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Tennis Elbow

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities can also put you at risk. It typically effects people from ages 30-50 but can happen to anyone.

Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists, and, in some cases, surgeons work together to provide the most effective care.

Anatomy of the Elbow:

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle. Tendons, muscles and ligaments cross and support the elbow joint.
Tennis elbow or lateral epicondylitis, is an overuse injury of the extensor tendon of the forearm. The tendon attaches on the lateral epicondyle. The tendon that is usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).
tennis elbow photo ap

Tennis elbow symptoms typically develop over time. In most cases, the pain begins as mild and slowly worsens over weeks and months. Often a sudden change in activity to the forearm muscles can be a contributing factor to getting symptoms.

Common signs and symptoms of tennis elbow:

  • Pain or burning on the outer part of your elbow
  • Weakened grip
  • The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench or door handle, or shaking hands. The dominant arm is often the most affected; however both arms can be affected.

Initial Rehab Advice

1. Reduce Flare Ups:

Try avoiding any activity that aggravates your symptoms. You are able to continue training and work once your pain doesn’t flare above a 4 out of 10 during or after activity. If pain goes above this number that’s when you need to modify activity.

2. Be more body aware:

Often times when people are in pain they stiffen as a natural instinct to protect the area of pain. This constant activation of the forearm muscles leaves them sore and overworked. Having more relaxed arm movements regularly during the day can help reduce tension.

3. Self-Massage and Regular Movement:

Regular self massage to the muscles of the forearm can really help reduce excessive tension on the tendon.
There is no perfect technique, just knead into the forearm muscles with your fingertips and the heel of your hand.
Try 30seconds every 1hour or as often as you can fit time for it in your day.

Mid Stage Rehab Advice

1. When symptoms have calmed down then we can introduce more load into the tendon of the elbow.
2. Start with isometric ball squeezes:
– Hold the squeeze for 10-15second
– Try 2sets twice a day
– Start day on, day off
– The exercise doesn’t have to be pain free once the pain doesn’t go above a 4/10 in the elbow
– Observe the technique as shown in the video
– Monitor symptoms during and after activity
– Avoid flare ups
– The exercises should not make your pain worse

Mid to late stage rehab for tennis elbow ??

The following rehab can be used in the mid to late stages of rehab.

  • Elbow and wrist at 90degrees
  • Use a resistance band
  • Resistance should be applied in the opposite direction to where you are moving the wrist.
  •  Start off with 10-12 reps twice daily
  • Avoid flare ups
  • Gradually start to increase dosage (reps, sets, times per day)
  • Watch the technique as shown in the video
  • These exercises should not be making your symptoms worse
  • A slight ache during the exercises is ok, once pain doesn’t exceed 4/10 during or after


Do You Suffer From Knee Pain?

Do You Suffer From Knee Pain?

Are you really into exercise and wondering why you have achy knees. This blog may give you a better understanding as to what’s going on.
For people who are really into the gym, fitness and sport. How we move becomes more and more important.

When it comes to lower body movements it can mostly be categorised into three different groups, knee dominance, hip dominance and a combination of the two. Any of the movements are good, but when it comes to high load and frequency, technique becomes very important and can stop and prevent aches and pains.

Knee Dominance:

Knee Dominance is when the initial movement starts from the knees. Typically the movement has a lot of knee drive, meaning the knees go much further over the ankles. Typically it is when the hips go in a straight line downwards as opposed to bum back and down.

People that are knee dominant movers generally feel the exercise mostly working the quads, which overtime can put the knee and patella tendon under more pressure hence why it may be easier to pick up achy knees. Also it means that the quads are doing majority of the work instead of the glutes.

Hip Dominance:

Hip dominant movement is when the initial movement starts from the hips. During hip dominant movements the hips go back and down as if sitting into a chair. Knees stay in line with the ankles or slightly over (which is fine). Hip dominant movers typically feel the exercise work the glutes (posterior chain) which are much better at handling load and much more powerful when trained correctly.

Studies show that when the glutes are strong and firing efficiently that it not only optimises performance, but also can decrease your risk for injury in the lower back and any lower body injuries to the hip, knee and ankle.

Combination of Hip and Knee:

Combination of hip and knee movement is when both joints move at similar times. Or sometimes people initialise the movement from their knees the sit back into their hips and vice versa.
Sometimes we need to reduce certain exercises that may be aggravating our symptoms only to add them back in with time.

Exercises that are quiet knee dominant that you may avoid if your knee pain is flared up are:

  • Step ups
  • Lunges (depending on technique)
  • Jumping and landing (depending on technique)
  • Weighted squats (depending on technique)
  • Hip Dominant Exercises to focus on when knee pain has flared up but you still want to get a leg session done:
  • Squat (bum back and down)
  • Crab Walks
  • Hip Thrusts
  • Step back lunge
  • Step down (depending on technique)

A good tip to become more aware of how you move and perform exercises is to notice where you feel the exercise work e.g. if you mainly or only feel the quads working in a squat it may indicate more towards knee dominance and more focus should be addressed to your hips (glutes).

Hamstring Injury

Hamstring Injuries:

What Does The Evidence Say Now?

The old advice used to be that you should rest it for 3/4 days, where now really the evidence shows that isn’t the case. We want to get moving it as soon as we can.


Early Stage Hamstring Rehab

Exercise 1: Working with available range of motion. Do 15 reps of this, every hour. This will help get blood flow and oxygen around the nerves in the area.

Exercise 2: Here the muscles are working but not moving (Isometric). These are VERY effective in the early stage of Rehab. – Apply downward pressure. Don’t lift your hips off the ground and you can dictate the level of pressure/can cope with. This is a continuous hold from anywhere between 10-30 seconds.5 reps at a time, a few times a day. Keep pain levels under a 4/10.

Exercise 3: Raised bridge, using both legs you can decide how much pressure the injured leg is taking. It could be 50% or it could be 30%.. Keep the pain levels at an acceptable level as done previous. 10-15 reps a few times a day depending on how you’re feeling.


Mid Stage Hamstring Rehab

Exercise 1: Heel walkouts. Hold at end range for 10-20 seconds. This will help get blood flow and oxygen around the nerves in the area. 5 reps at a time a few times a day, keeping pain levels under a 4/10.

Exercise 2: Single leg raised bridge, advancing the previous videos raised bridge. Keep the pain levels at an acceptable level as done previous. 10-15 reps a few times a day depending on how you’re feeling.

Exercise 3: Extender. Keeping our back flat on the floor. With fluid movement and without holding a stretch find a comfortable range of motion.


Late Stage Hamstring Rehab

Exercise 1:Heel slides. Use a towel or a non grip surface. Begin in a bridge position and slide your heels out. Hold at end range for a few seconds. 8-10 reps at a time a few times a day, keeping pain levels under a 4/10.

Exercise 2: Diver/ single leg RDL, begin standing on a single leg. As you bend down the knee bend you start with should be maintained and not bent more. 10-15 reps a few times a day depending on how you’re feeling.

Exercise 3: Single leg- jump for distance. Starting in the single leg position, we load the posterior chain. With an explosive jump for distance you can land on either two legs or single leg. 5 reps at a time 2-3 times a day depending on how you’re feeling.


These are examples of exercises and If you have a Hamstring injury it would be better to seek advice from a healthcare professional.

Why does the ACL suddenly tear?



Why does the ACL suddenly tear?

A question often asked is why the ACL tears in manoeuvres that the sportsperson has completed successfully many times in the past. The sportsperson could be off balance, be pushed/nudged by an opponent, have adopted an unusually wide foot position. Inadequate muscle protection, poor neuromuscular control, fatigue and loss of concentration may also be relevant factors. 

That’s one of the reasons why general conditioning in prehab programmes and ACL rehab is important. Roughly 70% of all ACL injuries are as a result of a noncontact mechanism of injury and usually occur as an individual is cutting, jumping or planting. Lower extremity movement patterns during these activities play a critical role in injury mechanisms because they influence the load and forces on ligaments, meniscus/cartilage, and bone (DiStefano, L.J., 2009). 

ACL injuries occur most frequently in field sports involving landing from jumps, side-stepping, turning sharply and decelerating, e.g GAA, soccer, rugby, basketball.

ACL Anatomy:

The ACL is one of the two cruciate ligaments. It is named in relation to its attachment to the tibia.

The two cruciates – ACL and PCL are crucial in providing knee stability. It is essential in controlling

pivoting movements. If the ACL is not functional the tibia may rotate under the femur when a person attempts to land from a jump, pivot, or stop suddenly.

treatment for running injury

The ACL has two primary functions:

  • It prevents forward movement of the tibia under the femur
  • It controls rotational movement of the tibia under the femur

Intrinsic Risk Factors:

  • Gender
  • Female have a wider pelvis and slightly knocked knee
  • Biomechanics
  • Body mass index
  • Age
  • Anatomy of the bones
  • Dynamic risk factors
  • How we move/ jump/ land
  • Extrinsic Risk Factors:
  • Sport type
  • Basketball
  • Football
  • GAA

The level of exposure to risk factors:

  • Weather conditions
  • Surfaces
  • Hard/ Soft
  • Uneven / Even
  • Footwear

Point of no Return:

Non-contact ACL injuries often exhibit a common body posture that involves a valgus collapse of the knee joint (knee falls inwards/ medially), with the knee near full extension (between 0 and 30 degrees), external tibial rotation with the foot planted during a deceleration manoeuvre. Approximately 85% of the knee joint’s total restraint to anterior tibial translation is provided by the ACL and as studies have shown that sagittal plane knee angles near full extension and large quadriceps muscle forces increase ACL loading (Quatman, 2009).

Sign & Symptoms of ACL Tear:

  • A description of valgus knee position at time of injury, a landing, cutting manoeuvre.
  • Patient can hear a ‘pop’ or ‘click’ or something ‘going out of place and then going back’.
  • Tears are extremely painful.
  • Players are usually unable to continue playing.
  • There can be relatively immediate swelling (2hrs)
  • Patients experience a feeling of instability in the knee.
  • Sometimes we need to reduce certain exercises that may be aggravating our symptoms only to add them back in with time.

Grades of Ligament Tears:

A tear occurs when the force placed on the ligament is too much for the ligament to control.

Grade 1: Mildly Damaged

Grade 2: Partial Tear

Grade3: Complete Rupture

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