Category: Sports Therapy

Hip Labrum Impingement

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Hip labrum impingement may occur when the ball and socket joint is unable to move smoothly within the joint. It is more frequently known as Femoral acetabular impingement (FAI). The ball and socket joint are lined with a layer of cartilage that assists in cushioning the femur bone into the socket, which allows free movement no grinding or rubbing within the joint, resulting in no pain. It is also lined with a ridge of cartilage called the labrum, this will keep the femoral head in its place inside the hip socket enabling extra stability.

Anatomy

The hip is a synovial joint more so known as a ball and socket joint. The ball of the joint is the femoral head (the upper part of the femur) more commonly known as the thigh bone. Within the socket is the acetabulum which is surrounded by the pelvis, this makes up the joint.

The surface of the ball and socket is protected by articular cartilage. This enables the bones in and around the joint to glide easily when performing everyday movements such as walking. The cartilage also helps prevent any friction around the surface of the joint avoiding any sort of impingement. Another feature around the joint is the hip labrum. This fibrocartilage labrum is found within the acetabulum, this enables stability to the joint as the hip has a large range of motion in movements such as flexion, extension, abduction, adduction and rotation.

Causes

Common causes of hip impingement are triggered by the femoral head being covered too much by the hip socket. Repetitive grinding at this joint leads to cartilage and labral damage, causing the feeling of impingement.

Other factors that may affect an individual to suffer with labrum impingement could be that individual may have been born with a structurally abnormal ball and socket joint. Also, movements that involve repetition of the leg moving into excessive range of motion may aid in the injury of hip labrum impingement.

Symptoms

Some common Hip Labrum impingement symptoms are as follows:

  • Stiffness in the hip or groin region
  • Reduced flexibility
  • Pain when performing exercise such as running, jumping movements and walking
  • Groin area pain, especially after the hip is placed into flexion
  • Pain in surrounding areas such as lower back and the groin
  • Pain in the hip even when resting

Causes

When you go to visit your doctor/ health care professional about hip complications they may talk about two main types of hip impingement:

  • Cam impingement
  • Pincer impingement

Cam impingement “occurs because the ball-shaped end of the femur (femoral head) is not perfectly rounded. This interferes with the femoral head’s ability to move smoothly within the hip socket”. 

Pincer impingement “involves excessive coverage of the femoral head by the acetabulum. With hip flexion motion, the neck of the femur bone “bumps” or impinges on the rim of the deep socket. This results in cartilage and labral damage”.

Unfortunately, both these two types can happen at the same time, more so known as combined impingement. Which may cause an individual to experience a lot of pain and discomfort.

Diagnosis

The diagnosis of hip impingement will be given by a doctor based on how you describe your symptoms and after performing a physical examination of the hip.

A passive motion special test that is commonly used for hip impingement is called the FADIR (flexion, adduction and internal rotation). This is where the patient will lie in supine position (on their back) with the legs relaxed, then the doctor will carry out the test:

  1. The affected leg will be raised so that the knee and hip are at a 90-degree angle
  2. The doctor will support the knee and ankle and gently push the entire leg across the midline portion of the patient’s body moving into adduction 
  3. Then whilst keeping the knee in position, the doctor would move the foot and lower calf away from the body into abduction 

People who are suffering with hip impingement would feel pain during stage 3 of the test, however it may be hard to differentiate between each injury as someone not suffering with impingement may still feel pain, so it is always important to test the unfaceted side for a comparison.

Some imagining tests may also be performed such as: 

  • X-Ray – The X-Ray screening may show an irregular shape of the femur bone at the top of the thigh or too much bone around the rim of the hip socket, thus causing the impingement
  • MRI Scans – This may pick up wear and tear of the cartilage which runs along the hip labrum 
  • CT scans may also be performed

Treatment

Non-Surgical Management

Activity Modification: 

Advise the patient to avoid activities that exacerbate symptoms, such as deep squats, prolonged sitting, or high-impact sports.

Physical Therapy:

  • Stretching Exercises: Focus on stretching the hip flexors, hamstrings, and quadriceps to improve flexibility.
  • Strengthening Exercises: Emphasise strengthening the gluteal muscles, core, and hip stabilisers to support joint function and reduce stress on the hip.
  • Manual Therapy: Incorporate techniques such as joint mobilizations and soft tissue massage to reduce pain and improve range of motion. A deep tissue massage or sports massage may be a good option.

Medications:

  • NSAIDs: Prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and alleviate pain.
  • Pain Relievers: Recommend acetaminophen for additional pain management if needed.

Injections:

  • Corticosteroid Injections: Administer corticosteroid injections into the hip joint to reduce inflammation and provide temporary pain relief.

Surgical Interventions

  • Indications for Surgery:Consider surgery if the patient experiences persistent pain and functional limitations despite exhaustive non-surgical treatments.
  • Arthroscopic Surgery:
    • Debridement: Remove bone spurs, damaged cartilage, or any other impinging structures to alleviate pain and improve hip function.
    • Labral Repair: Repair any torn labrum to restore joint stability and function.
  • Post-Surgical Rehabilitation:
    • Early Mobilisation: Initiate gentle range-of-motion exercises soon after surgery to prevent stiffness.
    • Progressive Strengthening: Gradually introduce strengthening exercises as healing progresses, focusing on restoring hip strength and stability.
    • Functional Training: Incorporate functional and sport-specific training to facilitate a return to normal activities and athletic pursuits.

Exercises

    • 1. Hip Flexor Stretches

      • Purpose: Stretch the muscles at the front of the hip to reduce tightness and relieve pressure on the hip joint, which can help alleviate impingement symptoms.
      • How to Perform:
        • Kneel on one knee with the other foot in front, forming a 90-degree angle at both knees.
        • Gently push your hips forward while keeping your back straight until you feel a stretch in the front of your hip.
        • Hold for 20-30 seconds and switch sides.

      2. Piriformis Stretches

      • Purpose: The piriformis muscle, located in the buttocks, can become tight and exacerbate hip issues. Stretching it helps improve flexibility and reduce pressure on the hip joint.
      • How to Perform:
        • Lie on your back with knees bent.
        • Cross one ankle over the opposite knee.
        • Pull the uncrossed thigh toward your chest until you feel a stretch in the buttock of the crossed leg.
        • Hold for 20-30 seconds and switch sides.

      3. Isometric Hip Raises in Abduction

      • Purpose: Strengthen the hip muscles, particularly the abductors, without moving the joint, which is beneficial when movement causes pain.
      • How to Perform:
        • Lie on your back with your knees bent and feet flat on the ground.
        • Place a resistance band around your thighs just above the knees.
        • Gently push your knees apart against the band without lifting your hips.
        • Hold the tension for 10-15 seconds, relax, and repeat.

      4. Glute Bridge

      • Purpose: Strengthens the gluteal muscles and stabilizes the hip, which can reduce stress on the hip joint and support recovery from impingement.
      • How to Perform:
        • Lie on your back with knees bent and feet flat on the floor, hip-width apart.
        • Press your feet into the ground and lift your hips toward the ceiling, squeezing your glutes.
        • Hold at the top for a few seconds before slowly lowering back down.

      5. Single Leg Bridge

      • Purpose: This variation of the glute bridge further challenges the glute and core muscles, improving stability and strength on one side of the body at a time.
      • How to Perform:
        • Begin in the same position as the glute bridge.
        • Lift one leg off the ground, keeping it straight, and then lift your hips using the strength of the supporting leg.
        • Hold at the top, then lower and repeat before switching legs.

      6. Straight Leg Raises (Can Also Use Resistance Band)

      • Purpose: Strengthen the quadriceps and hip flexors without putting undue stress on the hip joint, helping to maintain stability and reduce symptoms.
      • How to Perform:
        • Lie on your back with one leg straight and the other bent.
        • Keeping the straight leg’s foot flexed, slowly lift it toward the ceiling to about a 45-degree angle.
        • Lower the leg slowly and repeat. You can add a resistance band around your ankles for added difficulty.

      Prevention

      • When exercising avoid placing full body weight onto your hip when the legs are positioned in excessive range of motion
      • Do daily stretches morning and night
      • Always rest when needed
      • Perform rehabilitation exercises given by a physiotherapist

If you feel you may have this condition / injury and would like it assessed by a professional our team of sports therapists and physiotherapists can help. Alternatively you can speak to your doctor. Either way please contact us for further information alternatively please make a booking directly online.

Winging Scapula

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Scapula winging is a condition that affects the shoulder blades, the shoulder blade bones should usually lay flat against the back of the body. Scapula winging occurs when a person suffers with shoulder problems, causing the shoulder blades to stick out abnormally. The condition of scapula winging is quite rare but some individuals may suffer really bad from the condition and need effective treatment.

The main muscle involved in the cause of scapula winging is the serratus anterior. This muscle originates from the ribs 1-8 and attaches to the anterior surface of the scapula, which pulls the muscle against the ribcage. The long thoracic nerve is stimulated by the serratus anterior, when or if this nerve becomes injured the scapula will be affected as it jolts back adding more force onto the arm. Injuries to the shoulder may affect this nerve causing inflammation and added pressure onto the nerve, consequently triggering the onset of scapula winging.

Anatomy

The scapula more commonly known as the shoulder blade articulates with the humerus at the glenohumeral joint. The scapula has three surfaces: the costal, lateral and posterior.

Costal Surface

The anterior surface of the scapula faces the ribcage. This is where the subscapularis originates (one of the rotator cuff muscles). The coracoid process also originates here which lies underneath the clavicle allowing the pectoralis minor, coracobrachialis and bicep brachii to attach at this region.

Lateral Surface

The lateral surface faces the humerus bone. This is where the glenohumeral joint is situated, the main bones around this area are the glenoid fossa, supraglenoid tubercle and infraglenoid tubercle.

Posterior Surface

The posterior surface of the scapula is the site of the majority of the rotator cuff muscles. These include the Infraspinous fossa and the Supraspinous fossa.

All 3 surfaces of the scapula are important to know to locate the site of pain/ discomfort and understand what is causing the winging.

Symptoms

Scapula winging symptoms may differ as it depends where the location of the muscle or nerve damage is situated. Scapula winging is commonly presented by the shoulder blade sticking out from the back uncharacteristically. This may affect a person from even doing everyday things such as sitting down on a chair that has a hard back or even carrying bags that have straps.

Common symptoms of scapula winging are shown as:

  • Shoulder blades sticking out
  • Pain into the neck, shoulders and arms
  • Weakened muscles surrounding the shoulder blade
  • Tiredness and exhaustion when performing simple tasks
  • Pain and discomfort around the area
  • Inability to lift arms over the head
  • Sagging of the scapula

Causes

Scapula winging Is triggered by an individual sustaining a severe injury to any muscles that control the scapula. The serratus anterior is one of the main muscles that enables a person to lift the arm above shoulder level, therefore when this is injured it can cause many problems within the shoulder region.

The main causes of scapula winging are:

    • Nerve damage to the long thoracic nerve
    • Serratus anterior weakness
    • Weakness in the rotator cuff muscles (supraspinatus, infraspinatus, teres minor and subscapularis)
    • Compression on the dorsal scapula nerve (controls the Rhomboid muscles)
    • Weakness in the trapezius

Diagnosis

Firstly, for the diagnosis of scapula winging your doctor will look at the shoulder blades for any clear obvious signs of winging. Some patient’s scapula bone may be more visible than others and have distinct scapula winging. The doctor may also ask you to perform arm/ shoulder movements to examine the range of movement and stability at the joint.

One of the main tests that are used to aid in the diagnosis of scapula winging is the serratus anterior test. This is where the patient is asked to face a wall, standing about two feet from the wall and then push against the wall with flat palms at waist level. This test is carried out to identify if any damage is done to the thoracic nerve causing the scapula to wing.

Treatment

Treatment for winging scapula is dependent on which muscles or nerve is causing the issue. There are two types of treatment surgical and non-surgical.

Non-surgical treatment (Scapula Winging)

Surgical treatment (Scapula Winging)

One surgical treatment for scapula winging is nerve and muscle transfers. This is a process which involves moving a part of the nerve and muscle to a different portion of the body, this mainly focuses on the neck, shoulder, back and chest areas.

Static stabilization is another form of treatment used to prevent scapula winging, however there is a risk with this treatment that it may return. This procedure uses a sling to attach the scapula to the ribs to add extra stability to the shoulder blade.

Exercises

When performing these exercises aim to do 3 rounds of 15 sets for each exercise. Make sure they are slow and controlled so that it is solely focusing on strengthening the weakened muscles:

  • Scapula retraction
  • External Rotation
  • Horizontal Row
  • Standard press ups
  • Press up on knees (easier version)
  • Angel wings exercise

Prevention

Prevention for scapula winging may not always be possible, however there are procedures you can complete to reduce the risk:

  • Perform exercises to help with posture
  • Try and maintain correct posture positioning
  • Don’t carry anything to heavy on the shoulders and back
  • Do not lift heavy weights at the gym that could cause more damage to the shoulder
  • Strengthen the muscles in the neck and shoulders
  • Perform rehabilitation exercises given by a physiotherapist or doctor
  • Avoid constant repetitive shoulder/ arm movements
  • Rest when needed

If you want to discuss this concern with our specialists then please contact us or make a booking.

Achilles Tendinitis

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Achilles tendinitis may occur when overuse or to much strain is placed onto the tendon in the ankle region. The Achilles tendon is situated at the heel of the foot and connects the lower leg muscles of the calf to the heel bone of the ankle.

This pathology is mainly sustained by people who do a lot of running and high intensity exercises. Individuals who may have amplified the time and intensity of their runs, thus potentially leading to Achilles tendinitis. This injury could also occur with a lot of people who play sports such as tennis, netball or basketball, due to the fast pace and explosive movements, causing added pressure onto the ankle joint. If not treated correctly Achilles tendinitis could lead to further complications such as tendon tears or ruptures, which may require surgical repair.

Anatomy

The Achilles tendon, also known as the calcaneal tendon is situated at the back of the ankle. It is a hard band of fibrous tissue that attaches the calf muscles to the calcaneus (heel bone of the ankle). The Achilles tendon is also the largest and strongest in the body.

The two calf muscles; the gastrocnemius and soleus form into one band of tissue, which becomes the Achilles tendon at the lowest point of the calf. A bursa (small sac of fluid) covers the Achilles tendon to help support and protect the area.

When we flex the calf muscles the Achilles tendon pulls onto the heel. This enables us to perform day to day movements such as walking, running and standing on our tip toes. So, it is important to be safe when exercising ensuring the area is protected. The tendon has a limited amount of blood supply, so when we place the tendon under strain or tension it can be more susceptible to injury.

Causes

The main causes for Achilles tendinitis are from repetitive stress and tension placed onto the tendon, it is not usually related to one specific injury cause. Too much pressure on our bodies sometimes can be harmful and extra care should be taken whenever performing any sporting event or exercise activities. Here are some causes of Achilles tendinitis:

  • Tightness in calf muscles
  • Sudden increase in intensity of exercise
  • Longer duration of exercise
  • Unexpected bone growth

Symptoms

Common signs and symptoms of Achilles tendinitis are as follows:

  • Stiffness at the back of the ankle first thing when you wake up
  • Pain along the back of the tendon
  • Sharp pain along the back of the foot
  • Feels different e.g., thicker or tighter
  • Lack of range of movement
  • Severe pain after exercising
  • Swelling around the tendon

When exercising or walking and you feel or hear a loud popping noise, you should see your doctor immediately. As it is highly likely that you may have torn/ ruptured the tendon and will need medical attention.

Diagnosis

If you feel you are suffering with Achilles tendinitis, then it is best you go and see your doctor. The health care professional will palpate (feel) the area to determine the site of pain tenderness and swelling. The doctor will also complete a physical examination assessing flexibility, alignment, reflexes and range of movement around the effected area.

Special imaging test may also be used such as:

  • X-Rays
  • Magnetic Resonance imagining (MRI)
  • Ultrasound

Treatment

Now days there are many treatment theories available for Achilles tendinitis. These could be home treatments, anti-inflammatory medication or surgery.

  • Use the RICE acronym- Rest, Ice, Compress and Elevate the area of injury
  • Reduce physical activity until swelling and pain has reduced
  • Ice the area after exercising when pain has occurred
  • Anti- inflammatory drugs such as aspirin or ibuprofen (however this may just mask the pain)
  • See a sports therapist / physiotherapist for rehabilitation exercises and stretches
  • Wear protective equipment such as a brace to prevent heel movement
  • See a sports therapist and get a sports massage to ease the tension from the calves and plantar on the achilles tendon.

Exercises

Here are a few exercises which may aid in preventing Achilles tendinitis:

  • Calf Raises on Floor
    • Stand with feet hip-width apart.
    • Slowly lift your heels off the ground, then lower them back down. This strengthens the calf muscles and tendon.
  • Single Leg Calf Raises
    • Stand on one leg.
    • Lift your heel off the ground, then slowly lower it. This targets each calf individually and enhances strength and stability.
  • Calf Raises on Elevated Bench
    • Stand with the balls of your feet on the edge of a step or bench.
    • Rise onto your toes, then lower your heels below the step level. This increases the stretch and strengthens the calf muscles more effectively.
  • Lunge Calf Stretch
    • Step one foot forward into a lunge position, keeping the back leg straight and heel on the ground.
    • Push your hips forward to stretch the calf muscle of the back leg.
  • Resistance Band Calf Stretch
    • Sit with your leg extended and a resistance band looped around the ball of your foot.
    • Pull the band towards you while keeping your leg straight to stretch the calf muscle.
  • Resisted Plantarflexion
    • Sit with your foot flexed and a resistance band around the ball of your foot.
    • Push your foot down against the band, then slowly return to the starting position. This strengthens the calf muscles and tendon.
  • Walking on Tip Toes
    • Walk around on your tiptoes for a few minutes. This exercise helps to improve calf strength and flexibility.

Prevention

It may not be possible to full prevent Achilles tendinitis from occurring, however you can incorporate certain measures to reduce the risk factors:

  • Don’t over do exercise, make sure to have rest days and include full warm ups before exercising
  • Increase intensity levels of exercise progressively
  • Make sure you are wearing the correct footwear
  • Stretch daily, and even more importantly before and after exercising
  • Perform specific exercises to strengthen the calf muscles
  • Complete non weight bearing exercise such as swimming to reduce pressure onto the Achilles tendon.

If you think you may have achilles tendinitis or would like to find out if you have it, please contact a member of our team today or make a booking online.

Lateral Ankle Sprain

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A lateral ligament sprain within the ankle complex is one of the most frequently injured area within the body, being encountered at 83% in sports such as football and many athletic events.

The main mechanism of this occurring is when an individual will be placed in excessive inversion and internal rotation of the foot whilst the leg is forced into external rotation. The anterior talo-fibula ligament is thought to be the most susceptible within this Injury.

As soon as athlete or personnel have sustained a lateral ankle injury, mechanical limitations and neuromuscular control of the joint becomes effected, for example; ligamentous tear, reduced strength and loss of balance. Due to these influences effecting the ankle joint, it leads to a 73% chance of recurrent damage and injury within one year, especially if correct and safe rehabilitation is not carried out.

Anatomy

The ankle complex consists of three key joints; these are the talocrural, subtalar and distal tibiofibular. The talocrural joint is known as a hinge joint, movements such as plantarflexion, dorsiflexion, inversion and eversion can be experienced. However due to the fibula being protracted superiorly towards the lateral malleolus compared to the tibia with medial malleolus, eversion movements become restricted. Therefore, implying why inversion injuries may be more frequent in the lateral ankle complex.

Symptoms

A few symptoms of a lateral ankle sprain are as follows:

  • Tenderness and swelling
  • Bruising around the ankle joint
  • Tenderness on palpation around the joint
  • Unable to place full body weight onto the joint
  • Restricted range of movement
  • General pain and discomfort

Causes

A lateral ankle sprain may occur when the ankle joint is forced out of its natural position, causing an overstretch within the ligaments around the joint, therefore resulting in a possible partial tear or complete tear. Some causes may consist of wrongly falling on the ankle causing it to twist. Awkwardly landing from a jump or pivoting. Walking or running on an uneven surface resulting in loss of balance, or another person unintentionally landing onto the ankle during a sporting event.

Diagnosis

An injury to the ankle complex is classified by grades I to III to distinguish the severity of ligamentous damage and indisposition of the sprain. Lateral ankle injuries consist of two types of dysfunction, one being mechanical instability and the other being functional instability.

Both of these elements influence the acute injury, implying that once an individual has sustained a lateral ankle injury, a development of chronic ankle instability may transpire in the near future. The incidence of CAI may be present due to mechanical instability from where ligaments have not healed properly in the ankle region and joint laxity becomes effected.

Specific Tests can also be used to help with the diagnosis of a lateral ankle sprain:

  • The Anterior Draw test: Tests the ATFL
  • Talar tilt test: Tests the CFL
  • Posterior Draw test: Tests the PTFL

Treatment

Treatment for a lateral ankle sprain can vary as it will be dependant on the severity of the injury.

  • The first step that should be taken 24-72 hours after the injury is sustained would be to reduce the amount of swelling around the joint. An individual should follow the RICE model. Rest, Ice Compress and Elevate. This would include using a cold compress on the ankle and making sure no weight is placed onto the joint.
  • Soft tissue massage therapy may also be used to assist with the removal of oedema and aid in mild stretching. However, this technique should only be performed once swelling and bruising has reduced around the joint.
  • Once the ankle can handle some weight being placed onto it, rehabilitation exercises given by a Physiotherapist or doctor should be performed. This will help decrease stiffness around the joint, increase ankle strength and prevent any further complications such as long-term chronic ankle instability issues. These exercises may consist of proprioceptive, strengthening and early motion specific training exercises.

Exercises

Here is a list of exercises specifically for lateral ankle sprain injuries:

Single Leg Squat (with chair support)

  1. Setup: Stand beside a sturdy chair, using it for support if needed.
  2. Execution: Lift one leg off the ground, slightly in front of you. Squat down on the standing leg, ensuring your knee stays aligned with your toes.
  3. Depth: Lower yourself until your thigh is nearly parallel to the floor or as low as comfortable.
  4. Return: Push through your heel to return to the starting position.
  5. Repeat: Complete the desired number of repetitions, then switch legs.

Single Leg Hip Abduction

  1. Starting Position: Stand upright with feet together and hands on your hips or holding onto a support for balance.
  2. Movement: Lift one leg out to the side, keeping it straight and your toes pointing forward.
  3. Height: Raise your leg as high as comfortable without tilting your torso.
  4. Control: Lower your leg back to the starting position slowly.
  5. Repetitions: Perform the exercise for the specified number of reps, then switch sides.

Wobble Board Balance on One Leg

  1. Preparation: Place a wobble board on the floor and stand next to it for support.
  2. Positioning: Step onto the wobble board with one foot, maintaining a slight bend in your standing knee.
  3. Balance: Lift your other foot off the ground and try to balance on the board.
  4. Stabilisation: Use your core and small movements of your standing leg to maintain balance.
  5. Duration: Hold the position for as long as possible, aiming to increase your balance time progressively. Switch legs and repeat.

Standing Single Leg Balance

  1. Start: Stand with feet hip-width apart and arms at your sides.
  2. Lift: Raise one foot off the ground, bending the knee to a comfortable height.
  3. Hold: Maintain your balance on the standing leg, using your arms to help stabilise if necessary.
  4. Duration: Hold the position for a specified amount of time, then switch legs and repeat.
  5. Progression: Increase the challenge by closing your eyes or standing on an unstable surface.

Star Excursion Balance Test

  1. Setup: Place a series of markers or tape lines on the floor in a star pattern, with the centre being your standing point.
  2. Starting Position: Stand on one leg in the centre of the star.
  3. Reach: Extend the other leg to reach toward each marker, touching it lightly with your toe.
  4. Return: Bring the reaching leg back to the centre after each touch.
  5. Sequence: Move systematically around the star, reaching to each marker without losing balance.
  6. Repetitions: Perform the test on both legs, noting the distance reached and maintaining form throughout the exercise.

Prevention

To assist in the prevention of a lateral ankle sprain from reoccurring you should:

  • Ensure a full warm up and cool down is performed before and after taking part in Sporting events or exercise activities.
  • Wear the correct footwear that is made for your activity e.g., suitable running trainers when going for a run.
  • If suffered with an ankle sprain before then use protective equipment such as a brace or tape to add extra support to the ankle.
  • Perform some form of stability training and balance exercises regularly.
  • Use strengthening exercises for the ankle joint.
  • Make sure any rehabilitation strategies are executed and performed daily.

If you believe you have a lateral ankle sprain or at least want to find out, please contact a member of our physiotherapy or sports therapy team or make a booking online for an appointment.

 

Piriformis Syndrome

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Piriformis Syndrome is a condition where the small Piriformis Muscle, located in the buttock region, can press on or irritate the Sciatic Nerve. Many Doctors and other professionals mistake this condition for “True Sciatica” which is where the Lumbar Spine degenerates and pinches the Sciatic Nerve. Usually Piriformis Syndrome will be incorrectly diagnosed as “Sciatica” just because it affects the Sciatic Nerve. The piriformis muscle, as it irritates the sciatic nerve, will cause pain, numbness and a tingling feeling  along the leg and into the foot.

Anatomy

The piriformis muscle is one of 6 muscles known as the “Deep 6” and form the wider gluteal muscles or glutes in the buttock region. The Piriformis muscle alongside the other 5 muscles work together to bring the femur bone into external rotation in the hip socket. The other muscles that form the Deep 6 are the gemellus superior, gemellus inferior, obturator externus, obturator internus, and the quadratus femoris. The piriformis muscle sits over the Sciatic Canal where the sciatic nerve runs through and thus why Piriformis Syndrome gives you sciatic pain.

Symptoms

Piriformis syndrome is quite literally a pain in the ass! The symptoms will typically start with either pain in your bum, lower back, numbness or tingling down from the glutes and down the leg. This usually only presents in one side but in extreme cases can be in both legs depending on various factors. If you do suffer with pain this can range from a minor irritant to extreme pain which can run down the length of the sciatic nerve which runs down into the toes. This pain is known as Sciatica because it affects the nerve but is not as serious as true sciatica which is to do with issues in the lumbar vertebrae. The pain is caused from the piriformis muscle compressing or irritating the sciatic nerve.

Causes

The exact causes of piriformis syndrome are unknown, hence the “syndrome” terminology. However there are suggestions and suspected causes such as:

  • Tightness in the Piriformis muscle or a spasm. This can be because of over training, incorrect footwear, sitting for long periods of time or even tightness in the quad muscles that can affect the tilt of your pelvic bone.
  • Injury or  Swelling of the piriformis muscle.
  • Bleeding in the area of the piriformis muscle.

One or a multiple array of the above issues can cause Piriformis Syndrome of the above problems can affect the piriformis muscle.

Diagnosis

There is no definitive test for piriformis syndrome. In most cases just using questioning and getting a history of when the pain started, where the pain / tingling is etc the practitioner can usually have a good idea whether it is Piriformis Syndrome or Sciatica. In some cases, a contracted or tender piriformis muscle can be found on palpation / physical exam.

Treatment

There are a number of ways you can treat Piriformis Syndrome most will involve finding ways to stretch or loosen off the muscle itself. Starting with the least invasive and least painful:

  1. Take a hot bath and use hot water bottles on and around the glute / bum muscles as often as you can, at least twice a day. This will help relax the muscles if there has been a tightening or spasm.
  2. Trigger Pointing the piriformis muscle. If you have an good understanding of the glute anatomy, you can use a foam roller or trigger pointing ball (or a golf ball etc) to apply pressure to the piriformis in order to force it to relax and length.
  3. Stretching the Glute muscles, Hamstring Muscles, Lower Back (Quadratus Lumborum) and Quad (front muscles). Some may argue the anterior leg muscles however if they are tight they could be giving your pelvis an anterior tilt which by lengthening the Piriformis muscle too much can cause it to press against the sciatic nerve.
  4. Massage therapy. A good qualified sports therapist can provide a high level massage therapy / sports massage which can include things such as soft tissue release, neuromuscular therapy and general lengthening and loosing techniques to manipulate the muscle to relax.

Prevention

As this is a syndrome and the direct cause of this condition is unknown we would recommend if you are in a seated job to get up and stretch the hamstrings and glutes from time to time or adjust your sitting position so your legs do not continually get placed under the chair shortening the hamstrings for example.

Walking can also help as this will use antagonist muscles to help relax the posterior chain.

Reducing any sporting activity that you feel is increasing the symptoms.

If you feel like you could be suffering with Piriformis Syndrome our team of physiotherapists and sports therapists can help, contact us today or make a booking!

Morton’s Neuroma

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Morton’s Neuroma is a condition in your foot that affects one of the plantar digital nerves that are located between the metatarsals. A neuroma is a non-cancerous tumour that grows from a nerve; however, a Morton’s neuroma is not like this and instead it leads to the thickening of the nerve. This condition usually only affects one foot at a time and is mostly found to affect the nerve in between the third and fourth toes. Morton’s Neuroma usually occurs in women 75% of the time and commonly affects people over the age of 35. The reason for this happening is unknown but Morton’s Neuroma is believed to be a chronic condition that may have occurred as a result of the nerve being compressed or stretched.

Anatomy

Morton’s neuroma usually affects your foot between your 3rd and 4th toes.

It is sometimes referred to as an intermetatarsal neuroma. Intermetatarsal describes its location in the foot between the metatarsal bones. Neuromas can occur in other locations in the foot.

The thickening of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

Symptoms

The symptoms of Morton’s Neuroma will be aggravated by wearing tight or high heeled shoes and the symptoms will get worse over time. The symptoms will include but may not be limited to:

  • A shooting or stabbing pain in either the ball of the foot or the toes
  • Feeling like there is a small stone stuck under your foot
  • Tingling of the toes
  • May be difficulty walking

Causes

Morton’s neuroma is the directly caused by an irritated or damaged nerve, which sits between the toe bones.

It’s can often be a cause and linked to:

  • wearing shoes that are too tight.
  • Wearing pointy or high-heeled shoes.
  • Doing a lot of sports such as running, tennis, squash or other sports/activities that place pressure through the feet.
  • Having other foot related issues. These can be things such as high arches, flat feet, bunions or hammer toes.

Diagnosis

During your visit to your local GP or Sports Therapist / Physiotherapist, they will press on your foot to feel for a mass or tender spot. There may also be a feeling of “clicking” between the bones of your foot.

Imaging tests
You can have various imaging tests which come with varying levels of success.

  • X-rays – Your doctor is likely to go down the route of X-Ray’s first to look at your foot, this will be to rule out other issues / causes for your pain.
  • Ultrasound – Ultrasound is beneficial when looking at soft tissue abnormalities
  • MRI (Magnetic resonance imaging) –  This is an expensive but detailed scan of the area and often indicates neuromas in people who have no symptoms.

Treatment

The pain can sometimes be unbearable but whether it is or is not does not affect the fact that the immediate aim is to decrease the pain level.

There are many ways that you can decrease the pain that you are feeling but the most effect way for immediate relief would be to rest the area and then combine this with either heat or cold therapy. This should help to remove the pain or at least reduce the intensity; however, this will only act as a short-term pain relief so if the pain became persistent you would have to do this regularly.

For long term relief and hopefully a complete elimination of the pain there are further ways to treat the area.

By having a deep tissue massage in the area this would help to relieve the pain by focusing the massage on the metatarsal heads whilst being cautious to aggravate the neuroma.

Mobilisation techniques of the metatarsal heads would also be a viable option to try and relieve the pressure in the nerve. In addition to this stretching the toe extensors, calf muscles and the plantar fascia regularly should help to strengthen your feet and improve foot stability.

Exercises

The best way to treat Morton’s neuroma is firstly to rest. If pain allows, some stretching and strengthening exercises can help improve symptom’s and alleviate some pain.

  • You can stretch the calf muscles and Achilles tendon.
  • Stretch the plantar fascia along the underneath of the foot, this can be done using a hard ball also.

If you are going to exercise, make sure you build these up slowly so that you don’t irritate the nerve and start the inflammation process again.

Firstly, try a gentle walk to start, maybe start with a mile or 2 depending on your level of fitness.

Once you have done this for a week or two and feel comfortable, then try some HIIT walk/running with 4 minutes of walk followed by 2 minutes light jogging, repeating four to six times. The following day complete rest then try again the next day and as time goes on, pain allows and symptoms reduce, increase the length and intensity.

Please see some exercises and stretch examples in our video.

Prevention

There are a number of things you can do to prevent Morton’s neuroma:

  • Try to limit the time you are wearing tight or high-heeled shoes.
  • Try to wear shoes or trainers that are wider at the front to stop your toes being pushed together.
  • If you are training such as Running or Walking, try to wear shoes or trainers that have a good amount of cushioning especially around the balls or your feet.
  • Keep a Healthy Lifestyle and your Weight under control as excess weight can put undue stress on the foot.
  • For athletes, discuss alternative training plans with your coaching team.

If you believe you have this condition or would just like to have an assessment to see if you do, our friendly team of sports therapists and physiotherapists can help. Contact us or make a booking today.

Meniscus Tear

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This is one of the most common knee injuries, which can be sustained while participating in a number or sports or day to day activities. The severity of the injury can vary greatly from mild, where the injury will resolve on its own given time to heal, to severe, where surgery is often advised.

Anatomy

The meniscus is a ‘C’ shaped piece of cartilage that acts like a cushion between your femur (thigh bone) and tibia (shin bone). It acts to stabilize the joint and prevent wear and tear on the joint surfaces. As the name suggests, a this injury occurs when the meniscus cartilage tears.

Symptoms

The following symptoms could indicate a torn meniscus:

  • A popping sensation in your knee
  • Swelling or stiffness
  • Pain, in particular when twisting or rotating your knee
  • Difficult to straighten your knee
  • A feeling of the knee being locked in to place
  • Feeling like your knee could give way

Causes

A meniscus tear can occur as a result of any activity which requires the forceful twist or rotation of the knee- particularly when that knee is taking full body weight. Aggressive pivoting, sudden stops and turning actions carry a higher risk of injury. It is also possible to tear a meniscus while kneeling, deep squatting or heavy lifting.

Diagnosis

Your doctor my be able to identify a torn meniscus by performing a physical exam, assessing your range of motion, gait and ability to carry out certain movements. They may also use one or more of the following:

X-ray: this will not identify a torn meniscus but may be used to rule out other injuries.

MRI: this will produce and image of the hard and soft tissues in your knee and is considered the best imaging to identify a torn meniscus.

Arthroscopy: this uses a small instrument which is inserted through a tiny incision near your knee. It uses a light and camera to provide an image of your knee, then other surgical tool scan be inserted and used to trim or repair the tear.

Treatment

Treatment generally starts conservatively, depending on the severity of your injury.

  • Rest – You may be advised to avoid activities which aggravate the pain or involve any twisting, rotating or pivoting. If the pain is severe using crutches can rest your knee and give the injury time to heal.
  • Ice – This can be used to reduce pain and swelling. Generally it is advisable to apply a cold pack (wrapped in a towel) to your knee for 15 minutes while it is elevated. This can be repeated every 4-6 hours.
  • Medication – Over the counter pain relievers (often NSAID’s like ibuprofen) can be used to alleviate the pain.
  • Therapy – Physiotherapy or Sports Massage can help to stabilize and support the knee joint while strengthening the muscles surrounding it.
  • Surgery – If the injury is still painful after conservative treatment surgery may be advised to repair or trim the meniscus. In the case of severe degenerative arthritis a total knee replacement could be recommended.

Exercises

Once your knee is in recovery there are many exercises that can support your body as it heals. Remember for this type of injury it is not advisable to ‘push through the pain’. Pain is a warning sign from your body that you are asking more than it is capable of at the moment. Under advice from a soft tissue specialist your exercises are likely to proceed through the following stages:

  • Improve Range of Motion- flexing and extending your knee as far as possible without pain.
  • Stretches- reducing excess tension in your leg muscles.
  • Basic Exercises- e.g. straight leg raises and calf raises.
  •  Advanced Exercises- e.g. squats, weighted leg strengthening and advanced stretching.

Prevention

As they are normally caused by an accident, meniscus tears can be difficult to prevent, however the following precautions can lower the risk:

  • Strengthen your Quadriceps, Hamstring, Adductor and Abductor muscles of the upper leg (thigh muscles) with regular exercise.
  • Always warm up with light activities and active stretching.
  • Rest between workouts to allow your body to repair.
  • Wear shoes that fit well and provide support.
  • Stretch regularly to maintain flexibility.
  • Make changed to the intensity of your activity gradually.

If you have any issues around meniscus tears then our team can help diagnose but also and more importantly help you rehabilite the injury. Our specialists physiotherapists and sports therapists deal with issues like this frequency. Contact us today or make a booking.

Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome (CTS) is a form of repetitive strain injury (RSI) which occurs as a result of damage to soft tissue structures (such as tendons) and in some cases bones of the wrist. Women are three times more likely to develop CTS than men, with approximately 3 to 6 percent of adults in the general population being affected. The condition is particularly common in people who use their hands repetitively, for example individuals working on computers or assembly lines. It is quite common to develop CTS in both hands, however symptoms tend to be worse in the side of the dominant hand.

Anatomy

The Carpal Tunnel is a narrow passage made up of ligaments and bones at the base of the hand. The Median Nerve and tendons responsible for bending your fingers passes through this passage. The median nerve is the receptor (provides feeling and feedback) for the palm side of your thumb, index, middle and part of your ring fingers.

CTS develops when swelling or damage to the structures of your wrist creates pressure on the median nerve. In addition to swelling due to soft tissue injury inflammation any swelling can develop as a result of medical conditions such as diabetes and arthritis. It can develop during pregnancy, in this case it will probably disappear after delivery.

Symptoms

Symptoms tend to develop gradually over time, beginning with slight discomfort and deteriorating progressively if left untreated. Initially symptoms usually appear in one or both hands during the night. As symptoms get worse, tingling may be felt during the day, especially with repetitive activities such as typing or using a mouse.

Common signs and symptoms of CTS include:

  • Pain, tingling and numbness in your hand, wrist and also your thumb and fingers.
  • Fingers may feel and/or appear swollen.
  • Hand weakness and difficulty gripping.
  • Partial loss of sensation in the affected thumb and fingers.
  • In severe cases, where left untreated, muscle wastage of the muscles at the base of the thumb can occur

Causes

CTS is often a combination of many factors which increase pressure on the median nerve rather than a problem with the nerve itself.

Recent studies indicate that CTS can be idiopathic (no identifiable direct cause) and that there may be a genetic component which increases the possibility that an individual develops CTS.

Activities considered high risk for CTS include any which involve repetitive and/or forceful use of one or both hands. In terms of sports this can include gymnastics, weightlifting (Olympic style in particular), racquet sports, cycling, rowing, baseball and golf. CTS also has a high incidence in individuals who regularly use vibrating hand tools (e.g. hammer drill).

Research has shown that certain conditions can increase the risk of developing CTS by causing fluid obstruction in the carpal tunnel. These include:

  • Pregnancy
  • Menopause
  • Obesity
  • Renal failure/haemodialysis
  • Hypothyroidism
  • Use of oral contraceptives
  • Congestive heart failure
  • Tumours
  • Autoimmune disease (eg, rheumatoid arthritis)
  • Wrist fracture/dislocation/deformity
  • Age – The majority of those affected are in range 40 to 60 years old, CTS usually only occurs in adults.

Diagnosis

To determine the cause of your CTS your doctor may conduct a physical examination of hands, arms, shoulders and neck. This can help them to decide if the condition is being caused by daily activities, an underlying disorder, or if it is a condition which presents similar symptoms to CTS. They will look for abnormalities in wrist tenderness, swelling, warmth and colour. Your doctor will probably conduct nerve testing to establish sensation in each thumb and finger any check for muscle atrophy (wasting).

You should inform your doctor of any history of fractures, arthritis or diabetes. It will also be helpful if you can provide them with an insight in to your daily activities and hobbies. They will discuss when your symptoms occur, improve or get worse.

They may ask you to have and X-Ray (to check for fractures or arthritis), an ultrasound (which can show if the median nerve is an abnormal size) or an MRI (to check the wrist anatomy).

Treatment

It is important not to ignore the symptoms of CTS. You can often treat it yourself, but it can take months to get better. Leaving the condition untreated can lengthen recovery time considerably.

REST – Where possible stop any activities which make your symptoms worse. Ask an occupational health advisor how you can modify your work station and/ or the activities that cause the pain.

ICE – Applying an ice pack for 5-10 minutes every 1-2 hours in the early stages of the pain/numbness may help reduce swelling and the pressure on the nerve.

SUPPORT – A wrist splint will help limit movement of your wrist which may help reduce the pain and risk of further swelling.

ELEVATION – Try and keep your wrist elevated to reduce the potential for swelling in your wrist. When you lie down this may mean resting your hand on pillows.

MASSAGE – A Sports Massage Therapist can help to relive the pressure in your carpal tunnel by encouraging the proper flow and drainage of fluids to and from your wrist. They may use Soft Tissue Release (STR) to lengthen and normalize the muscles from your wrist in some cases up to your neck. These muscles often become very tight when performing repetitive tasks, this tension can exacerbated the symptoms of CTS. If your therapist is trained in the use of Kinesiology taping they can also use this to create space in the carpal tunnel and support the soft tissue structures of your wrist. Because the problem may be caused, or made worse, by structures as far up as the neck, your therapist will be keen to address these problems as well as the ones at your wrist. Treating the cause of a problem is always more effective than treating the symptoms alone if the condition is to be resolved.

PHYSIOTHERAPY – Consider seeing a Physiotherapist if other treatment have not improved the symptoms.

CTS can be resolved without invasive procedures, following treatments such as those outlined above has been shown to reduce symptoms effectively if properly followed. It is important to be consistent with treatments for CTS as it may take a number of moths for the issue to resolve.

STEROID INJECTION – A medical professional may suggest a treatment involving a steroid injection to reduce inflammation.

SURGERY – In some cases surgery may be necessary but only after all non-surgical methods have been tried.

Exercises:

Wrist Flexor Stretch

  1. Start Position: Extend your arm straight in front of you with your palm facing up.
  2. Movement: Use your other hand to gently pull back on the fingers of the extended hand, bending the wrist downward.
  3. Action: Hold the stretch when you feel a gentle pull along the inside of your forearm.
  4. Hold: Maintain this position for 15-30 seconds.
  5. Switch: Repeat on the opposite arm.

 

Wrist Extensor Stretch

  1. Start Position: Extend your arm straight in front of you with your palm facing down.
  2. Movement: Use your other hand to gently pull the fingers of the extended hand back towards your body.
  3. Action: Hold the stretch when you feel a gentle pull along the top of your forearm.
  4. Hold: Maintain this position for 15-30 seconds.
  5. Switch: Repeat on the opposite arm.

 

Tendon Gliding Exercises

  1. Start Position: Hold your hand up with your fingers straight and close together.
  2. Movement:
    • Start by bending your fingers at the knuckles to form a hook fist, keeping your thumb straight.
    • Next, make a full fist, curling your fingers into your palm.
    • Then, return to the hook fist position.
    • Finally, straighten your fingers back to the starting position.
  3. Action: Move through each position slowly and smoothly.
  4. Repetitions: Perform 5-10 repetitions, 2-3 times a day.

 

Median Nerve Glide

  1. Start Position: Extend your arm straight out to the side, parallel to the ground, with your palm facing down.
  2. Movement: Bend your wrist so that your fingers point down towards the ground.
  3. Action:
    • Slowly tilt your head away from the outstretched arm.
    • You should feel a gentle stretch along your arm and hand.
  4. Hold: Maintain this position for 15-30 seconds.
  5. Switch: Repeat on the opposite arm.

Make sure you are pain-free at all times and take care not to progress too quickly. Where possible stop any activities which make your symptoms worse. We have given suggested sets and repetitions, but everyone is different so your practitioner may give guidance that is more specific to you. It is important to perform the exercises correctly and at the frequency prescribed in order to reach a successful outcome.

Prevention

As CTS can be idiopathic it is not easy to prevent its occurrence. If possible avoid repetitive activities, when unavoidable take time to perform stretches and take regular breaks. Be aware of the first signs of symptoms developing, the earlier you start treatments the quicker it can be resolved.

The video above is not just to help rehabilitate the area it will also help in strengthening the area and again you should seek professional advice for this.

For more infomation or to make a booking with one of our team to help with your Carpal Tunnel Syndrome then please contact us today.

Is It Tendonitis or Tendinopathy…

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Tendonitis and Tendinopathy are often used interchangeably as they both present very similar symptoms however the conditions are very different.

Tendonitis: Tendonitis is when a tendon (attachment point of muscles) becomes swollen / inflamed. This can be because of a number of issues such as overuse or a specific injury / movement. The inflamed tendon can become stiff and can cause joint pain as it will be affected in the way it functions. Usually, but not always tendonitis is presented once you finish an exercise or immediately after you have rested it for a period of time and can go away during exercise or use. However it can also present as a dull ache more frequently.

Tendinopathy: Tendinopathy, also referred to as tendinosis, is the breakdown / de-generation of collagen in the tendon. This causes burning pain as well as reduced functionality of the tendon, flexibility and range of movement. While tendinopathy can of course affect any tendon, it’s more common in the Achilles tendon, rotator cuff tendons, patellar tendon and hamstring tendons.

Some suggest that tendinitis precedes tendinopathy (tendinosis) however the fact that a healthy tendon can be up to twice as strong as the muscle is true. This would in turn make the body of the tendon unlikely to tear, unless the tendon is already weakened by degenerative change.

So the very idea that tendinitis is the initial stage of tendinopathy as it will presume micro-tears and inflammation precedes collagen degeneration is wrong. Recent research shows that torn fibres, scar tissue, and calcification are only found in conjunction with tendinosis some of the time, and inflammation are rarely found in tendinosis, which would support the idea that tendinitis occurs secondarily to tendinosis

Symptoms

The symptoms of tendonitis and tendinopathy are very much similar at will present itself at the insertion point where the tendon meets the muscle. The symptoms typically include:

  • Pain often described as a dull ache, especially when moving the affected limb or joint
  • Tenderness to touch
  • Swelling
  • Pain or Stiffness in the morning
  • Pain or stiffness after long periods of rest

Causes

Although tendinitis / tendinopathy can happen through a sudden injury or event the condition is much more likely to appear over a long period of time due to overuse or repetitive movements.

Treatment

Tendonitis and Tendinopathy can both be treated in the same way. In more cases Tendonitis will be more effectively treated through conservative methods of rehabilitation as well as rest. The initial advice would be to rest of area that is causing pain, so for example if you are running and that is causing pain to the Achilles tendon then we would advise you to stop that activity an rest usually for around 3-6 weeks depending on the severity. Through this rest period there will be exercises to do in order to strengthen the tendon in question but also by offering stretching techniques and massage to the affected area / muscle attachment.

Tendinopathy can be treated as above however in some more severe cases surgery can be recommended and can also be very effective in providing around 90-95% range of movement and great results.

Golfers Elbow

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Golfers elbow, clinically known as medial epicondylitis, is a condition that causes pain around the inside of the elbow joint. Often occurring after repetitive overuse of the forearm muscles and tendons used for moving the wrist and hand. Due to the constant strain of the wrist flexors on the insertion (attachment) point, inflammation or micro tears can occur.

Golfers elbow is a musculoskeletal condition usually seen in people aged 40 – 60, whose daily activities include repetitive wrist flexion. Despite generally being diagnosed in golfer’s, the injury can occur in several other professions or sporting activities.

The level of pain associated with the pathology can vary from a mild niggle to a severe ache. Fortunately there are many different treatments available to help, with more than 80% of people recovering with basic treatment.

Anatomy

Your elbow joint is a joint consisting of 3 bones. The first is in your upper arm and known as the Humerus. The other 2 bones are in your forearm and known as the Radius and Ulna bones. At the bottom of the humerus there are small bony prominences called epicondyles, where muscles within the forearm attach. The bony prominence located on the inside side of the elbow is called the medial epicondyle.

Muscles, ligaments, and tendons play a huge role in holding the elbow joint in position with strength but also flexibility to move.

Medial epicondylitis, or Golfer’s elbow, is a condition that affects the muscles and tendons of your forearm which attach onto the medial epicondyle. Research suggests that the flexor carpi radialis (FCR) and the pronator teres are the muscles most commonly affected.

Symptoms

The symptoms of golfer’s elbow usually develop over a long period of time. In the vast majority of cases the pain can be minor and more of a side note but can worsen over time. In most cases there is no specific mechanism of injury associated with the condition, it is usually due to repetitive overuse.

Common signs and symptoms of tennis elbow include:

  • Pain or burning on the inner part of your elbow
  • Weakness or pain when gripping, lifting or twisting objects
  • Pain when straightening the arm
  • Sometimes, pain at night

The symptoms are often worse when the forearm is being used in activities that can be as simple as pouring water into a cup, using a screw driver even shaking hands.

Causes

Overuse – As mentioned previously the underlying cause of Golfer’s elbow is overuse, causing the tendons of the muscles to become inflamed. Overtime this inflammation can lead to small tears within the tendon or muscle. Recent studies have shown that particular muscles when damaged can play a large part in the cause of Golfer’s Elbow. These muscles are located in the forearm, known as the flexor carpi radialis (FCR) and the pronator teres. When these muscles become injured or weak from overuse they can get very tight causing the muscles to shorten and pull on the tendons at the insertion point. This constant pull on the tendons is what then causes the inflammation and micro tears, resulting in pain.

Activities – Activities play a large part in the cause of Golfer’s Elbow (Medial epicondylitis). As you would expect Golf and other sports are a factor in the case of Golfer’s Elbow (hence the name) however, anyone can get it and it could even be down to work related overuse. Professionals such as Plumbers, Electricians, Carpenters, Factory Workers and Office Workers can get this condition, any work where grip and wrist strength is important.

Age – Anyone can get Golfer’s Elbow at any stage in their life depending on the activities they are doing and how they are using their arm. That said, the majority of cases we see can range between the ages of 40 and 60.

Diagnosis

When discussing this issue with your doctor, they will take into consideration a number if factors before making a diagnosis. These will include how your symptoms developed, your work and your hobbies etc.

The Doctor will discuss how and when the symptoms occur and are more severe and where on the arm the pain / symptoms are materialising. You will need to make sure you inform your doctor of any underlying health issues such as Arthritis (RA or Osteo), you you have injured your elbow in the past or any other medical issues that has a baring on your elbow.

There are a number of tests the doctors can and should perform during your examination such as asking you to try straighten your wrist and fingers with the doctor providing resistance with your arm straight.

Your doctor may recommend additional tests such as X-rays, Magnetic resonance imaging (MRI) scan or an Electromyography (EMG) – this will be to rule out nerve compression.

Golfers Elbow Treatment

Golfer’s elbow is a condition that will eventually get better over time, the length of time will be determined by how much you are using the arm in the way in which it was damaged in the first place. This may mean you will need to stay off certain activities indefinitely for a period of around 6-8 weeks. This could be shorter or longer depending on what state the injury is in.

However, there are treatments that can be used to speed up your recovery and ultimately help alleviate symptoms while you recover.

The first stage in any recover is

REST. It is important you rest your injured arm and stop doing the activity that’s caused the problem in the first instance.

ICE – Apply a cold compress to the injured arm, such as a bag of frozen peas or a sports ice pack / gel pack for a few minutes several times a day, this will reduce inflammation and ease the pain. Some people have great success with contrast bathing the area so for example, icing the joint itself (the bony / tendonous areas) and using heat on the muscular areas such as Forearm to relax the muscles and speed up recover.

PAINKILLERS – Taking Paracetamol to ease the pain and Non-Steroidal Anti-Inflammatory’s such as Ibuprofen to reduce the inflammation can help greatly whilst in recovery.

MASSAGE – Asking your personal Sports Massage Therapist / Massage Therapist to perform massage on the arm offering STR (Soft Tissue Release) as well as general massage to relax the area and stimulate blood flow can really help to speed up recovery and make you feel better.

PHYSIOTHERAPY – Physiotherapy should be considered with other conservative treatment options especially for more severe and persistent cases.

A good rehabilitation plan with those elements mentioned above has seen great results and improved recovery time as well as reduced inflammation, reduced pain and improvement to the range of movement in your arm.

SURGERY – may be an option if the issue persists and you have gone through a considered and tailored physiotherapy and massage program as a last resort to remove the damaged part of the tendon.

Exercises

 

  1. Wrist Flexor Stretch
  1. Start Position: Extend your arm straight in front of you with your palm facing up.
  2. Movement: Use your other hand to gently pull back on the fingers of the extended hand, bending the wrist downward.
  3. Action: Hold the stretch when you feel a gentle pull along the inside of your forearm.
  4. Hold: Maintain this position for 15-30 seconds.
  5. Switch: Repeat on the opposite arm.
  1. Wrist Extensor Stretch
  1. Start Position: Extend your arm straight in front of you with your palm facing down.
  2. Movement: Use your other hand to gently pull the fingers of the extended hand back towards your body.
  3. Action: Hold the stretch when you feel a gentle pull along the top of your forearm.
  4. Hold: Maintain this position for 15-30 seconds.
  5. Switch: Repeat on the opposite arm.
  1. Wrist Flexor Strengthening (with a Dumbbell)
  1. Start Position: Sit on a chair and rest your forearm on your thigh, holding a light dumbbell (1-3 lbs) in your hand with your palm facing up.
  2. Movement: Slowly curl the dumbbell upwards by flexing your wrist.
  3. Action: Lower the dumbbell back down in a controlled manner.
  4. Repetitions: Perform 10-15 repetitions for 2-3 sets.
  5. Switch: Repeat with the opposite arm.
  1. Reverse Tyler Twist (Using a Flex Bar)
  1. Start Position: Hold a Flex Bar vertically with your injured arm at the bottom, palm facing inward.
  2. Movement: With your other hand, grasp the top of the Flex Bar and twist it downward.
  3. Action: Slowly extend your injured arm while keeping the twist in the Flex Bar.
  4. Repetitions: Perform 10-15 repetitions for 2-3 sets.
  5. Switch: Repeat on the opposite arm if necessary.

There are a number of exercises you can perform to help in the Recovery of Golfers Elbow but also to help strengthen the area to help in the prevention moving forward. We have put together a video of some of the popular and most effective exercises / rehabilitation programs for this condition.

Prevention

It’s not easy to avoid getting golfers elbow as it can be very minor issues that cause it. However a dynamic and considered training program with a qualified strength and conditioning coach can really help. Further to this if your injury was caused through overuse then looking at reducing that particular activity until you have strengthen the area or looking at other ways to do the task in question will help.

The video above is not just to help rehabilitate the area it will also help in strengthening the area and again you should seek professional advice for this.

If you need any help with your rehabilitation of this particular issue our sports therapy specialits and physiotherapy specialists can help. Please contact us today.

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