Tag Archives: tendonitis

Shin Splints

RunnerMedial tibial stress syndrome, commonly called “shin splints”, is a term used to describe pain and tenderness felt on the inside, lower border of the shin bone. Shin splints are commonly experienced by athletes who take part in activities involving repetitive running and jumping, particularly after a sudden increase in activity level (either duration, distance or intensity). The repetitive stress placed on the bones, muscles and joints of the lower leg during these high impact activities may result in irritation and inflammation of the shin bone (tibia).

Shin splint pain is usually described as a dull ache. It usually develops slowly over time, first being noticed at the end of activity. Some athletes may complain of pain at the beginning and end of activity, but not affecting their performance. Over time, pain will commence during activity and eventually may be felt during regular day to day activities such as walking. As shin splints progress, they also make the lower leg sore to touch.

Bones- Shin SplintsThere are a number of factors that may predispose an athlete to develop shin splints including: flat feet, rigid arches, muscle weakness, and/or muscle tightness. Other contributing factors may include running downhill, running on hard surfaces, running in worn-out footwear, or playing sports with frequent stops and starts (e.g. basketball, squash, tennis). While the pain presentation is often similar across individuals, there are a variety of bio-mechanical abnormalities in the pelvis, hips, knees, and ankles that can also lead to the development of shin splints.

Proper treatment requires a detailed assessment by a registered Physiotherapist to identify and target the contributing factors as well as the location of pain. Treatment includes rest, ice, specific joint mobilizations, an individualized stretching and strengthening program, and if needed a gradual return to regular activity. During recovery, aerobic fitness can be maintained with low impact activities such as swimming and biking. If left untreated, the repetitive stress on the tibia may result in a stress fracture yielding a longer recovery time.

A physiotherapist can perform a full assessment to determine the exact cause of an athlete’s pain and develop a treatment program to relieve pain, facilitate return to activity, and prevent future injury.

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Tennis Elbow

Tennis Elbow

Lateral epicondylitis, more commonly referred to as “tennis elbow”, is a term used to describe pain just above the elbow joint on the outer side of the arm. Contrary to popular belief, tennis elbow is not a condition that is exclusive to tennis players or athletes. The term tennis elbow was coined from the fact it can be a significant problem for as many as 50% of tennis players during their careers. However, less than 5% of reported cases of tennis elbow result from playing tennis!

More specifically, tennis elbow is a tendinopathy at the origin of the extensor carpi radialis brevis tendon (the tendon that is responsible for wrist extension). This tendinopathy is due to degeneration of, or damage to the tendon causing inflammation and subsequently, pain. In order to understand what causes tennis elbow, it is important to first understand tendons and how they function. Tendons are like “ropes” made of collagen tissue. They are flexible, but do not stretch when pulled. It is the job of the tendon to connect muscle to bone. In the case of tennis elbow, the area on the bone where the tendons attach, just above the elbow on the lateral side (or outer side) of the arm, are sometimes incapable of handling the force of the arm muscles. Strong forces or sudden impact to the tendons at this point of attachment are what cause damage, like small tears in the fibers of the tendon (similar to a rope becoming frayed).

Activities that exacerbate tennis elbow symptoms are those that involve repetitive motion of the arm, forearm, wrist, and hand. Movements that are commonly associated with the development of tennis elbow are: lifting, gripping something tightly in combination with inward or outward rotation of the forearm, jerky throwing motions, swatting with the hand, and simultaneous rotation of the forearm and bending of the wrist. Racquet sports may be the most “popular” activity to associate with tennis elbow, but as previously mentioned most cases are the result of a wide range of actions that include, but are not limited to: painting/plastering, excessive and repetitive use of a computer mouse, carpentry work, gardening and repetitive lifting and carrying.

Tennis elbow can be suspected when performing routine tasks, such as gripping objects or turning doorknobs, become painful. A physician or physiotherapist can diagnose tennis elbow by discussing symptoms and examining the affected arm. Diagnostic tests are not typically necessary for an accurate diagnosis, however, a physician may request an X-ray or MRI imaging if symptoms do not improve with treatment.

Treatment options for tennis elbow include modifying activities that exacerbate symptoms. Movements that cause an increase in pain should be avoided to help allow the tendon to heal. Pain management is also important to consider. Anti-inflammatory painkillers are commonly used for some symptomatic relief, however physiotherapy remains the most successful tool in the treatment of tennis elbow long-term. A physiotherapist will perform manual therapy on the affected arm, to mobilize the underlying stiff joints and tight structures. Modalities such as ice, and ultrasound, as well as taping may be used to ease pain and encourage healing. A physiotherapist will implement stretching and strengthening exercises to help restore normal function of the arm, and also prevent tennis elbow from occurring in the future.

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Acupuncture

Acupuncture is a form of treatment which involves the insertion of tiny needles into the skin at very precise points throughout the body. The needles are solid, sterile, and single-use. No medication is injected. The presence of the needles creates a therapeutic effect by encouraging healing, reducing pain, and promoting energy.

Acupuncture

How does acupuncture work?
There are two approaches to acupuncture: classical acupuncture and anatomical acupuncture.

Classical acupuncture is rooted in Traditional Chinese Medicine (TCM). In TCM theory, energy flows through the body in predictable channels, called meridians. Pain and dysfunction occur when the flow of energy is deficient or out of balance. TCM theory proposes that acupuncture relieves pain and promotes good health by restoring the body’s energy balance. The acupuncture points are located along the meridians. Needles are inserted to correct energy imbalance and restore energy flow throughout the meridian. Therefore, pain and dysfunction in one part of the body can be treated with acupuncture points at a distant location in the body.

Anatomical acupuncture was developed based on Western anatomical and physiological concepts. In this theory, acupuncture has both local and distant effects:

  • Locally, acupuncture needles stimulate the release of endogenous opioids at the site of the needle. Endogenous opioids are natural painkiller molecules that are synthesized in the body and released to decrease pain. Blood supply to the area is increased, which promotes healing by improving the delivery of oxygen and immune cells to the injured tissue. Immune cells, such as mast cells, macrophages, and fibroblasts aid the natural process of tissue healing. The needles also suppress the local inflammatory response, which further helps to decrease swelling and pain.
  • Distal to the needle site, acupuncture stimulates peripheral afferent nerves. Afferent nerves carry sensation signals from nerve endings to the brain (such as sensations of touch, temperature, and pain). The acupuncture needle interacts with the afferent nerves to modulate and suppress the transmission of pain to the brain. This reduces the perception of pain.

What are the benefits of acupuncture?
Acupuncture is effective in treating a wide variety of neurological and musculoskeletal disorders, including:

  • Tendonitis and tendinopathy
  • Ligament sprains
  • Muscle strains
  • Myofascial pain and inflammation
  • Osteoarthritis
  • Nerve pain, such as sciatic pain
  • Low back pain and disc bulges
  • Whiplash and other neck pain
  • Muscle tension headache and suboccipital headache
  • Bell’s palsy and trigeminal neuralgia
  • Fibromyalgia

In Traditional Chinese Medicine (TCM), acupuncture is used to treat many other conditions:

  • Digestive problems (nausea, vomiting, constipation)
  • Respiratory problems (sinusitis, congestion, bronchitis)
  • Urinary problems
  • Menstrual pain
  • Insomnia
  • Anxiety and stress

What can I expect from acupuncture treatment?
The reaction to treatment is unique to each person. Some people feel relief immediately, while others notice improvement after hours or days. Some people require several treatments before noticing improvement. Some people do not respond at all. The number of treatments required varies for each patient and condition. Similar to most types of treatment, acupuncture works best if it is repeated a few times.

Are there any side effects?
There are usually no side effects to acupuncture treatment. The most common side effects are tenderness or slight bruising/bleeding at the needle site, but these only occur approximately 6% of the time. Occasionally, someone may feel nauseous, faint, or dizzy. This occurs less than 1% of the time.

Your physiotherapist will assess you thoroughly to ensure that you are a safe and appropriate candidate for acupuncture treatment.

Preparing for acupuncture treatment
Prior to treatment, have a light meal and be well-rested. Avoid alcohol or sedative medications for 4 hours before treatment, and avoid smoking tobacco for 1 hour before treatment. Continue to take medication as prescribed by your doctor.

After acupuncture treatment avoid alcohol, caffeine, and smoking tobacco for 1-2 hours. If you are being treated for pain relief, avoid strenuous activity for 1-2 days after treatment, even if you feel pain-free.

Conclusion
Acupuncture is a useful adjunct treatment to physiotherapy. It is effective for treating a wide variety of musculoskeletal and neurological problems, including acute and chronic conditions. Your physiotherapist will assess you thoroughly and create a treatment plan to address your unique needs.

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References
ZQ Zhao. Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology. (2008)

ZJ Zhang, XM Wang, GM McAlonan. Neural acupuncture unit: A new concept for interpreting effects and mechanisms of acupuncture. Evidence-Based Complementary and Alternative Medicine (2012)

SM Wang, ZN Kain, P White. Acupuncture analgesia: I. The scientific basis. Anesthesia and Analgesia (2008).