IPHREHAB : TENNIS ELBOW OR LATERAL EPICONDYLITIS

IPHREHAB

What is Tennis Elbow ?

Tennis elbow is an injury to the muscles and tendons on the outside (lateral aspect) of the elbow that results from overuse or repetitive stress. The narrowing of the muscle bellies of the forearm as they merge into the tendons create highly focused stress where they insert into the bone of the elbow. If one hyper extends an elbow in any sport, this may be classified as tennis elbow. Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to tennis elbow. The medical term is lateral epicondylitis. 

TENNIS ELBOW

LATERAL  EPICONDYLITIS (TENNIS ELBOW)

Lateral Epicondylitis is defined as a pathologic condition of the wrist extensor muscles at their origin on the lateral humeral epicondyle. The tendinous origin of the extensor carpi radialis brevis (ECRB) is the area of most pathologic change.

Changes can also be found in the musculotendinous structures of the extensor carpi radialis longus,extensor carpi ulnaris and extensor digitorum communis. Overuse or repetitive trauma in this area causes fibrosis and microtears in involved tissues.

Nirschl referred to the microtears and the vascular ingrowth of the involved tissues as angiofibroblastic hyperplasia. Degenerative process should be termed tendinosis.

Most patients with lateral epicondylitis are between the ages of 30 and 55 years and many have poorly conditioned muscles. 95% of tennis elbow occurs in non-tennis players. 10 to 15 % of regular tennis players experience tennis elbow symptoms of varying degree in their tennis lives.

 The most common cause in tennis players is a "late" mechanically poor backhand that places excess force across the extensor wad i.e. the elbow "leads" the arm.

Other contributing factors includes-

1. incorrect  grip size

2. string  tension

3. poor  racquet "dampening"

4. underlying  weak muscles of the shoulder,elbow,and arm

Tennis grips that are too small often exacerbate or cause tennis elbow.

History of repetitive flexion-extension or pronation-supination activity and overuse is obtained.

Causes of lateral epiconylitis:

#Tightly gripping a heavy briefcase is a very common cause.

#raking leaves

#baseball

#golfing

#gardening

#bowling 

IPHREHAB : Lateral Hip OR Thigh Pain , Gluteus Minimus

 
Lateral Hip / Thigh Pain 

Anterior Gluteus Minimus 

Gluteus Minimus causes lateral hip thigh and even lower limb pain. Regular snap diagnosis of sciatica is common, but because there is no pain in the posterior thigh, one should focus on the anterior portion of Gluteus Minimus (G Min.). Trigger points in this muscle will refer down the lat thigh and into the lower lateral leg to just above lateral malleolus. 

Diagnosis:Ask the patient if it reproduces or intensifies their pain when pressed forcefully into the G Min. If it does then most likely its a triggered G min. To palpate the anterior G Min, locate the ASIS, then the TFL just inferior and posterior to it. Then move about an inch posterior to the TFL. Now you are on the anterior portion of the Gluteus Minimus. 

PROFESSIONAL,PHYSIOTHERAPIST,CLINICAL TECHNIQUE.

Release:   Counter strain for the anterior Gluteus Minimus. With the patient supine, stand on the side of the triggered G Min, gently palpate the trigger point while you: 

• Flex the hip to approximately 40- 60 degrees. 
• Abduct the hip 45-60 degrees. 
• Rotate internally or sometimes externally to fine tune and soften the trigger point until it no longer is painful to poke. 
• Hold this position for approximately 90-120 seconds and then slowly and passively return the patient’s hip back to the table. 
• Poking again should no longer produce any discomfort or at least a 75% reduction in tenderness. 
• As with all counter strain positions, fine tuning to fully turn off the trigger requires a little experimentation with all planes of movement so try a variations within the parameters. 

But one have to see if the pain returns. Many times, cycling and running cause this muscle to increase tone. Also, prolonged sitting as well as pelvic asymmetry and leg length difference add to the dysfunction. 

Recommend strengthen the Gluteus Minimus with closed chain hip abduction on a phone book, lateral walking with cable resistance, etc. (See Closed Chain Hip Abduction exercise below). At end, check the feet to see if a rear foot and or forefoot varus deformity exist. Any or all of these situations may bring the trigger right back by the time the patient resumes normal activity. 

CLOSED CHAIN HIP ABDUCTION 

1. Stand on phone book with affected leg keeping that knee straight. 

2. Raise the opposite foot off the floor keeping the trunk still and knee straight.

3. Repeat 10-15 times or more as tolerated. 

4. Do these 4 times per day as tolerated. 

5. Note: the hip on the phone book side will start to burn, this is norma

IPHREHAB :LATERAL HIP / THIGH PAIN,TFL

IPHREHAB

Lateral Hip / Thigh Pain

TFL , Tensor Fascia latae

SYMPTOMS: Pain that begins in the lateral part of the hip OR  thigh and Pelvis,  just lateral and/or inferior to the Anterior Superior Iliac Crest (ASIS) may be one of the most stubborn and difficult pains to treat. At times the referral pattern goes down the lateral thigh and even down as far as the head of the fibula and lateral ankle.

Snap diagnosis might be made for Sciatica but since there is no pain in the post thigh, we should be focusing on two muscles in the hip and not the sciatic nerve or piriformis muscle. The two muscles in question are the Tensor Fascia Lata and (TFL) and the Gluteus Minimus (G Min.) Trigger points in these muscles will refer down the lat thigh and into the lower leg. 

Now if further to differentiate between which muscle is the culprit, instruct and ask the patient if the pain goes into the buttock and or in the lower lateral leg. If it does not cross distal to the knee or hurt in the buttocks it is TFL. To confirm, palpate the TFL just inferior and slightly lateral to the ASIS. While palpating, have the patient internally rotate the thigh which causes the TFL to tense up under your palpating fingers.

Once you have determined that you are right on the belly of TFL, poke sharply and deeply into the belly of the muscle. If the patient complains that this brings on their symptoms, then you have the reason for pain.

 

FOR PROFESSIONAL,PHYSIOTHERAPIST,CLINICAL TECHNIQUE.

RELEASE : now for the release, Chronic Pelvic Pain Syndrome (CPPS). 

It is Counterstrain for the TFL.

With the patient supine stand on the side of the triggered TFL and gently palpate the trigger point while you:

1. Flex the hip to approximately 90 degrees.

2. Abduct the hip by resting the pt’s knee on your abdomen and sliding it down to the floor until you have 45-60 degrees of hip horizontal abduction.

3. Holding those previous positions, internally rotate the hip slightly by drawing the patient’s foot /ankle to you. You are looking to palpate the belly of the muscle get very soft and relaxed, and when you poke, there is no pain at all. (Patients may even say, you are not on the right spot or
you move your finger because what was a very painful spot just seconds ago is pain free.)

4. Hold this position for approximately 90-120 seconds and then slowly and passively return the patient’s hip back to the table.

5. Poking again should no longer produce any discomfort or at least a 75% reduction in tenderness.

But one have to see if the pain returns. Many times, cycling and running cause this muscle to increase tone. Also, prolonged sitting as well as pelvic asymmetry and leg length difference add to the dysfunction. Lastly, one should check the feet to see if a rear foot and or forefoot varus deformity exist. Any or all of these situations may bring the trigger right back by the time the patient resumes normal activity.