Osteoarthritis: What It Is, Symptoms, Prevention

Osteoarthritis is a set of mechanical abnormalities that lead to joint degeneration, mainly affecting the articular cartilage and subchondral bone. Symptoms include joint pain, tenderness, stiffness, blockage, and swelling of the joint. The causes can be various, including hereditary, developmental, metabolic, mechanical reasons that lead to the destruction of cartilage. The loss of cartilage leaves the bone exposed, thus making the joint unable to cope with the loads it can receive in everyday life. The joints most affected are those that receive the most loads such as the spine, hip and knee, but this does not mean that it can not occur in other joints.

Osteoarthritis is categorized into:
Primary osteoarthritis: It is a chronic degenerative process associated with aging, but it is not necessarily caused by it, as it is observed in older people without signs of degeneration.

Secondary osteoarthritis: Caused by other factors which include: Injuries to the joints (such as the anterior cruciate ligament), surgery, joint instability, obesity, various inflammatory diseases, etc. These factors affect the function of the cartilage and the way it receives loads, gradually leading to its degeneration. Secondary osteoarthritis occurs at a much younger age than primary osteoarthritis.

Symptoms

Cases of osteoarthritis are mostly over 50 years old, often people are obese and are mostly women. Younger people diagnosed with osteoarthritis may have a history of strain on the knee joint, such as a fracture, an older injury, or a specific anatomical morphology.

Symptoms begin mildly and increase steadily, with periods of remission often lasting months. Changes in muscle synergies occur and trigger points of pain in periarticular muscles. In the case of unilateral arthritis, atrophy of the quadriceps muscle is characteristic. The joint is often swollen due to swelling and increased amount of synovial fluid and thickening of the synovial membrane.

The clinical picture includes pain in the knee joint. The pain is usually located in front of the patella, in the intervertebral space, behind the iliac cavity and often in the calves. In the early stages of the disease, the pain appears during exercise and goes away with rest. As the disease progresses eventually, the pain settles and increases. The person now complains even after the end of the exercise. Advanced pain can be reported even during sleep. At the end of the exercise, the wear pieces mentioned cause hymenitis. The pain is not due to the degeneration of the cartilage as they are not ribbed. The pain seems to be mainly due to follicular fibrosis and vascular congestion. The pain does not allow the person to act normally and makes the movements difficult, thus reducing the functionality of the joint.

Osteoarthritis is characterized by stiffness in the joint. The person has the feeling that the knee “stuck” during movement. Stiffness occurs after periods of joint immobility. In the early stages of the disease the stiffness lasts only a few minutes. As the disease progresses, the stiffness becomes more intense and they settle, reducing the normal trajectory ranges and causing the joint to lose its normal movement.

Over time, the person eventually obeys the needs of the joint and finds it difficult to sit deep, climb stairs and even walk. The functionality of the individual as a whole without realizing it, decreases. He no longer walks often, abstains from activities that pleased him and changes his quality of life.

By palpating the area, in addition to swelling and thickening, one can understand the osteophytes around the bones of the joint, especially in the femur. When moving on your knees with osteoarthritis, you notice the characteristic sound of a patella. This is because the articular cartilage that lubricates the joint has degenerated and the bones are rubbing against each other.

Diagnostic Approach

At the beginning of the disease the X-ray does not show significant diagnostic evidence. Radiographic findings are typical of degenerative joint diseases (stenosis of the joint, thickening of articular surfaces, hypochondriac cysts, osteophytes). At the beginning, small osteophytic treatments are presented in the middle part of the tibial joint, in the upper and lower pole of the patella and in the tops of the medial spines, which thus become more acidic. On x-rays with the patient standing up in the upright position, the narrowing of the inner intervertebral space and the degree of deformity are better seen.

Prevention

Active people with frequent moderate-intensity exercise, create a good musculoskeletal system that can properly absorb the loads of everyday life seems to play an important role, also moderate activity helps move the synovial fluid and provide nutrients to the cartilage. In addition, the reduction of body weight (in cases of extra pounds), the correct recovery of possible injuries, are important elements that help prevent the disease.

Physiotherapy Treatment

The goals of the physical therapy program are as follows:

Pain reduction. Various natural means (electrotherapy, iontophoresis, ultrasound, etc.), but also special mobilization techniques available to the physiotherapist can help reduce pain and reduce the inflammatory response.

Fight stiffness and regain elasticity. Specialized exercise is also the answer to this symptom as prolonged immobilization exacerbates stiffness.

Muscle strengthening – improving coordination – balance. Exercises to improve the strength but also the balance and coordination of the affected limb are important to implement so that the limb can cope as best as possible with daily challenges.

Increase functionality. The ultimate and basic goal is to reach the individual at the highest possible functional level in order to carry out his daily activities with the least possible restriction. Thus, in the restoration, everyday activities are simulated, such as walking, climbing, descending stairs, etc. depending on the patient’s habits. This process starts early and depending on the margins that the disease gives us. It is a learning process, including ergonomic interventions.

Sources
Dandy D., & Edwards D., (2010). Essential Orthopedics and Trauma, 5th edition, (translation – editing from English by: Korres D., Xenaki Th.,) Parisianou Scientific Publications, Athens: Chapter 1 pages 7-11, 24-27, chapter 16 pages. 273 – 279.
Kisner C., & Colby L.A., (2003). Therapeutic exercises: Basic principles and techniques, (Greek curation: Spyridopoulos, K,

Backache – Sciatica: Ways to treat it

Back pain or lower back pain can manifest in two ways: as chronic back pain and can last for months or years and as acute back pain or lumbago.

The worst development of back pain is sciatica. Sciatica is pain that starts in the waist and ends in the foot at a different height each time and can reach the toes and the sole of the foot.

Sciatica is an urgent condition and should always be examined by a doctor. The risk in these cases is chronicity. If the condition remains untreated then the pain will become permanent, the loss of sensation will become complete anesthesia and the simple muscle dysfunction will develop into complete paralysis of the lower limb.

Symptoms

In terms of symptoms, acute back pain is manifested by an acute, usually sudden pain in the lower back, which reflects up to the buttocks while at the same time a reflex contraction of the lumbar muscles occurs and the patient unconsciously assumes a scoliotic (oblique) posture every time he stands up.

The pain is so strong in the beginning that it can immobilize the person for many hours in the place where it first appeared.

The cause most of the time is the lifting (lifting) of a weight in the wrong way. The person has the feeling that something has broken in his waist, he feels intense pain and gives up the weight he is holding by screaming from the pain.

Other times the seizure occurs 1 to 2 days after lifting the weight or after opening a drawer or after a long time of crouching and working at a low table or after turning the waist, etc. Usually, each patient has his own way of starting the seizure.

The crisis usually lasts for 4 to 5 days and gradually disappears.

Diagnosis

A non-urgent evaluation to control sciatica involves a physical examination and testing of the strength of the muscles, their reflexes and their senses to determine if the problem is caused by a compressed nerve. An X-ray, MRI or CT scan or electromyography (nerve conduction study) may also be needed.

Radiological examination is also necessary in cases where the symptoms persist. Because then it may not be the same known and old disease but something new such as for example a small vertebral fracture from osteoporosis that the patient has acquired but does not know. If the patient also has a fever or other general symptoms, then a hematological laboratory test will be helpful. Of course, all these examinations will be done naturally, since the patient feels a little better and can move without much pain.

Prevention

Prevention is achieved through:

• Use a hard mattress for sleep and during sleep the posture should be on the back or side.
• Proper postures and proper use of the body in daily activities. Those involved in sports to improve their technique.
• Encouraging activities such as swimming, walking, cycling, etc.
• If it is considered necessary to use special zones for intense activities, not for a long time.
• Daily exercise with special exercises, designed by the therapist and tailored individually to each patient.
• In case of persistent pain, consult a specialist who can identify the cause.

Treatment

From the beginning of the crisis until 15 to 20 days when he is standing, the patient should wear a belt with straps, which he can then use only when he is going to tire his waist, such as in long hours of standing or in a large travel by car.

In addition to the medications that will be used in the initial acute phase, from time to time the patient may often use an anti-inflammatory ointment which he will apply with a light massage to relax the back muscles.
Losing a few pounds, if any, helps in recovery. Kinesiotherapy and physiotherapy should be done by specialists. The best physical therapy for the spine is swimming. The more you swim in the pool or the sea, the stronger your waist and the better you feel.

Swimming will begin after the crisis is complete, in as warm a sea or pool as possible and at the beginning the patient uses a life-saving device (lifebuoy) for safety. Theoretically, if the person manages to protect his waist and does not have another crisis in the next two or three years, then he can be considered cured.

Chronic back pain usually does not end in surgery. In rare cases when it causes severe pain and is extremely persistent or when the patient has a profession in which the perfect function of his waist is necessary (such as an athlete), then he is referred to the Orthopedist for surgery.

Therapy

The therapy will depend on the final diagnosis and should be individualized to the needs of the individual.

The conservative method includes:

• Anti-inflammatory drugs such as aspirin or ibuprofen to reduce swelling.
• Physiotherapy, which includes exercises aimed at strengthening the muscles and restoring range of motion.
• Physiotherapy with natural means
• Acupuncture

Sources

Kontzaelias DA, (2011). Physiotherapy in diseases of the musculoskeletal system, Publications: University Studio Press, Thessaloniki.

What Is The Right Position In The Office When I Work?

What Is The Right Position In The Office When I Work?

Daily questions I receive from my patients with chronic neck and waist problems are:

1. What is the right position for me in the office when I work?
2. Why is it important to have the right position when sitting in front of the computer?

In a developed society in which on a daily basis and for many consecutive hours we use the computer, tablets and smartphones, without the minimum training for the correct posture and ergonomics, we are called to deal with many incidents that we could have helped preventively. It is very important to know some basic things, such as what is the correct sitting position, how much you have to sit constantly and what ergonomics the space around you should have, in order to help you and not to burden your posture. Poor posture is responsible for lower back pain, neck pain, dizziness, etc.

So what you need to know when sitting in front of a computer:

• A proper ergonomic chair can provide the right posture and support for the spine.
• The head should be in a position where the chin is bent backwards and does not bend forward! Do not forget that the head is one of the heaviest parts of the body !!!
• My shoulders should be pulled back and straight at the waist.
• It is good for the elbows to be in contact with the desk and to rest on it.
• The knees should form an angle of 90 degrees, the soles should be in full contact with the floor and should not exceed the height of the pelvis.
• The waist, and more specifically the pelvis, should rest on the chair in such a way that there is a complete support in the lumbar spine. In case the chair does not have a support mechanism to help our waist, anatomical waist pillows with special foam material and excellent support are commercially available, with quick relief and reduction of pain from the strain on the lower back.

However, in addition to the right position that we must have when we sit in a chair, we must also take into account basic elements of proper ergonomics of the space.

• The height of the desk should be such that the elbows form close to 90 degrees.
• The chair should be as close as possible to the desk. This way we can easily reach all the objects on it And thus avoid minor injuries from wrong postures and strange angles that we form with our body.
• The keyboard, mouse and anything else we use should be close to us without having to bend over to reach it again to avoid any injury.
• The computer screen should be at the same level and slightly lower than right in front of our eyes.

If we take frequent breaks, get up and walk, we should not worry about anything. There are also specific exercises with light stretching that help during breaks. Usually every hour of office work we have to get up for at least 10 minutes to walk and do exercises. Consult your Physiotherapist, who can help you have a much more comfortable & quality life. And do not forget that “prevention is much more important than recovery”.

Work and musculoskeletal disorders. How can we deal with them?

The term musculoskeletal disorders includes health problems of the elements that contribute to movement, such as muscles, tendons, bones, cartilage, vascular system, ligaments and nerves.

Work-related musculoskeletal disorders are injuries to parts of the body such as muscles, ligaments, tendons, joints, nerves, bones and blood vessels, which are caused or exacerbated mainly by work and its effects. of the immediate work environment. Most work-related musculoskeletal disorders are cumulative diseases, due to repeated exposure to high or low-intensity stress over a long period of time. However, musculoskeletal disorders can also be acute injuries, such as fractures, that occur during an accident.

These diseases mainly affect the back, neck, shoulders and upper extremities, but can also occur in the lower extremities. Some musculoskeletal disorders, such as carpal tunnel syndrome, have clear signs and symptoms. Others present only with pain or discomfort without a clear indication of a specific condition.

Musculoskeletal disorders are the most common work-related problem in Europe. Almost 24% of workers in Europe report suffering from back and lumbar pain and 22% complain of myalgias. Both diseases are more prevalent in the new Member States, at 39% and 36% respectively.

Depending on the type of work, there are different risk factors for the body, increasing the risk of developing some musculoskeletal disorders.

RISK FACTORS

Indicative risk factors that may be responsible for the occurrence of musculoskeletal disorders are:

• Prolonged standing
• Prolonged sedentary work
• Large power applications
• Repeated movements
• Weight lifting mistakes
• Poor body alignment when performing the task
• Work tool weight and tool handle
• Work rate
• Habits of the person (smoking, lack of exercise, etc.)
• Somatometric characteristics of the individual (age, height, weight, etc.)
• Psychological stress at work etc.

PREVENTION

In order to reduce the risk of disorders, first of all, on the one hand, the factors related to the employee must be improved and on the other hand, the work must be ergonomically correct and psychosocially tolerated.

Regular exercise for strengthening and flexibility of the body, adopting a healthy lifestyle, maintaining the desired body weight, creates a strong body so that it can cope with stress. On the other hand, the implementation of correct ergonomic tactics play an important role. Maintaining a generally upright posture at work, frequent breaks especially if the work is monotonous, has many repetitions, or prolonged static position, as well as the correct lifting of loads are some of the basic things that need to be taken care of. Also, the lack of pressure in the workplace and good cooperation with colleagues is essential.

Unfortunately, despite the advancement of science and the possibilities for safe and productive work at work, work-related musculoskeletal disorders are a major problem worldwide, constantly worsening even in the most economically developed countries. The modern way of life, smoking, poor diet, stress and lack of exercise as well as working conditions that are mostly characterized by intensification, flexible hours, overtime and measures such as the abolition of the Sunday holiday and raising age limits retirement contributes to the exacerbation and perpetuation of the phenomenon if we do not take action.

The solution to deal with this phenomenon is in the hands of every human being. In order to achieve prevention and to have a drastic reduction of work-related musculoskeletal diseases, it is crucial that workers collectively work with health professionals to improve their working conditions and to create free public sports and leisure facilities. contribute to improving health and quality of life.

REHABILITATION

The rehabilitation of such diseases includes the treatment of the symptoms and the restoration of strength and neuromuscular coordination with exercises and natural means in order to restore the functionality of the affected area. In addition, proper ergonomics and body function are learned for daily life activities to reduce the risk of re-injury.

Essentially, the treatment of musculoskeletal disorders requires an integrated management approach. This approach should include not only the prevention of new cases, but also the stay at work, the rehabilitation and reintegration of workers already suffering from musculoskeletal disorders.

Sources

Kontzaelias DA, (2011). Physiotherapy in diseases of the musculoskeletal system, Publications: UniversityStudioPress, Thessaloniki.

Respiratory Physiotherapy: Benefits – Programs

Respiratory physiotherapy is a special branch and is performed by specially trained physiotherapists for the purpose of harmonious cooperation of the respiratory muscles, good ventilation of the lungs and good drainage of bronchial secretions.

Respiratory physiotherapy refers to the exercises and techniques used to relieve patients with chronic respiratory problems.

Patients with chronic respiratory diseases, face major breathing problems, even for performing small and easy movements, as well as intense stress.

The goals of respiratory physiotherapy are to improve pulmonary ventilation, increase endurance in patients with reduced respiratory capacity, and bronchial cleansing.

Specifically, respiratory physiotherapy is indicated in acute and chronic diseases of the respiratory system, in operated patients, in disorders of nervous respiratory control, in deformities of the chest and in disorders of respiratory function due to poor posture.

TECHNIQUES

The physiotherapist is called upon to apply the techniques of respiratory physiotherapy in daily clinical practice, knowing that:

A) For the techniques of improving pulmonary ventilation and reducing respiratory work there is clear research evidence of their effectiveness.

B) For bronchial cleansing techniques, because not all bronchial clearance measuring instruments are valid, the evaluation of the effectiveness of the applied techniques is scientifically questionable.

The decision to choose the technique that the physiotherapist will choose, depends on many factors such as the patient’s history, clinical picture, laboratory test, time available and the patient’s ability but mainly on the goal we want to achieve. specific time for that particular patient.

For the physiotherapist it is important to know if the technique he decides to apply is more effective, with less cost of time and money, more understandable and in the long run more easily applicable by the patient himself.

These techniques are:

• Proper Positioning: With proper positioning of the patient from supine to sitting position and gradually to the upright position, all lung tumors, capacities, and oxygen flow in the body’s airways increase.
• Exercises for controlled breathing: Chest breathing, abdominal breathing and their combination are taught. In this way the synchronization of the movements of the chest and abdomen is achieved, increasing the pulmonary capacity and reducing the dead space.
• Applying positive pressure to the body’s airways: This application is done with the use of various oxygen devices and achieves the temporary increase of lung tumors and the improvement of gas exchange.
• Strengthening of the respiratory muscles: To strengthen the respiratory muscles, the intensity of the exercise should be high enough to achieve a result, its duration reaches 30 minutes and the frequency is up to three times a week.
• Bronchial drainage with gravity and manipulations: Using gravity provides small results in bronchial cleansing, while clearly better results exist when bruises and vibrations are applied to the patient’s back and chest which is placed in different positions.
• Technique of rapid exhalation: Cough removes foreign bodies or mucus from the upper respiratory tract. Thus, in cases where the patient can not cough, special tricks are adopted such as panting and flossing, which in combination with boredom and vibration help in bronchial cleansing.
• Autogenous drainage: It is the combination of abdominal breathing together with chest expansion exercises that improves bronchial clearance and pulmonary ventilation.

BENEFITS

The physiotherapist involved in respiratory physiotherapy should be informed in detail by the treating physician about the condition and precautions related to the patient’s problem. Then seeing the patient makes his own assessment, about his posture, chest shape, way of breathing, shortness of breath, cough, secretions and his general condition (color of face, lips, mental mood etc). So he implements a respiratory physiotherapy program suitable for the specific patient. In acute lung diseases in combination with drugs, it facilitates and accelerates the recovery of the patient while in chronic diseases it slows down the progression of the disease.

Serious daily problems of the respiratory system are COPD, asthma, chronic bronchial asthma, allergic asthma, pulmonary emphysema, pulmonary abscess, chronic obstructive pulmonary disease.

gonorrhea, atelectasis, pulmonary embolism and pneumonia. So with respiratory physiotherapy we can significantly improve many of the problems of the respiratory system whether it is the result of an illness or condition or due to anatomical changes, injuries, through the techniques of the physiotherapist and the aids to improve the respiratory capacity.

PhysioGalinos Rehabilitation Clinics have specialized physiotherapists on chronic respiratory problems as well as state-of-the-art equipment for immediate results. We also provide home support where necessary with portable special equipment.

Photo source: physioathens.gr

Neck Pain: What Causes Neck Pain And How Is It Treated?

Neck pain is an extremely common problem, as neck pain is reported in about 60% of the adult population with concomitant functional disorders.

The neck is probably the only area of ​​the body that is affected by so many factors and so many other systems for the appearance of a semiology. It supports the head and rests on the chest. It is a sensitive area in which a simple touch of the hand can convey feelings of friendship, love and offer.

Cervical pain is a very common ailment of various origins, which can occur in the form of an acute crisis or even have a chronic course. It can take many forms, be it unilateral or bilateral, cause headaches and restrict cervical movements. The complex anatomy of the cervix makes it difficult to identify the structure responsible for pain. Many times the cause is multifactorial.

Diagnostic Approach

In patients with neck pain the clinical approach aims to determine the origin of the symptoms, the extent of the lesion and the need for conservative treatment or surgery. Paraclinical tests and in particular neurophysiological and neuroimaging methods are necessary if the history and rheumatological-neurological assessment indicate the presence of damage, in order to accurately diagnose the problem.

Treatment

Medication for neck pain involves non-steroidal anti-inflammatory drugs, steroids, muscle relaxants, tricyclic antidepressants, vitamins, as well as vasodilators and circulatory enhancers.

In patients diagnosed with neck pain, only a small percentage need surgery and this percentage includes patients where the causes of dysfunction are related to the spinal cord, resulting in weakness of the upper limb or prolonged shoulder pain, provided that it has failed. the conservative approach. Conservative treatment should be maintained and last as long as possible. Conservative treatment should be given for at least 6 to 12 weeks before deciding on surgery. Of course there are exceptions, such as in marked motor impairment with worsening symptoms where it is best not to expect more than three weeks.

Physiotherapy Treatment

Organized physiotherapy is the best therapeutic intervention in the treatment of neck pain and the only one that has no side effects. Offers:

• Reduction of pain
• Relaxation of the muscles of the area
• Improving the mobility of the cervical spine, the head of the shoulders, the rest of the spine and possibly other disorders in the other joints
• Increasing the strength of the neck muscles, back muscles, shoulder girdle muscles, abdominal muscles, etc.
• Relapse prevention

Physiotherapy for neck pain is performed with the following techniques:

• High Power Antistatic & Capacitive Radiofrequency Therapy – TECAR therapy
• Thermotherapy – Cryotherapy
• Cryotherapy
• Electrotherapy
• Classic form of TENS
• Form of electroacupuncture
• Massage
• Kinesiotherapy

Plantar Fasciitis

What is plantar fasciitis?

Plantar fasciitis is a condition in which there is injury and inflammation in the plantar fascia, i.e. the part of the connective tissue that forms the arch of the sole.

This usually happens at the point where the plantar fascia joins the heel bone. Plantar fasciitis is the most common cause of pain in the heel area.

During walking or running tension is created in the plantar fascia. When this tendency is excessive or repetitive, the plantar fascia is injured. This condition is also characterized by inflammation and degeneration of the area.

This can be exerted by a very large load along the plantar fascia (greater than its strength) or by its gradual injury due to overuse.

Sometimes the so-called “heel spur” develops due to plantar fasciitis.

Cause of plantar fasciitis

It usually occurs in runners, dancers and instrumental athletes. Also in people who walk too much especially on uphill ground or uneven surfaces. It also occurs in older patients who stand for long periods of time.

Plantar fasciitis is often associated with stiffness of the gastrocnemius muscles or with incorrect biomechanical limb flexion such as flatfoot or clubfoot.

Symptoms

Patients with plantar fasciitis experience pain below the heel and along the sole. There is a hypersensitive spot when touching the lower surface of the heel. The pain is increasing in the first steps of the day and subsides as the area warms up.

In mild cases patients ache after walking, running, jumping, etc. As the disease progresses, pain also exists during the above activities.

In very severe cases the patient is unable to charge his leg.

Diagnosis

A history and clinical examination are sufficient to lead the physiotherapist to diagnose plantar fasciitis. Additional tests (x-rays, diagnostic ultrasound, magnetic topography) confirm the injury and determine the exact degree of fracture.

Treatment

The treatment of plantar fasciitis requires a detailed evaluation of all the factors that cause it, as well as their effective treatment. Most patients recover completely with appropriate physiotherapy. The degree of success of the treatment depends to a large extent on the cooperation of the patient with the physiotherapist. It is very important to avoid activities that increase the symptoms. This helps the body heal its damaged tissues.

Avoid activities such as running, standing and jumping. Ignoring the pain and symptoms and continuing the full activity the condition passes into the chronic stage. Immediate and appropriate treatment is valuable for the rapid recovery and healing of the injury. The treatment for the first 72 hours aims to reduce pain and swelling, so the patient rests the leg and applies ice therapy (3 to 4 times a day).

Causes of plantar fasciitis

There are many factors that cause plantar fasciitis. All should be evaluated by a physiotherapist and treated appropriately. Some of them are:

• Biomechanical imbalance (especially flatfoot)
• Ankle joint stiffness
• Calf muscle stiffness (gastrocnemius, tibia)
• Excessive training is inappropriate
• Overweight patients
• Unsuitable shoes
• Insufficient warm-up
• Imbalance

Physiotherapy for plantar fasciitis

Physiotherapy in patients with plantar fasciitis is necessary for the rapid and complete recovery of the disease.

Physiotherapy includes:

• TECAR
• Massage
• Manual therapy
• Electrotherapy
• Taping
• Exercises to improve elasticity, strength and balance
• Dry needle technique
• Education
• Ergonomics tips
• Program for gradual return to daily activities

Lateral Epicondylitis – Tennis Elbow

What is Lateral epicondylitis?

Lateral epicondylitis is an overuse syndrome that causes pain on the outside of the elbow. Although it can occur at any age, it is most common between the ages of 40 and 50.The muscles on the outside of the elbow are called the extensor muscles of the wrist and fingers. These muscles move the wrist and fingers (stretching movements, opposite movement to what we do when we clench a fist). The extensor muscles of the fingers and wrist begin (adhere) to the outer epicondyle, a bony protrusion on the inner surface of the elbow with a common tendon.

During the contraction of the extensor muscles, their joint tendon and the lateral epicondyle are burdened. When this load exceeds the strength of the tendon then the tendon is injured. This is usually due to a gradual tendon injury (overuse syndrome) or a direct injury ratio (eg a fall).

Causes of lateral epicondylitis

Although the name “Tennis Elbow” implies that the incidence of injury is high in tennis athletes, one does not need to play tennis to develop lateral epicondylitis. It is a fact that we find it more often in “non-tennis players” than in tennis players. It is directly related to the repetitive contractions of the extensor muscles of the wrist and fingers.

We observe this in athletes of tennis, babington and generally in racket sports.

Also in professions such as carpenter, oil painter, woodcutter, builder, electricians (repeated use of screwdrivers), sewing, knitting and typing.

It is common for the onset of the condition to be associated with the patient’s involvement in an activity for which he was not properly prepared (eg a tennis match after a long absence from the sport). More rarely it appears suddenly. This happens when the extensor muscles are called upon to cope with a load far greater than their strength.

Finally, a serious cause is the wrong technique in tennis.

Symptoms of lateral epicondylitis

The symptoms of lateral epicondylitis usually develop gradually over time. Initially there is discomfort on the outside surface of the elbow which increases with activity. The pain is 1 to 2 cm below the lateral epicondyle, a point which is also sensitive to touch. The pain often reflects up to the wrist. In more severe cases there is pain at night and acute pain with activity.

There is also muscle weakness resulting in a weak grip. Patients with lateral epicondylitis of the elbow experience pain with daily movement such as lifting the glass, turning the door knob, opening a jar or turning the steering wheel while driving.

Stiffness in the elbow area is common especially in the morning.

Diagnosis

Subjective (taking a history) and objective (clinical examination) evaluation are sufficient to lead the physiotherapist to diagnose lateral epicondylitis. Further testing (eg diagnostic ultrasound, magnetic resonance imaging) helps to confirm the diagnosis and gives us additional information about the severity of the disease.

Treatment

In most cases of lateral epicondylitis, patients recover completely with appropriate physical therapy. This requires detailed evaluation and treatment of all risk factors for the development of the disease.

The degree of success of the treatment depends to a large extent on the cooperation of the patient with the physiotherapist. It is very important to avoid activities that increase the symptoms. This helps the body heal damaged tissues. Ignoring the symptoms and pain and continuing to be fully active, the condition progresses to the chronic stage.

Immediate and appropriate treatment is valuable for the rapid recovery of the disease. The treatment in the first 72 hours (acute stage) aims to reduce pain and inflammation. So the patient rests from activities that aggravate the symptoms and uses ice therapy 3 to 4 times a day. A program to improve the strength and elasticity of the extensor muscles of the wrist and fingers should be implemented as soon as possible in the painless range.

Prognosis of lateral epicondylitis

With proper treatment in most cases the recovery takes a few weeks. In case of chronic pain, the recovery lasts up to six months.

Factors for the development of lateral epicondylitis

There are several factors that contribute to the development of lateral epicondylitis. All should be evaluated and corrected by the physiotherapist in collaboration with the patient. Some of them are:

• Excessive or inappropriate work
• Wrong sport technique or wrong equipment
• Muscular weakness
• Muscle stiffness
• Joint stiffness
• Insufficient warm-up
• Inadequate recovery from a previous injury in the area of ​​the match
• History of neck injury

In tennis athletes the size of the racket, the size of the handle, the surface of the court and the weight of the ball play a crucial role in the development of lateral epicondylitis.

Physiotherapy for lateral epicondylitis

Physiotherapy is vital not only for faster and more complete recovery but also for the prevention of the disease. Physiotherapy includes:

• Soft molecule techniques (massage)
• Electrotherapy
• Stretches
• Manual Therapy
• Taping
• Dry needle technique
• Ice therapy or heat therapy
• Progressive program to strengthen and increase the elasticity of the extensor muscles of the wrist and fingers