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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by Michael Brezak, PT, DPT – Hampton NH Clinic

We all live stressful lives. The hustle and bustle of day to day activities at times can leave us feeling a bit stretched too thin. Stress plays an important role in how we feel and interact with our friends, family, and colleagues. Leaving stress to become so ‘built up’ as it were can lead to further medical complications including headaches. It is estimated that about 80% of all individuals have experienced some form of a headache in one way or another(1). It is about understanding your symptoms to find the best treatment for your condition. This article will go over three different types of headaches (Tension, Migraine, and Cervicogenic) and then see how Rye Physical Therapy can help.

Tension headaches are the most common and usually the type that affects the majority of the population on a day to day basis(1). It is that constant “pounding” sensation that one may experience along their temple or even in the back of the neck. This type of headache typically is the result of increased stress which can cause tightened muscles at the base of the neck. Largely these can be managed with over the counter medication, ice, and reducing stress levels all are effective management treatments to reducing your symptoms.

“Migraine headaches have controlled my life for years now. After trying just about every medicine available, I have found the best way to keep the migraines under control to be dry needling therapy. Kate and the team at Rye Physical Therapy are great!” Ginny Carr

Next are migraine headaches which can often times be debilitating in terms of severity or longevity. Migraine headaches can be attributed to certain ‘triggers’ that develop over time, but largely their exact cause is unknown(2). The more common triggers include light sensitivity, noise levels, and even changes in the weather. These type of headaches are usually precipitated in the form of an ‘aura’ which foreshadowing of impending symptoms.

Lastly are cervicogenic headaches which can often times be confused with tension headaches are their presentation is similar. These types of headaches present with decreased range of motion in the neck and joint pain ranging from the shoulders to the base of the skull(3). One aspect of these type of headaches is even a joint dysfunction of the spinal column can be the underlying cause(4). An interesting specific feature of this type of headache is that they are usually one sided in origin(5). Meaning that its presentation is one where it feels as if it radiates from the base of the neck and wraps around in a crescent pattern towards the eye.

In the end, it truly depends on what type of headache you have and how to find the right treatment. A thorough evaluation by a primary physician or a physical therapist can be the first step in the right direction. Each therapist at Rye Physical Therapy is trained in various treatments including the latest research based treatment of cervical manipulation (similar to chiropractors) and Trigger Point Dry Needling to reduce or eliminate headaches and related symptoms.

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Ouch my aching elbow! Most of us are familiar with issues related to overuse injuries of our muscles and joints. Whether you are a weekend warrior that really tries to push it when they get in the gym and pulled in their calf, or you’re at work performing the same task over and over again and now your elbow just seems to throb. We are all familiar with injuries that just nag on and on, and think it will get better on its own. Well 6 months later you are still hobbling along because that calf hasn’t healed and you are constantly rubbing your elbow to make it feel better. There is no reason to live in pain. There are many non-invasive treatments at Rye Physical Therapy. One of the options to treat musculoskeletal injuries is the Graston Technique™. This technique involves using an instrument to perform soft tissue mobilization, and it allows the therapist to not only detect scar tissue but treat it as well.

The therapist works the specialized tool along the affected area to assess for restrictions in the tissue. As this is taking place there are several physiological effects occurring at a cellular level. As pressure is applied tissue remodeling and fibroblast recruitment is taking place^1,2. A fibroblast is a fiber producing cell that when it is stimulated can produce new tissue to an area to aid in healing. An inflammatory response takes place which allows for blood flow to a localized area. Mechanotransduction takes place, cells sense and respond to the force applied. The tissue responds by remodeling the tendon, muscle, cartilage or bone³. A piezoelectric phenomenon causes the soft tissue to generate an electrical signal when subjected to mechanical stresses. This occurs due to the shearing of collagen fibers past one another. Then there is the concept that soft tissue models around demand imposed on it.

The problem with thinking that your injury is just going to heal on its own is that you aren’t completely wrong. Yes it will heal but it won’t heal properly causing scar tissue to build up. If there is scar tissue in the muscle the muscle is now in a shortened position and can’t function properly. The muscle fibers are no longer sliding and gliding smoothly underneath the fascia, and can cause other issues in the chain. The muscle can now have limited range of motion causing the patient pain. So if you have been walking around with a calf strain for 6 months now and all of the sudden your knee or foot starts to hurt it could be caused by altering your gait due to the initial calf injury. Now your injuries are multiplying because you never addressed the root of your issue.

The Graston Technique™ could have ended all of this discomfort from the start. If you contact Rye Physical Therapy from the time of initial injury or even now that you have several areas of discomfort you are still a great candidate for this treatment. Upon evaluation with the Graston tools the therapist can assess for any restrictions in the muscles and then treat those areas using the same tools. Following the Graston treatment the patient is then instructed in effective ways to properly stretch the affected areas to promote the blood flow that was just attained with the tools and aid in proper healing of the tissues. The patient will then perform strengthening exercises, and possibly ice and electrical stimulation if deemed appropriate for the patient. Frequently patients will ask how long it will take for positive effects to be noticed. The standard plan of care is twice a week for 4-5 weeks. The patient should notice improvements within 3 to 4 treatments. Typically patients are able to complete all of their daily activities following treatment. The Graston technique has positive outcomes in 75–90 percent of all conditions treated. It is equally effective in restoring function to acute and chronic injuries, and pre- and postsurgical patients.

Now that tight calf that was stopping you from getting back to running or that elbow that is stopping you from raking your yard can be treated. You could be back to your activity in just a couple weeks. With such a high likelihood for improvement why not give physical therapy a chance. Call me at Rye Physical Therapy at: 603-474-2259 for more information on how this therapy could help you! Or visit us online at www.HamptonPT.com.

<sub>CITATIONS:
1. Gehlsen GM, Helfst R. Fibroblast response to variation in soft tissue mobilization pressure. Medicine and Science in Sports and Exercise, 31(4): 531-535.
2. Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. JOSPT 39(7): 506-514
3. Khan KM, A Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sp Med, 43(4): 247-251.</sub>

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