Tennis Elbow (Lateral Epicondylitis) is inflammation of the tendon and bony attachment of the forearm extensor muscles. The muscles that straighten our fingers and pull our wrist backwards all join into one common tendon which attaches to a bony bump (lateral epicondyle) on the outside of our elbow.
When we form a grip or just simply bend our fingers, these extensor muscles work constantly to stabelise our wrist. Over many hours of writing, typing, using a mouse, gripping a hammer or power tool these muscles become tighter and more fatigued. Eventually, if we don’t stretch these muscles, they put so much tension on the tendon and its bony attachment that they become inflamed. Whilst ice and anti-inflammatory medication can relieve the pain, the underlying cause of tight and tired forearm muscles will most likely maintain the condition.
What’s Tennis got to do with it? As mentioned before, when we make a grip the forearm extensor muscles work hard to stabelise the wrist (keep it stiff), hence the stronger the grip the harder these muscles have to work. Many years ago tennis racquets were quite heavy and poorly weighted which meant greater wrist strength was required to control the racquet. No doubt this created a common injury in people playing tennis.
Today we all use a computer, tablet or mobile phone constantly, which is the major cause of tennis elbow due to the repetitive use of the fingers. A common cause of tennis elbow is the combination of using a computer all day and then lifting weights in a gym at night time requiring an excessive use of these forearm extensor muscles.
As it is an inflammatory condition, rest and medication will often help but to control the condition long term it is essential to have your wrist/elbow mobility and forearm muscular flexibility assessed and treated. More recently we have seen much faster pain reduction from using Shockwave Therapy in conjunction with osteopathy and without the need for anti-inflammatory medication.
Finally, addressing the aggravating factors is imperative to manage this:
– Regular breaks from the keyboard, mouse, power tool, hammer etc.
– Stabelising the wrists with straps or taping when using excessive grip strength.
– Regular stretching of the forearm muscles.
Many of our patients are walking out a more colourful than before with the addition of Gripit tape products to our treatment rooms. Over the last 6 months our staff have attended workshops on application methods and implications for using Gripit tape. Gripit Active tape is produced from an Australian owned company StrapIt. This active tape has great applications in returning patients from injury.
It can be considered the “functional tape” assisting in unloading muscles and joints, reducing pain and enhancing performance and recovery. Gripit Active is a low allergenic (no latex or zinc oxide) smooth & comfortable to wear multi-directional stretch tape. Gripit Active comprises of a blend of nylon and cotton cloth giving it a light and athletic feel which is durable and contours well to the body. It is safe to use on all ages from children through to adults as well as during pregnancy. It is also waterproof and effective over many days, which makes it economical for patients to use.
Gripit Active will allow full movement and as it stretches with movement it can absorb force (load) and slow down movement (reduced eccentric contraction workload). Using the elastic recoil stretch properties, it can therefore be used to transfer the absorbed energy into assisting movement (assist concentric contraction work load). This can be beneficial in reducing pain, improving muscle and joint function and therefore improving movement, power and potentially performance.
Essentially, Gripit Active aids in absorbing load and re-directing it to assist in the line of muscle force, over all decreasing the amount of work a muscle has to do to generate power (decrease muscle work load) and conserve energy.
The major difference with this particular tape over Kinesiology tape is the amount of deloading that can be applied to a joint/muscle/tendon. Put simply it does what we have wanted tape to do for a long time; it helps the patient move more easily. This is in part, due to its extreme elastic recoil and stretch of greater than 250% its length.
So far we have used in clinic for injuries such as shoulder rotator cuff tears, shoulder bursitis, acute low back pain, tennis elbow, plantar fasciitis and achilles tendonpathy. Patient feedback has been extremely positive as it has not only allowed reduction in pain but also increased the speed of recovery.
At the end of last year two of our Osteopaths, Drew and Jason, attended a 3 day course on Functional Movement Screening. At Wantirna Osteopathy we are always striving to offer our patients the best possible care. This course was focussed primarily on people not in pain but leading active lifestyles or looking to start a new exercise regime. One of the major factors for attending was the amount of professional sports teams that have adopted the screening process over the last 5-7 years.
What is it?
Functional Movement screen is focussed on improving performance, fitness, rehabilitation and management of injury risk in active people. It will identify movement dysfunction quickly and with the help of our qualified Osteopaths produce a targeted plan to restore healthy movement patterns.
- The screen consists of 7 basic movement tests that require balance mobility and stability.
- Highlights compensatory movement patterns in otherwise non painful athletes
- Has a ranking and grading system of movement patterns that are key to normal function.
- A score is produced in order to track progress and target areas that require attention and improvement.
- The system allows easy application of the most beneficial corrective exercises
For example someone who is apparently able to squat double legged but struggles to lift one leg above 90 degrees when laying on their back is compensating for that lack of movement elsewhere in the overall movement pattern. The screen will break down complex movements into basic components quickly and allow assessment of true function. If you had the opportunity to improve movement at a basic level then complex patterns of movement will become more efficient.
Is FMS for me?
Are you about to start training for a 5km fun run; are you in pre season training? Anyone who is pain free and looking at taking up a new exercise regimen would benefit from the screening process. It will highlight any areas that may be deficient and potentially lead to injury.
Who uses it?
The system has been in place in many professional sporting organisations including the NFL, the Atlanta Falcons who were in this year’s Superbowl have been using the system to identify movement dysfunctions and susceptibility to injury for many years. Many attribute their lower injury rate to the Functional movement screen and exercise prescription process.
Several teams from the English Premier League and Series A Soccer are regular advocates of the screen for prevention of injury in their players. The US armed services are also regularly screening, including the US Navy Seals to ensure optimal performance from all their personnel. Recently the Denver fire department implemented FMS and the work compensation claims decreased by 42%. At Wantirna Osteopathy we are excited to implement FMS with our athletes returning from surgeries such as ACL reconstructions and Rotator cuff repair.
The FMS – will take about 20 minutes. Once our Osteopath has analysed your movement patterns they will send you an email of the results and what areas you may need to target, areas for improvement and any major asymmetry of movements. This initial screening process is charged at $85
Follow up appointments to run through rehabilitative exercises will be charged at our standard appointment fee $85 and go for 30 minutes.
If you would like to know more please contact us at firstname.lastname@example.org
What Is Shockwave Therapy?
Shockwave therapy involves using an applicator against your skin, which generates high-pressured soundwaves to break down targeted tissue and stimulate tissue repair. The high energy soundwaves have been research proven to stimulate white blood cell production to promote healing, stimulate collagen production to aid tendon repair, break down soft tissue calcification and reduce substance P which is a major cause of chronic pain. In summary, acoustic waves used in Shockwave therapy interact with tissues causing overall medical effects of accelerated tissue repair and cell growth, analgesia (pain relief) and mobility restoration.
What can Shockwave Therapy Treat?
Shockwave therapy is a research proven treatment approach effective in treating many chronic musculoskeletal conditions such as:
- Plantar Fasciitis
- Achilles tendinopathy
- Impingement and Calcification of the shoulder
- Patella tendinopathy
- Tennis elbow (lateral epicondylitis)
- Hamstring tendinopathy
- Shin splints
What does Shockwave Therapy Cost?
Shockwave with Osteopathy consultation – $50 surcharge on top of usual fee
Short Shockwave Only session – $85
What does treatment involve?
Shockwaves are applied via an applicator held against the skin. The initial phase of treatment may cause some deep pain which indicates correct targeting of the problem area and stimulation of the required inflammatory process. As the treatment continues there will often be a feeling of numbness which may reduce the degree of discomfort. The applicator delivers 2000 pulses which can take between 3-10minutes depending on the condition being treated. Many patients get pain relief after the first treatment, however, research shows that 3-6 treatments are required for optimal results.
What Shockwave Machine do we use?
Wantirna osteopathy has recently invested in the latest EMS Swiss Dolorclast Smart Shockwave Machine to use in conjunction with osteopathy management of chronic musculoskeletal conditions.
Effective for a range of orthopaedic and soft tissue injuries the DolorClast machine is not only used by several AFL teams but is also the official shockwave treatment for the Olympic Games. DolorClast was the inventor of radial shockwave therapy and since inventing the technology have continually strived to improve the quality of shockwave treatment their machines deliver. The majority of research quoted and carried out on shockwave therapy has been conducted using DolorClast machines.
Our highly trained and experienced Osteopaths can help you decide whether Shockwave Therapy is appropriate for you.
Wantirna Osteo’s Mountain Bike Star, Dr. Drew Blatchford gives us an insight into the upcoming Olympic event this weekend.
Mountain biking first entered the Olympic games in Atlanta 1996 and has been present ever since. The format is Cross country or XCO in abbreviated form. The women’s race is on Sunday 21st August and the men’s race is Monday 22nd August. Riders will compete from a mass start over a steep and technically demanding course with many obstacles. Racing will likely be for approximately 90 minutes and is a multi lap format. Finish the laps first and the Gold is yours.
Rebecca (Bec) Henderson (25, Canberra) is the sole Australian representative. Bec is a seasoned professional representing on the world stage for Trek factory racing. Australia has two male riders Dan McConnell (31, Victoria) and Scott Bowden (21, Tasmania) a slight surprise inclusion due to his young age, but an exciting prospect.
Bowden has a great opportunity for experience, our best chance is with McConnell, he has previously won World level, however he is up against two of the all time greats. Julian Absalon of France won gold in Athens and Beijing and Nino Schurter of Switzerland, a multiple World Champion and silver medallist from London are arguably the favourites. The joy of mountain biking is that almost anything can happen, mechanical incidents, crashes, punctures, it will make for a fast and entertaining event.
Bowden was also a surprise call up to the road cycling team as Australia had a spare place in the road team after the track cycling team utilised one of their allocated places. This was a sensible decision to bolster the track squad where Australian cycling has its best medal chances.
Interesting fact: the current Road race World Champion Peter Sagan, who recently won another Green sprinters jersey at this year’s Tour de France has gone back to his roots and has entered the Mountain bike race, representing Slovakia. He decided against racing in the road race as it was too hilly for him to be a realistic medal chance.
The highest rate of basketball related injuries occur between the ages 15-24 years old. Common causes of injuries are falls, player contact, awkward landings, abrupt changes in direction. The most frequently injured body region is the ankle and knee, accounting for 37% of basketball injuries in Australia.
The most common ankle injury is a lateral ankle sprain, also known as ‘rolling the ankle’. Lateral ankle sprains occur frequently in athletic populations and the re-injury rate can be as high as 80%. They can be caused by overuse or high demand, underlying restrictions in the body and lower limb or often by standing on another player’s foot. If the injury isn’t addressed properly, this often leads to chronic ankle instability, decreased ankle movement and ankle pain.
There are many structures than can be injured surrounding the ankle joint including bone, ligaments, muscles, nerves, arteries and connective tissue. A thorough assessment as well as clinical testing will determine the most appropriate management.
- Ice the ankle to help decrease swelling
- Keep the ankle compressed – There are many different types of compression bands available
- If able to, keep the ankle as mobile as possible. Your Osteopath will be able to grade your ankle sprain based on its severity and determine how much time you need to rest.
- Depending on symptoms, you may need imaging done to rule out a fracture
- The most recent research suggests that keeping a sprained ankle as mobile as possible initially is more effective than keeping it immobile or in a restricted brace.
- Use Lectric Soda/Crystals to help draw out the swelling – These can be bought from the supermarket. Place them in an old sock or pillow case and place this over the swollen area over night. Make sure you cover your leg in a towel to absorb the fluid that is drained out of the ankle
- Arnica cream – This is great to help bring out bruising in the ankle
- Osteopathy will aid in returning function to the ankle joint, restore mobility and provide balance exercises to prevent further injury
- Dynamic, basketball specific warm-up prior to training and a game. Foam rolling following training and game.
- Recovery plays a huge component in injury prevention, especially with younger populations playing high level and frequency of sport each week
- Address any predisposing factors such as poor foot mechanics, any other knee or lower limb injuries or spinal restrictions – Your Osteopath will be able to help identify these
- Rehabilitation is imperative to improve balance and strength in the lower limb
- Good runners are really important; this will depend heavily on your foot type.
ANKLE MOBILITY EXERCISES – This will help to improve movement in the ankle joint and improve drainage from the area
- Write the alphabet with your foot, start with small letters, then get bigger.
- Use a towel and try to pull your toes towards you. This should be very gentle and shouldn’t cause any pinching in the front of the ankle.
- There are many other mobility and balance exercises that are really important, based on your specific injury.
Dr Meg Withers is an Osteopath at Wantirna Osteopathy who has a keen interest in treating athletes. She is passionate about an individual’s health and well being in general, particularly nutrition. Meg has a love for basketball, playing at a semi professional level for many years. Her love for the sport has given her vast insight into the biomechanics and rehabilitation required to return to such an agile and physical game.
Last month Wantirna Osteopathy’s very own mountain bike fanatic Drew Blatchford competed in one of Australia’s toughest mountain bike marathon races. The Otway Odyssey is a 100km race through the beautiful Otway forest region of Victoria. Climbing almost 2500 vertical metres within the gruelling 100km any rider that finishes this event can be proud of their achievement.
Drew had specifically targeted this event with goals to improve his position and time from his last attempt. Training had involved some very early rises over summer at 0430am just to fit extra kilometres in for the week as well as a training week in the Adelaide hills.
Over 1,200 riders took part in many different distances and categories at this year’s 10th anniversary edition of the Giant Odyssey set in Forrest, Victoria. The Odyssey is known as one of the toughest mountain bike marathons and attracts an impressive line-up of riders. It also caters for novice and junior riders with a range of distances to suit all abilities.
The training did pay off, despite Drew’s slight disappointment at missing his target time of less than 5hrs. Drew finished 26th in a time of 5hrs 3mins and 30 seconds, a 6minute improvement in time and 23 place improvement from 49th. Drew will now look ahead to shorter races including the National Cross country championships in Bright and the Victorian championships in Castlemaine.
As Osteopaths, we often see the detrimental side of exercise when people take on too much, too early. Unfortunately, it is human nature, that once we decide it’s time to change it needs to happen overnight. I am writing this article to hopefully convince a few of you to set a long-term exercise plan and ease your way into it.
Exercise has so many proven health benefits but unfortunately, it can also exploit your lack of joint range of motion and muscular flexibility, resulting in injury. As Osteopaths we regularly see shin, knee, hip and low back complaints because patients are undertaking an exercise regime that is beyond what their body can handle.
My advice to anyone looking at losing weight is to do it slowly and look at a lifestyle change not a ‘quick fix’. Exercise is very important to de-stress and burn kilojoules, but if you get injured you are likely to end up more frustrated and put on further weight. Begin with a low-grade exercise such as walking or water aerobics regularly for 30 – 60 minutes whilst changing some obvious dietary issues, for example, reducing alcohol intake and eating smaller meals. Combine this with increasing your flexibility by stretching and perhaps even yoga.
As your weight reduces, your flexibility improves and your energy levels increase, you can then consider raising the intensity but remember this is a long-term exercise regime so only increase if you really want to and you know you will ‘stick to it’. My theory on exercise is the more you enjoy it and the longer you undertake it, then the less reliant you are on the fridge and pantry to make you feel happy.
My final tips with a new exercise regime are to:
- ensure you have the correct footwear
- stretch before and after exercise.
- consider touching base with an osteopath, dietician, personal trainer and shoe specialist before launching into a Spring training program.
Dr. Jason Stone (Osteopath)
Sports Injury Assessment Evening 2019
Throughout the Winter Sports Season, Wantirna Osteopathy, will again hold a FREE injury assessment session on a Monday evening for sports people of all ages and sports.
This popular session has been a longstanding offer from our experienced practitioners to help our local sporting community.
Their professional advice and guidance helps to manage and rehabilitate the sports person’s injury.
Sessions will commence on Monday 8th April and are open to all our local senior and junior sporting clubs.
There will be limited numbers each Monday Evening. You will need to ring the clinic on 9800 0388 to reserve your place. Simply mention the ‘free sports injury assessment’ and the club you are involved with.
Please note we are at our new location at Level 2, 171 Stud Road, 5 doors down from the old clinic.