Outer Elbow Pain? You may have Tennis Elbow.

Could you be suffering from tennis elbow and not realise it?

The most common kind of elbow pain is a condition known as lateral epicondylalgia – or tennis elbow. Ironically, you also don’t need to be a tennis player to get tennis elbow. Many who have suffered from tennis elbow, actually do not play tennis. It’s also important to point out that recovery from tennis elbow requires a proactive approach involving diagnosis, treatment and strengthening. Through rest alone, your recovery will be very slow.

The causes of tennis elbow

This type of problem can occur at any age, but is most common between the ages of 35 and 50. Predictably, it is more common in your dominant arm but can affect both. The biggest misconception about this type of elbow pain is you don’t have to be a tennis player to get this condition. In fact it is just as common in people who repetitively overuse their forearm muscles such as office workers or tradespeople.

Referred Pain
A huge contributing factor to this condition which can be easily forgotten is referred pain from the neck or shoulder. This can either mimic symptoms of tennis elbow, or most commonly there is a combination of elbow and neck, shoulder or thoracic spine issues. You will need to have a thorough examination by a physiotherapist to determine if you have any referred pain from your neck and shoulder or if your elbow pain is isolated. This will assist in a more direct approach to your problem and a speedier recovery.

Tennis elbow and it’s symptoms

Typically, this condition presents as pain at or just below the lateral epicondyle- that is, the pointy part on the outside of your elbow. Generally people experience pain with gripping, lifting or wringing activities which cause tension over the tendon (see above picture). Clinically, we as physiotherapists often find people suffering this condition have weak and/or tight forearm muscles and stiff elbow and wrist joints.

There is a wide variation in the severity of this condition and how long the symptoms may last for. As with any injury, it is best that we see you as soon as possible to start you on an injury management plan. On assessment, your physiotherapist will be able to give you a guide as to how long your injury may last.

6 Steps to treating tennis elbow pain

Initial management of this condition is through pain relieving techniques such as soft tissue massage, joint mobilisations, stretching tight nerves and muscles, dry needling, heat and/or cold therapy and taping. We also sell tennis elbow braces to our clients that are effective in relieving pain in some people. I’ll cover these methods in more detail;:

1. Soft Tissue Massage: A massage therapist can use a range of techniques to release soft tissue, break down tension and realign the fibres. These techniques include myofacial release and transverse friction techniques.

2. Joint mobilisation: this management may include massage around the problem area or gently mobilising the joints of your neck and elbow.

3. Stretching: As soon as your pain allows, start stretching the area. Extension exercises of the wrist will be the most important stretches you can do to improve your range of motion and to increase the amount of load on the tendon.

4. Dry Needling: Dry needling is a technique that is fast gaining appreciation within the physiotherapy world, with many practitioners throughout Australia now trained in the use of acupuncture needles to assist with their client’s pain and rehabilitation. The insertion of needles at varying lengths and points are thought to alter the way pain signals are transmitted by nerve pathways.

5. Hot/Cold therapy: Apply ice to the elbow regularly to reduce the pain and inflammation will be a good start, particularly at the early onset of pain.

6. Kinesio Taping: Kinesio taping may help decrease the pain and can reduce the likelihood of injury aggravation.

Another exercise option is the ‘The Tyler Twist”, where clients are asked to perform an exercise using a FlexBar®. The experiment consisted of a group of 22 subjects who suffered from tennis elbow. These subjects were then split into 2 groups. The first group were asked to perform the FlexBar® exercise as well as receive standard physiotherapy. The control group received physiotherapy alone. It was found after 7 weeks of therapy that the first group had significantly more improvement than the group receiving only standard physio; in particular, the eccentric exercise group improved their pain level 81% vs. 22% in the standard group.

Ongoing management and prevention of tennis elbow.

Of utmost importance in managing this condition is a progressive strengthening program. Tendons require gradual load in order to heal correctly, so it is very important to continue to strengthen your muscles even if your pain is gone. At this phase of your rehabilitation, it is also important to look at contributing factors such as workstation setup and your posture. If you have some referred pain, assessing your pillow may also be necessary to ensure that your whole body is always in optimal alignment.

Sometimes patients are recommended by their GP to consider a cortisone injection into the elbow. The most recent research regarding this shows that it actually makes you worse in the longer term. Cortisone assists in settling inflammation, which may help in the short term, but generally this condition is not an inflammatory condition.

Recovery from tennis elbow pain

Typically, tendon overload injuries such as this can take anywhere between 2 and 24 months to be back to normal. No, this doesn’t mean you will be in pain for that long or that you will necessarily need one on one treatment for that long. It means that the healing process of tendons is longer than any other tissue in the body so you may need to continue with an exercise regime in the longer term- even after you stop seeing your physiotherapist. This will ensure that your pain stays away.

Remember, tennis elbow is not the same as Golfers elbow which we’ll be covering in a later post. If you are experiencing elbow pain, even if you’re not sure if it’s tennis elbow, it is important to seek treatment as soon as possible to reduce your recovery time. 

This article originally appeared on sportandspinalphysio.com.au and was written by Craig Honeybrook

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Acupuncture: The Treatment of Seasonal Affective Disorder

Seasonal affective disorder (SAD), a type of depression, is a debilitating problem that interferes with the quality of life of thousands of patients, especially during the fall, winter and early spring.

This syndrome seems to be a worldwide phenomenon and occurs cross culturally, especially in countries far from the equator. Clinical symptoms that reappear regularly with the seasonal changes include lethargy; difficulty concentrating; depression; negative thoughts; elevated cravings for carbohydrates with corresponding overeating and weight gain; hypersomnia (excessive sleepiness); tiredness in the morning; diminished libido; and decreased social interaction. Patients typically become more anxious by the end of the summer as they anticipate the coming months, during which less sunlight is present and their symptoms return. (acupuncturetoday.com, written by Skya Abbate)

Clinical experience reveals that patients may have other mental problems as well, such as substance abuse disorders, personality disorders and anxiety disorders, which as comorbdid conditions, further exacerbate the degree of the SAD patient's symptoms. Flaws and Lake define SAD as "a variant of bipolar disorder characterized by cyclic manic, depressive or mixed mood states that are somehow triggered by external clues to changing seasons, including principally, increased or decreased day length. Individuals with SAD tend to become depressed during the autumn months and manic during the springtime."1 This is a complicated disorder that may accompany many severe illnesses such as cardiovascular and endocrine disease, and for which a patient should seek qualified professional help. Seasonal affective disorder does, however, respond well to treatment with Oriental medicine.

Seasonal Affective Disorder (SAD) is an example of how a change in seasons can affect our emotional and physical wellbeing. Between 4 and 6 percent of the U.S. population suffer from SAD. It is more commonly observed in those who live at high latitudes (areas farther away from the equator to the north and south). Seasonal changes are generally more extreme in these regions, supporting the idea that SAD is caused by changes in sunlight availability.

While SAD can occur during summer with limited symptoms such as weight loss, trouble sleeping and decreased appetite, its winter symptoms tend to be more severe. Winter-time sufferers of SAD can experience fatigue, increased need for sleep, decreased energy levels, weight gain, increase in appetite, difficulty concentrating and increased desire to be alone.

The TCM yin and yang forces of the seasons coincide with those of the body. The Yellow Emperor’s Classic of Medicine states that, “People and nature are inseparable.” While yang’s warmth, activity and brightness work through out the spring and summer months, yin’s passivity, coldness and darkness begin in autumn and continue until spring equinox. Therefore, the winter months, which represent the height of the yin cycle and the water element, can cause those whose constitution tends toward yin to feel the effects of this season more acutely.

Western medicine currently treats seasonal affective disorder with light therapy and sometimes with antidepressants. This is because energetic imbalances, which are associated with emotional and physical disturbances in the body, can become more pronounced after a change in weather and sunlight. The downside to these light therapies is that they carry side effects such as eyestrain, headache, irritability, fatigue, insomnia, palpitations, high blood pressure and reduced libido. Also, these therapies do not address the underlying problems, but merely offer symptom relief.

Acupuncture is a natural alternative to light therapy or antidepressants. Acupuncture, which has shown promising results treating depression by releasing serotonin and noradrenaline-norepinephrine, has no side effects. Together with a treatment plan created by a licensed acupuncturist, acupuncture can improve balance of mood and energy, relieving the patient from the burdens of a depressed, unbalanced system.

The winter months are associated with the kidney system, which is the base of qi, our vital energy. The kidney creates fire and warmth and provides energy to other organs. As our bodies use up energy keeping warm, they begin to crave quick sources of new energy in high calorie foods, which are stored as fat to keep the body warm. These foods do not sustain energy levels in the body, nor do they properly nourish the kidney, and with this energy depletion we tend to feel more lethargic and sensitive to our surroundings. This is why winter is a time to seek replenishment of body, mind and spirit.

Nourishment in all areas of life is especially important during the winter months when SAD is most common. Although many people head indoors during winter, it is important to continue outdoor activities to expose yourself to daylight, and to take part in activities that support inner balance. Physical and mental stress, as well as poor sleep and nutrition, further deplete the body’s energy and leave you susceptible to illness. You should rest and conserve energy, but also spend time with friends and loved ones, cultivate your inner dialogue and eat a well balanced diet. Eating less fruits, increasing whole grain intake and plenty of warming foods such as soup, is a great way to nourish the kidney system.

Oriental medicine can restore the balance our bodies seek during seasonal transitions. While the tendency is to look inward or become preoccupied with one area of our health, such as maintaining energy and keeping warm, it is important to remember that balance in everything from your diet to your living environment is essential in sustaining a positive outlook and a healthy mood. (pacificcollege.edu)

7 Signs That You Need Acupuncture This Spring

Last week was the first day of spring. Yahoo! Except for that fact that many people don’t feel so hot this time of year.

The flu is — knock on wood — mostly behind us. Allergies have not quite exploded yet. So, why do so many of us feel off in the early days of spring?

You can kindly thank your liver!

In acupuncture theory, humans are viewed as microcosms of the natural world that surrounds them. Seasons — particularly the transitional periods, when we move from from one season to the next — factor significantly into how we feel.

Each season is linked with an organ system in the body, and spring’s system is liver. This means that the liver, as it adjusts to taking over the seasonal reins, is especially vulnerable.

When the liver is vulnerable, the functions throughout the body for which the liver is responsible have a tendency to get out of whack.

Eventually, spring can become a time when the liver and its associated functions thrive. However, during this transitional period, when the liver is still finding its footing, certain symptoms commonly show up. Acupuncture improves these symptoms by restoring balance to the liver system.

Here are seven signs that your liver may need some acupuncture love:

You Feel Extra Tense

In acupuncture, liver is the system that’s responsible for smooth flow throughout the body. When the liver is not functioning optimally, things like emotional stress, rigid posture, shallow breathing, and jaw clenching may become exacerbated.

You Have Headaches and Other Aches and Pains

When things aren’t flowing smoothly, we start to experience what acupuncturists think of as stagnation-type symptoms. These include pain, and specifically pain that feels like pressure, tightness or restriction. Tension headaches and menstrual cramps are commonly worse this time of year.

Your Muscles are Really Stiff

The liver and its associated system, gallbladder, nourish the body’s connective tissue, tendons and ligaments. You may notice increased stiffness, tension or tightness in your muscles and joints in the coming weeks.

You Feel Irritable and Frustrated

Are you feeling more annoyed than charmed by the springtime sound of chirping birds? The emotional symptoms associated with Liver imbalances mimic the physical stagnation that happens. You may notice yourself feeling extra irritabile or frustrated, perhaps more easily annoyed. There’s an emotional stuckness that can take hold in spring.

Your Fuse Is Shorter Than Usual

All organ systems in acupuncture have an associated emotion. Liver’s emotion is anger. A healthy dose of anger helps complete a balanced emotional profile. However, when the liver isn’t appropriately keeping things in check, there is a tendency for anger to rise up. Along with feeling irritable, you may have a harder time than usual controlling your anger.

Your Digestion Is Messed Up

Healthy digestion is heavily dependent on consistent and smooth movement throughout the whole body. When the liver fails to maintain flow, digestive disturbances can easily occur. There’s also the whole brain-gut connection. When emotional stress is higher than usual, digestive function naturally declines.

Your Eyes Are Bothering You

Just as all organ systems have an associated emotion, they also have an associated sense. Sight goes with the liver system, so any issues related to eye health are usually attributed, at least in part, to a liver imbalance. This can include poor vision as well as eye pain and fatigue, and dry eyes. This simple exercise can help.

The Springtime Acupressure Point

If you only remember one acupuncture point all spring, it should be Liver 3.

Located on the foot, between the first and second toes (click here to see exact location), Liver 3 is the source point on the liver channel.

Source points behave sort of like central stations on subway lines. They are hubs where internal and external energies gather and transform. They are single, high-concentration points that grant access to the larger system.

Any time of year, Liver 3 is a go-to point for stagnation throughout the body. Because of the spring-liver connection, the point is doubly useful for addressing springtime stagnation-type symptoms.

Applying acupressure to Liver 3 will help get things moving like no other point. Poke around the point area until you discover a tender spot. Liver 3, if pressed firmly enough, is sensitive on most people.

Once you have the point, apply firm pressure. This should feel a little achy. The more the better on this point, so feel free to do this acupressure exercise anytime your bare feet are available. Liver 3 can be pressed on one or both sides.

Incidentally, an acupressure device we reviewed recently on AcuTake can be used for Liver 3. The device was designed for Large Intestine 4, a point on the hand, but it also fits nicely and works just as well on Liver 3 (click here to see picture).

If in the coming weeks you experience some telltale signs of a liver imbalance, don’t get down on yourself — they’re completely normal during the seasonal transition. A little acupuncture will help realign your system so that you can enjoy the wonders of spring.

This article originally appeared on huffingtonpost.com and was written by Sara Calabro

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