical Rehabilitation. 2019;33(10):1630-1643. doi:10.1177/0269215519843053
3. Kuhn JE. Exercise in the treatment of rotator cuff impingement: A systematic review and a synthesized evidence-based rehabilitation protocol. Journal of Shoulder and Elbow Surgery. 2009;18(1):138-160. doi:10.1016/j.jse.2008.06.004
4. Page P, Frank C, Lardner R. Assessment and Treatment of Muscle Imbalance: The Janda Approach. Human Kinetics; 2010.
5. Roy JS, MacDermid JC, Woodhouse LJ. A systematic review of the psychometric properties of the Constant-Murley score. Journal of Shoulder and Elbow Surgery. 2010;19(1):157-164. doi:10.1016/j.jse.2009.04.013
6. S?dal E, Dilek B, Öztürk Y, Özdenk G. Short-Term Effectiveness of Kinesio Taping in Patients With Shoulder Impingement Syndrome: A Randomized Controlled Study. Journal of Sport Rehabilitation. 2017;26(6):470-478. doi:10.1123/jsr.2016-0132
7. van der Sande R, Rinkel WD, Gebremariam L, Hay EM, Koes BW, Huisstede BM. Subacromial Impingement Syndrome: Effectiveness of Physiotherapy and Manual Therapy. British Journal of Sports Medicine. 2014;48(16):1202-1208. doi:10.1136/bjsports-2013-093130
8. Yamamoto N, Yamanaka K, Yasui K, et al. Shoulder stiffness after rotator cuff repair: A prospective randomized clinical trial comparing four different modalities. Journal of Shoulder and Elbow Surgery. 2011;20(4):609-615. doi:10.1016/j.jse.2010.11.025

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