Tennis elbow, or lateral epicondylagia, can be a nagging injury that can last for months. Many studies point to the benefits of isometric contractions to reduce pain related to tendinitis/tendinosis. An isometric contraction is one in which the muscle contracts, but does not produce joint movement. Check out this video for a couple examples of isometrics for tennis elbow.

Regional interdependence is a fancy term which basically means the joints of the body are all related and can have an effect on other areas. This is why we assess the structures surrounding the painful area. For example, if you have knee pain, we will assess the hip and ankle for possible contributing factors.

In the body, joints are designed to be stable or mobile. Thankfully, there is a pattern…they alternate. Let’s take the foot-ankle complex for example. We have always heard that flat feet (think too mobile) are bad so we want the foot to be stable. Then, the next closest joint, the ankle, needs to be mobile. This alternating stable-mobile-stable patterns continues throughout the body, so the mobile segment can work on a stable base. You might think of this like standing on a skateboard…the board can move (mobile) and if we are also mobile when we stand on it, things don’t go so well. We need to be stable when standing on the mobile skateboard to not fall.

Check out this video:

Here’s how things went yesterday at the gym and some simple tweaks.

About a week ago I noticed some pain on the outside of my left elbow while lifting weights. I knew it was nothing serious, but needed some attention. Check out this video as I explain a little more. I will post updates as I go along.

The next phase in treating pain associated with the patellar tendon is the isotonic phase.  Progression to this phase can be done once isotonic exercises can be performed with less than 3/10 pain.

Isotonic exercises are defined as exercises that are performed under a constant load.  This means the same amount of weight is applied while the muscle is changing in length.  Examples of these exercises include weight machines (leg press, knee extension, etc) and body weighted exercises (lunges, squats, etc.)

Research suggests staying within 10-60 degrees of knee flexion during isotonic exercises .  This is because full knee extension and deep knee flexion (90* or greater) can induce pain in the patellar tendon.  It also suggests starting isotonic exercises with both legs before progressing to single leg exercises.

It is still important to self assess knee irritability during this phase, especially before progressing intensity.   If pain lasts longer than 24 hours, weight should not be progressed.

Tips for Isotonic Strengthening:  3-4 sets of 15 reps

• 15 reps should be challenging in order to produce tissue changes in the tendon
• Progress the load until you’re performing 3-4 sets of 6 reps (optimally your 6 rep max)
• Perform these exercises every other day, allowing a day of rest
• On “rest” days, continue with exercises from isometric phase to manage soreness

Below are two videos demonstrating isotonic exercises:

Pain at the front of the knee, especially with jumping, running, and squatting is commonly diagnosed as patellar tendinitis, which translates to inflammation of the patellar tendon.  Usually, this pain has persisted for some time, and what we have learned over recent years is the tendon is not actually inflamed…painful, but not inflamed…and now referred to as patellar tendinopathy.  This condition commonly occurs in sports such as running, basketball, and volleyball to name a few.

The first step to treat this condition is to decrease training intensity and volume as this has been shown to be the biggest risk factor for patellar tendinopathy.  Other factors include: decreased flexibility in the quadricep and hamstring muscles, a more vertical (stiff-leg) landing pattern, low arch height (pronation), decreased ankle dorsiflexion (Rudavsky & Cook, 2014), decreased hip internal rotation range of motion and decreased hip external rotation strength (Mendonca et al, 2018).

A common treatment approach is to utilize eccentric exercises.  Eccentric exercise focuses on the lowering phase, like standing on one leg and lowering down to a chair, but not using that leg to stand back up.  Some research has shown this type of treatment to be effective over a 12 week period.  The problem with the eccentric program for patellar tendinopathy is that pain is often increased and the majority of people will not complete the program.

Another method is to do isometric exercise, which means the muscle contracts but there is no movement.  Isometrics have been shown to decrease pain in the patellar tendon (Rio et al., 2015).  This is a great way to self-manage your symptoms before moving on to the next phases of rehab.

Here are some tips:

1. Carefully monitor and alter load until the tendon settles within 24 hours of activity.
2. Keep pain level below 5/10 during the exercises and the pain has to settle within 24 hours.
3. 5 reps x 45 sec hold at 70% of your maximum contraction and 2 minutes rest between sets
   1. Best at 30-60 degrees of knee flexion (not straight and not bent 90*).
   2. Can be performed on a leg press.
   3. You should notice reduction in pain after treatment.

Here is a short video on one possible way to perform an isometric quadriceps exercise at home:

While watching the 2018 World Cup, we might see someone grab the back of their thigh and then begin to limp, following a kick or after a fast sprint towards the ball.

Hamstring injuries are common in fast-paced sports that require both kicking and sprinting.  They occur either by over stretching the muscle, like during a high kick motion or during a quick contraction of the muscle such as sprinting.  A “pulled” hamstring or hamstring strain can be a minor injury due to a stretch of the muscle or it could be a tear of more than half of the muscle.  Due to these varying degrees of injury, consult from a medical provider may be necessary.

Signs of a hamstring strain include pain, tightness, and/or localized tenderness over the backside of the thigh.  Some people with this injury have a difficult time walking, and swelling with bruising can occur as well.

Immediately following a hamstring injury, it is important to recall the acronym RICE, which we introduced last week.  Specifically with this type of injury, wearing a compression short or applying a cold compress is important to reduce muscle injury and swelling.  Following the acute phase,  gradually adding in stretching of the hamstrings and eccentric strengthening will aid in the healing process.  As you progress, strengthening exercises should always be pain free.

Below is an exercise for the later stages of rehabilitation of a hamstring strain…

World Cup 2018 is in full effect and we will likely see many ankle sprains, or at least players rolling on the ground in pain grasping at their ankle.

Ankle sprains are one of the most common injuries in sports, with sprains to the outside of the ankle (lateral ankle sprain) being the most prevalent.  These can occur when the ankle rolls while the foot is pointed down and turned in, such as when changing direction, landing on another’s players foot, or stepping in a hole while mowing the lawn, causing some degree of tearing to the ligaments.   There are varying degrees of lateral ankle sprains so a medical consult may be necessary.

Swelling on the outside of ankle, pain, and bruising into the foot are hallmarks of this injury.  With fracture ruled out, it is important to bear weight on the injured limb and perform gentle, pain-free ankle movement. Initially, use the acronym RICE:

Rest: don’t do activities that may re-injure (sports, running, jumping cutting)
Ice: 15 min every 2 hours x 48 hours
Compress: use compression wrap or tape to reduce swelling
Elevate: as much as possible

A good rehabilitation program is important to return to sport/activities.  We focus on mobility/flexibility to ensure full ankle motion, strengthening of the muscles around the foot/ankle complex and supporting musculature (hips, hamstrings, core) as needed, and balance/coordination activities.  Here is one simple activity at home that can address mobility and stability in the ankle…

Here is a short video discussing common mistakes and quick tips to enhance the performance of a common rotator cuff exercise.