Healthy Everytime

Tennis elbow is an inflammation of the outside of the elbow, technically named lateral epicondylitis.

The pain of tennis elbow is caused by inflammation of the tendon and periosteum (the outer layer of the bone) where the tendon from the back of the forearm joins the humerus (upper arm bone). The tendon connects the bone to the muscles that straighten the wrist. Any tension on that muscle - for example from a tennis backhand - will cause pain.

It is not just tennis backhands that put a stress on the muscles of the forearm and their attached tendon. Activities such as using a screwdriver, typing, or writing can all cause the typical tennis elbow pain.

Since tennis elbow affects the straightening of the wrist, you can test for it by lifting a weight, such as a book, with your palm facing down. Any pain in the outside of the elbow suggests you have tennis elbow.

As you can see, tennis elbow is ultimately caused by overuse of the wrist extensor (straightening) muscles which, by means of the tendons, connect to the elbow. Classically this is caused by the tennis backhand but, as we have seen, can also be caused by other types of repetitive activity.

Too much tension in the muscle group can also cause a decrease in the joint space in the elbow and actual inflammation of the joint. In time this can cause not just the typical pain from the epicondylitis, but also from the elbow joint itself.

Treatment usually involves taking anti-inflammatory and muscle relaxant medication, along with some lifestyle modification. Also used are physiotherapy treatments such as TENS, laser therapy, ultrasound, and interferential current.

Chiropractic treatments are also helpful. These include soft-tissue techniques such as Graston, active release, or cross-fiber friction massage. Chiropractic adjustment of the elbow joint, can also bring relief.

The aim of the chiropractic adjustment is to momentarily separate the joint surfaces in the elbow by just one to three millimeters. This takes the pressure off the joint, and eases the pain. It may be that some manipulation of the wrist can also help.

As we have seen, it is tight muscles that cause the elbow pain. But if the wrist tightens up, the muscles have to work harder, thus putting more tension on that lateral epicondyle. So keeping the wrist supple and flexible should help to ease the condition.

The use of a tennis elbow band may also prove effective in decreasing symptoms. This works by forming an artificial origin for the muscle before it crosses the elbow. This allows a decrease in tension of the wrist extensor muscles as they cross the elbow which eases tension on the lateral epicondyle and decreases pressure on the elbow.

Rest would, of course, be ideal. But sometimes some lifting has to be done. In that case , be careful to make sure that you only lift with the palm of the hand turned upward. This causes the wrist flexors to be used more than the wrist extensors.

Two things that have been found to help is to limit salt intake to help reduce water resorption in the body and to supplement with Vitamin B6.

It is best to check with your medical doctor or chiropractic professional if you feel that you have this condition for with proper assessment, a treatment plan can be initiated will help with accelerated recovery.

Carpal tunnel syndrome is defined as a condition involving numbness, tingling, weakness, pain and/or muscle wasting of the hand along the distribution of the median nerve. This relates to the thenar or thumb-side of the hand.

Surgery is often recommended as the best treatment. However, it is a serious undertaking, and sometimes a more conservative approach might be better. To know what route to take, we first need to have a good understanding of the different causes of Carpal Tunnel Syndrome.

The wrist is formed by four bones, the carpal bones, which make an arch across the back of the wrist. This arch is spanned by a strong ligament, the flexor retinaculum, which forms the front of the wrist. The space between the bones and the ligament is the carpal tunnel.

Through this tunnel pass a number of crucial structures, including the tendons that bend the fingers, and the median nerve. With Carpal Tunnel Syndrome, this nerve gets squeezed and compressed. The result is a decrease in its conductivity, meaning the nerve does not function as it should.

The median nerve supplies the palm side of the hand including the thumb and the first three and a half fingers. It also supplies the tips and the backs of the same fingers. When the nerve gets compressed, it is only in this area that symptoms are felt. So, if you are getting symptoms in your little finger, for example, then that is NOT caused by Carpal Tunnel Syndrome.
Diagnosis of Carpal Tunnel Syndrome is usually done by EMG (electromyelogram) which measures the conductivity of nerves. If the median nerve is compressed (as in Carpal Tunnel Syndrome) then this will show up on the EMG test.

This entails putting one electrical probe into the median nerve on either side of the carpal tunnel. An electrical current is then put into the nerve on one side and checked to see if it is picked up by the probe on the other side. If the current is diminished to a great degree, it is deemed that carpal tunnel syndrome is present.

The surgery for this condition would then include cutting some of the flexor retinaculum to allow less pressure on the median nerve by essentially expanding the carpal tunnel. This procedure may often help to decrease the symptoms of carpal tunnel syndrome, but is it the only option? Absolutely not.

There are two main reasons for carpal tunnel syndrome to present itself. The first is a deterioration of the joints between the carpal bones leading to a collapse of the carpal tunnel. The second reason is a swelling of the tendons which pass through the carpal tunnel taking up too much space resulting in compression of the median nerve.

The problem with using solely EMG to determine the presence of carpal tunnel syndrome is that it doesn’t differentiate between the two causes. This leads to a lack of differentiation of treatment which may, in turn, result in unnecessary surgery.

If the problem is arising from tendonitis, I believe it is much better to treat the tendonitis. The way tendonitis occurs is from having too much strain or tension placed on the tendon for too long of a time.

Repetitive use of a muscle often results in the muscle getting too tight. Since muscles are attached to tendons, this results on the tendon being too tight and that, in turn, can lead to tendonitis and Carpal Tunnel Syndrome.

Treatment for tendonitis can include stretching, pysiotherapy, ergonomics (eg typing posture), chiropractic manipulation, nutritional support etc. These are all a lot less invasive and have fewer side effects than surgery.

Surgery can certainly work. But my preference is to start with the simpler, less risky alternatives. If having tried those, things are no better, then by all means consider surgery.

Soft tissues around the spine play a key role in low back pain. There is a large and complex group of muscles that work together to support the spine, help hold the body upright and allow the trunk of the body to move, twist and bend in many directions.
Types of muscles that affect low back pain

Three types of back muscles that help the spine function are extensors, flexors and obliques.
— The extensor muscles are attached to the posterior (back) of the spine enable standing and lifting objects. These muscles include the large paired muscles in the lower back (erector spinae), which help hold up the spine, and gluteal muscles.
— The flexor muscles are attached to the anterior (front) of the spine (which includes the abdominal muscles) enable flexing, bending forward, lifting and arching the lower back.
— The oblique muscles are attached to the sides of the spine and help rotate the spine and maintain proper posture.

Exercise to help low back pain

Back muscles—like any other muscle in the body—require adequate exercise to maintain strength and tone. While muscles like the gluteals (in the thighs) are used any time we walk or climb a step, deep back muscles and abdominal muscles are usually left inactive and unconditioned. Unless muscles are specifically exercised, back muscles and abdominal muscles tend to weaken with age. Physical therapy and exercise regimens to treat low back pain usually focus on strengthening the flexor, extensor and oblique muscles to help reinforce support of the spine and in turn, reducing low back pain and sometimes eliminating the need for surgery.

The role back muscles play in low back pain

When the facet joints or certain other structures in the spine become injured or inflamed, the large back muscles can spasm and cause low back pain and marked limitation in motion.
An episode of low back pain that lasts for more than two weeks can lead to muscle weakness (since using the muscles hurts, the tendency is to avoid using them). This process leads to disuse atrophy (muscle wasting), and subsequent weakening, which in turn causes more pain because the muscles are less able to help hold up the spine.

Chronic stress can also lead to muscle weakness and back pain. Stress causes back muscles to tighten in a fight or flight response, depriving muscles of energy needed to support the spine.
Muscles and proper posture contribute to low back pain.

Muscle strength and flexibility are essential to maintaining the neutral spine position. Weak abdominal muscles cause hip flexor muscles to tighten causing an increase in the curve of the low back. An unhealthy posture results when the curve is overextended called lordosis or swayback. Proper posture corrects muscle imbalances that can lead to low back pain by evenly distributing weight throughout the spine.