A breakdown of a potential injury that can occur in your elbow that can easily become debilitating if not addressed early.

By Michael Brezak, PT, DPT

Winter may be finally coming to an end with the appearance of grass and increase in wet puddles in the road and yard. At least we all hope so, but this being New England how can anyone truly tell what the weather will do in an instant. One minute it is snowing in the morning, then sunny with clearing skies and warming sun. Yet as the snow starts to melt, we all experience the change of seasons. I personally call this mud season up here, but spring would also suffice. And with spring comes the term we have all come to love and hate, spring cleaning. Whether it is yard work or cleaning out items in the house/condo/apartment what have you, that tends to mean a lot of carrying, raking, or picking up heavy items to dispose of. This can bring on a whole mess of problems, but today I am going to delve into pain along the inner aspect of your elbow and help you better understand the cause, symptoms, and management of a debilitating injury that is oftentimes ignored.

Pain is something that at one point in our lives we have all experienced in one form or another. Oftentimes it is in or joints whether it is the knee, hip, or shoulder, but the elbow is also a joint that can be injured just as well. Excessive overloading usually with carrying based activities or repetitive use at our wrist with twisting/grasping motions can have an effect at the elbow. Largely this type of action can cause lateral epicondylitis or tennis elbow, but there is also medial epicondylitis or golfer’s elbow (golfer’s pay attention now). These two conditions are the result of overloading the tendons at the elbow of the muscles in the forearm through the aforementioned methods. A simple test is to place 1-2 fingers just below the joint line and ‘pluck’ or ‘strum’ your fingers back and forth across the tendon. If pain or discomfort ensues, well then you could be experiencing some joint tendonitis. Typically, this is reported as no pain or a dull ache throughout the day until on use it becomes a sharp/stabbing often causing a release while holding or carrying items.

“Typical symptoms are pain along the origin of the common flexor tendon with repetitive wrist flexion, pronation, and valgus stress. Patients may complain of night pain and pain at rest.” Christina Brady, MD and Anil Dutta, MD

So then what does treatment look like for someone who is experiencing this condition? Medical management is fairly straightforward upon completion of a medical history including a description of events or factors that tend to flare up or calm down the symptoms. Therapists at Rye Physical Therapy use techniques and manual therapy applications that are evidence based to achieve optimal results in the shortest amount of time. The therapists upon completion of a medical history will determine the best course of action for you whether it includes the newest ultrasound guided dry needling, instrument assisted soft tissue, or neural mobilization to facilitate tendon healing and decrease the inflammatory response. Ultimately with the mindset and goal to return you to your prior level of function. Still unsure? Rye Physical Therapy offers Free Discovery Visits in which a therapist will go over your symptoms and determine with you if physical therapy can be beneficial.

References:
Dutta, C. B. and A. (n.d.). Medial epicondylitis and medial elbow pain syndrome: Current treatment strategies. ClinMed International Library. Retrieved February 25, 2022, from https://clinmedjournals.org/articles/jmdt/journal-of-musculoskeletal-disorders-and-treatmentjmdt-2-014.php?jid=jmdt

Javed, M., Mustafa, S., Boyle, S., & Scott, F. (2015, November). Elbow pain: A guide to assessment and management in Primary Care. The British journal of general practice : the journal of the Royal College of General Practitioners. Retrieved February 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617264/

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Being a Physical Therapist is a very rewarding career that makes you look forward to going to work every single day. It’s a specialized field where you can impact someone so much, that post-treatment, they can resume living their life again. You get to work with people one-on-one and watch them progress before your very eyes. Your treatments truly make a difference. Those are some of the benefits of being a physical therapist.

As someone that has been practicing physical therapy for over 5 years now, I feel so lucky to have a career not just a job. I remember being in high school and having all the pressure to go to a good college and find a career. It all seemed so daunting at the age of 17. Luckily, I attended a proactive high school that supplied us with opportunities to be exposed to different careers. I saw a variety of occupations that seemed appealing but still wasn’t sure what I truly wanted to be when I grew up. I found out more about physical therapy and decided to attend graduate school. All of the schooling seemed overwhelming at first and can be a deterrent for many. After 7 years of school I was finally done and ready to get started on my career path as a Doctor of Physical Therapy!  I began working in a private practice outpatient clinic. There, I enjoyed great mentoring and opportunities to build my skills as a therapist. I can’t say enough about how lucky I am to love my career and want to encourage students to look into a physical therapy career.

When I recently attended a career fair at a local high school I felt compelled to share my joy for this career. I was sad that few kids came towards our booth or seemed apprehensive when told about the duration of schooling. There are so many benefits to becoming a therapist. In terms of employment opportunities, according to the Bureau of Labor Statistics “employment of physical therapists is expected to grow by 36 percent from 2012 to 2022, much faster than the average for all occupations. While demand for physical therapists varies by geographical region and area of practice, the unemployment rates are low across the country. The need for physical therapists is expected to remain strong into the foreseeable future.” So in a time where most employment opportunities are seeing a decline its encouraging for a young person to find a field that is actually growing.

At the career fair I wanted to have a serious discussion with the kids to find a true path and be realistic with them. I wanted to explain to them that it’s important to do something that they love but they need to make sure that they choose a major in college that will lead them into a job when they are finished school. College is a very expensive endeavor and in order to pay off loan debt it is critical that students find something that will create opportunities. In my opinion physical therapy fits that description to a tee.

All of my days are similar but drastically different keeping me constantly on my toes. I see and treat a variety of conditions throughout the day. I can start my day with a 10 year old child with knee pain, then a 90 year old that has a history of falls and we work on balance, and end my day with a patient suffering from chronic headaches and I perform dry needling and cervical spine adjustments. The  amount of variety makes the days and weeks fly by.

I’ve found that over the years I still love my job. I don’t dread going to work every day and I’m not stuck behind a desk pushing papers. Job satisfaction is felt throughout the profession.

“Physical therapist report one of the highest job-satisfaction levels in the country. Forbes ranked physical therapists as having 1 of the ‘The Ten Happiest Jobs’, according to articles published in 2013 and 2011. CNNMoney.com gave physical therapists a grade of ‘A’ in Personal Satisfaction in 2012, as well as in its ‘Benefit to Society’ categories. A National Opinion Research Center survey, which was chronicled in an April 17, 2007, article of the Chicago Tribune. With more than three-quarters of physical therapists polled reporting to be ‘very satisfied’ with their occupations. PT’s were second only to clergy, and were the only health care professionals in the top 5.” I continue to encourage students to look at physical therapy as a career. At Rye Physical Therapy we offer different shadowing and clinical experiences. Feel free to contact either our Hampton or Seabrook, NH clinics to arrange a job opportunity if your child is interested in learning more about being physical therapist.

APTA “Benefits of a Physical Therapist Career” https://www.apta.org/Careers/

APTA “ Who Are Physical Therapists” https://www.apta.org/Careers/

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You have a choice in your healthcare, it’s time you choose wisely.
Do you have an insurance deductible? Then this is a must read.
Fed up with deductibles? It’s time YOU take control of your healthcare!

I invite everyone to check out this excellent site: www.mymedicalshopper.com where you can explore how to reduce your medical costs with pricing and quality information on over 9,000 tests and procedures.

For many years, many of us were very fortunate to have no deductible insurance plans. In fact, even just a decade ago, only 55% of insurance plans had a deductible, compared to 81% today. Prior to deductibles, it was like going to an all-inclusive healthcare resort where we didn’t ever ask to see the bill since it didn’t matter, nearly everything was covered. Your employer paid most of your premium and you were good to go, life was good. Unfortunately open bar has closed and we’re now all responsible for the tab. A tab that is increasing on average of 17% for premiums and 21% for deductibles for 2017 Obamacare plans and 6% for premiums for employee plans. We are now concerned about the cost, which is why we must now shop around!

Because we were so fortunate to not have to worry about deductibles we only had to focus on our care and make sure we picked the right doctor, yes that was really nice. Now, we need to continue to make sure we get the best care for the best price. Research has actually found that there is no correlation between what people pay and the quality of healthcare they get. What many of us don’t realize is that the cost for care is NOT the same across the board. Many of us assume that the cost of lab work, imaging (MRI’s, x-rays, etc.), and even Physical therapy treatments are all about the same regardless of where or who is doing it. The truth is that there is a huge discrepancy between private practices and hospital based practices.

Hospital based care, whether it’s at the hospital or at a hospital owned outpatient satellite, has a significant price increase in comparison to private practice facilities. Hospital’s charge a facility fee which is meant to cover hospitals overhead that a freestanding physician or privately owned clinic would not carry. For example, if you were to go to a hospital for a service vs a private practice, the insurance company pays twice: To the facility and to the provider. The hospitals justifiably have some legitimate reasons to have a facility fee since 1) hospitals provide access to critical hospital based services that may otherwise not be available in the community 2) hospitals have higher cost structures due to offering 24 hr. standby services, and 3) they have more expensive licensing and regulatory requirements.

“It is definitely a flaw in the payment system that should be corrected. If it costs more to provide a service in a physician’s practice that’s owned by a hospital, maybe it shouldn’t be provided in that kind of a setting.” Stephan Zuckerman, PhD

Since the hospitals are essentially getting paid TWICE what the independents are getting paid, this incentive to the hospitals has encouraged them to buy out local independent facilities (Primary care doctors, Physical Therapy clinics, and other Specialists) and turn them into hospital based facilities. Many times they will make no other changes and offer the same services but allow them to charge 2 TIMES what the independent doctor was making. Stephan Zuckerman, PhD co-director and senior fellow of health policy center, urban institute said it best “It is definitely a flaw in the payment system that should be corrected. If it costs more to provide a service in a physician’s practice owned by a hospital, maybe it shouldn’t be provided in that kind of a setting.” This flawed system has allowed for hospital growth to more distant communities which has consequently decreased competition and increased the costs of our healthcare. The remaining private clinics struggle to compete since the hospitals strive to close doors and relationships in hope of maintaining referrals. And now private practices are fighting back with transparency and educating patients on the hidden costs.

So, how do we determine who has not only the best cost but the best services? Glad you asked, www.mymedicalshopper.com has created a website that has tried to inform the patients “medical consumer” to choose their care based on price, quality, and convenience. They have integrated actual medical procedure cost data with real-time consumer insurance information in order to create an unparalleled, personal tool. Their driving vision is to reverse the trend of rising healthcare costs and to develop technology to transform the healthcare industry into a fair market for consumers. Yes, consumers!

You need to no longer be a patient but an educated consumer that pays less in deductibles, has more control over the quality and price of your care, and understands that there is no relationship between the quality and price of your care. The goal is to empower each consumer and take control of your healthcare, stop overpaying medical care, start choosing based on price, quality, and convenience. Whether or not you have a deductible you need to recognize the power of the consumer and realize that you can make a difference. By using a transparency website you will drive down high cost, low quality care facilities that will consequently give economical force to drive down the inflated healthcare costs.

Here is an example of www.mymedicalshopper.com price comparison:
MRI COMPARISON – Local VS Hospital costs

Moving forward, I encourage you to NOT just go where your Doctor’s office tells you to go. They’re usually just going to refer you to their own facilities and why wouldn’t they? Next time, remember you are a medical consumer and YOU HAVE A CHOICE! It’s up to you to make sure you’re getting the best care at the best price. Always do your homework, ask a friend or family member where the best care is and then leave the rest to www.mymedicalshopper.com where you can compare price, quality and convenience.
DISCLAIMER – I have NO affiliation with this site.
Feel free to contact us to discuss or for more information: www.HamptonPT.com

TIPS

Need an MRI? American Health Imaging or Shield imaging which averages $1000 LESS than hospitals
Need Lab work? Quest Diagnostics is a fraction of the price! www.questdiagnostics.com/
Need urgent care? Convenient MD (www.ConvenientMD.com) This saves you a lot! The price is the cost of a copay to your PCP compared to the cost of ER where most of us have a $500 copay.
Need Physical Therapy? A private clinic will save you 200-300% per visit compared to hospital affiliated clinics! (You could choose Rye Physical Therapy to save money! www.HamptonPT.com)
Need medical care and want the best quality for the least cost?
Look at www.MyMedicalShopper.com first.

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