Whalley Physiotherapy

Blog archive: Jun 2017

  • Tennis Elbow: Early Treatment is Vital

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    RV88 Whalley Physio Tennis Elbow

    There are plenty of things you can do to alleviate the pain caused by tennis elbow, says physiotherapist Jane Connolly HPC CSP

    Tennis elbow – or lateral epicondylitis – is a common injury affecting the muscles or tendons of the forearm where they attach to the epicondyle of the humerus. It is classed as a tendinopathy which is aggravated by repetitive wrist extension or by gripping strongly whilst twisting your wrist.
    Despite being called ‘tennis elbow’ it isn’t only racquet sports that causes the problems. Any job that involves a repetitious overuse of the wrist results in micro trauma within the tendons and may explain why, apart from the very early stages, the problem has been shown to be due to degenerative changes rather than an inflammatory process. Poor working positions on a computer over an extended period of time can also cause pain.

    The most common symptom is pain and tenderness on the outside of the elbow or in the muscles of your forearm which comes on gradually over time or even a few days after the initial injury. The pain can vary from mild discomfort to severe pain that gets worse when trying to stabilise the wrist whilst gripping, like holding a cup, opening a jar, using a screw driver or shaking someone’s hand firmly. It’s also aggravated when you bend your wrist backwards against a force, for example when doing backhand in tennis.

    Mild symptoms of tennis elbow ease with rest and most importantly by avoiding aggravating activities. There are some things you can do to help yourself. Lifting objects with your palm facing up, not down, will put less strain on your damaged muscles or using ice on your elbow can ease your pain for a while. For some wearing a strap, splint or brace around your forearm may help relieve the strain on your tendon meaning that you can continue with activities once the pain has settled down.

    Physiotherapy is usually very effective in reducing pain and maintaining and improving movement and mobility. There are various techniques to reduce pain including deep tissue massage, ultrasound and laser therapy and most importantly exercises which are graded within the limits of pain to slowly increase muscle strength and length without causing damage.

    Early treatment before the condition becomes chronic is most beneficial. Waiting too long can mean that the treatment choices become more invasive such as steroid joint injections, but often these ease pain initially but have limited success in the long term. As with every procedure, there are some risks linked with steroid joint injections. Other procedures offered are autologous blood injections which involve a sample of your blood being taken and injected back into your elbow or platelet-rich plasma injections which involves the plasma and platelets being injected.

    Tennis elbow usually gets better using the treatments listed above. Early treatment intervention and rest, avoiding things that make it worse, is essential due to the degenerative nature of the condition. As a last resort you may be recommended to have surgery but often by this time the damage is done.

  • Sprained Ankle: A Full Recovery

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    RV89 Whalley Physio Ankle

    You don’t have to play sports to sprain your ankle. A sprain is an overstretch or tear of the ligaments which attach bone to bone. Sometimes other soft tissues are involved but most often it is the three ligaments that lie on the outside of the ankle attaching the fibula to the foot. The cause of injury doesn’t have to be excessive. Simply rolling inwards on your ankle, usually when you have your toes on the ground and heel up, can result in pain and then swelling and bruising on the outside of the ankle which migrates down to the toes.

    For diagnosis sprains are classified from Grade l to 3.

    Grade 1 – a mild sprain which settles in two to three weeks but needs to be rehabilitated properly to prevent joint stiffness, ligament laxity, muscle weakness or tightness plus reduced proprioception.
    Grade 2 – the ligament is excessively stretched or partially torn causing extensive swelling and bruising. Recovery takes four to six weeks and rehabilitation becomes more complex and extensive.
    Grade 3 – the ligament is completely ruptured resulting in instability and needs immobilising. It may be the bone is fractured which is difficult to differentiate without an x-ray. If you are unable to bear weight or if there is significant swelling or deformity, you should seek medical treatment.

    Treatment in the first instance is usually to follow the RICE regime. Initially it involves resting, protecting and reducing swelling of your injured ankle. Physiotherapy helps with pain relieving techniques, massage and strapping to assist you during this painful phase and advises on pain-free exercises.

    As the pain settles the focus changes to restoring your ankle’s flexibility, range of motion and strength. Scar formation takes at least six weeks and the aim in this time is to achieve a normal functional length of the ligament and muscles with specific lengthening and strengthening exercises. One important aspect of rehabilitation that is often overlooked is proprioception ie our sense and awareness of the position of our body parts. It is closely linked to balance and helps to reduce the risk of re-injury. Located within the muscles, tendons and ligaments are tiny sensors which relay information about joint position, pressure and muscle stretch to the brain. If you’ve ever automatically recovered as you’re about to twist your ankle then this is the proprioceptors working automatically to prevent further injury.

    Proprioception is improved through exercises which begins as soon as possible after an injury. Generally in lower limb injuries, this is as soon as full weight bearing is possible. This kind of exercise can start very simply, without the need for equipment using single leg balance exercises, closing your eyes and then progression to a wobble board.

    All in all, with correct treatment, recovery from a lateral ankle sprain should be full and not recurring so you have confidence to return to everyday activities or chosen sport.