Sports Injuries: A guide to Recovery

When you have sustained an injury, it can be a daunting time. You may be wondering what you have done and how you can best manage it to get back on your feet as quickly as possible and return to normal function. This is where Physiotherapy can help you.

We are qualified and highly experienced at the assessment of any musculoskeletal condition, the management for and the expertise to get you back to the highest level of function in a timely fashion.

During any acute injury, at the level of your tissues, there will be a level of disruption. Some of the tissues in the area, whether ligaments, tendons or muscles may have sustained a degree of tearing or compression. As a result, we experience pain and swelling local to the area of concern.

The best management for your acute injury at this stage is to cease participation immediately and to follow the following steps:

  1. Apply ice to the area. This may take form of an ice pack, a bag full of ice and water or melting an ice cube directly over the skin (but not over a wound). Apply the ice until the area feels very cold, but not painful;
  2. Apply some form of compression. If you have sustained an injury to your foot, it may be best to leave your shoe on to support the foot and to minimise the swelling. If you have a leg injury, then donning a pair of compression tights will assist you in relation to swelling;
  3. Keep the area elevated. If you have an injury to the hand, wrist, ankle or knee, elevating the limb above the level of the heart will help to reduce the swelling and fluid around the injured area; 1
  4. Avoid applying heat to the area. This will promote bleeding to the area, which in turn will increase the swelling and pain of the injury;
  5. Avoid running or excessive movement to the area. This will increase the blood flow to the area and increase the bleeding, pain and swelling;
  6. Do not consume alcohol. This will expand the blood vessels and lead to increased bleeding, that will slow down the injury process

It is important to follow these steps as soon as you have sustained your injury. The sooner you act, the higher the chance of enabling your body to move on to the next stage of healing. If you have great concerns about your injury, it is integral that you liaise with your Physiotherapist or Doctor as soon as possible.  If you require the fitting of crutches or a sling, general guidance and/or reassurance, it is crucial to make that phone call straight away.

If you have a deep skin tear, a gross deformity at the area of the injury, excessive and uncontrolled pain, it is critical to seek the medical attention at the Emergency Department of your nearest hospital.  You will be able to receive adequate pain relief, attention to any wounds and imaging, if required.

Once you have survived of the first 24 to 48 hours, it is important to meeting with your Physiotherapist. They will be able to assess you, determine the type and severity of the injury and devise an appropriate rehabilitation plan.

From this point, your Physiotherapist will seek to minimise the pain, swelling and inflammation of the area and commence work to restore normal movement. These factors will involve a combination of many treatment modalities including hands on treatment, taking you through certain movements and exercises, taping techniques or bandaging, fitting of a brace or walking aides, etc. You will also receive a program that you will be advised how often to partake in, to actively assist in the recovery process.

Any soft tissue injury can take a minimum (with minimal tissue disruption) of three weeks to recover and upwards of six weeks.  This will typically be the case if you have a very complex injury, or it involves structures that have a poor blood supply or under a great load in the body (such as the intra-vertebral discs or a nerve) 3. It is important to be aware of things that you can do to reduce the risk of delays or setbacks. During each of your consultations, your Physiotherapist will continue to progress your program, to put gradually increasing stress on the scar tissue that is healing, to help lengthen it and strengthen it.

When your body is ready, you will be given progressive exercises to help strengthen the area and the surrounding structures, to ensure your body is not compensating for the original injury. These compensatory strategies are an easy habit in which to fall, and can be very difficult to break.  Your body may have other mechanisms that require attention during your rehabilitation, such as your balance, or components of your balance.  You should be regularly taken through mini-assessments of each component that has been affected by the injury, to ensure there is reasonable progress and an adjustment of your exercises and home program to match accordingly.

During the recovery progress, your Physiotherapist will continually liaise with you, as to your goals for returning to particular levels of function, aspirations with your sporting, social and working environments.  They will also make recommendations for the steps you can take to reduce the chance of injuring yourself again.

If you would like more information, or have a question about your recovery, be sure to speak with your treating Physiotherapist today.

Written By Sophie Halsall-McLennan, Fresh Start Physiotherapy

  1. Website: https://www.ausport.gov.au/__data/assets/pdf_file/0005/380426/SP_32434_Incident_Management.pdf
  2. website: sma.org.au/resources-advice/injury-fact-sheets/soft-tissue-injuries
  3. website: highered.mheducation.com/sites/dl/free/0078022649/…/Prentice15e_Chap10.pdf

 

About The Author

Sophie Halsall-McLennan is the owner of Fresh Start Physiotherapy and has a special interest in Hand Therapy and Shoulder Rehabilitation.  She has a Bachelor of Physiotherapy from Charles Sturt University, over 13 years of clinical experience as a Physiotherapist and is registered with AHPRA. She is also a lecturer at Deakin University.

A Physiotherapists Guide To Tennis Elbow

INTRODUCTION

The following is a guide to understanding Tennis Elbow, its symptoms, who is vulnerable, how it is diagnosed and the recommended treatment.

TENNIS ELBOW

“Tennis Elbow” is a broad term often used to describe pain or discomfort on the outside of the elbow. This pain has occurred from overuse of the hand, wrist and forearm musculature. The term “Tennis Elbow” was given after a high proportion of tennis players developed the condition through repeated stress of the common extensor tendon of the elbow. Despite the origin of its name, Tennis Elbow is not limited to the tennis population 1.

Tennis elbow occurs either acutely or gradually over time.  The bony part on the outside of the elbow (lateral epicondyle) is where the muscles and tendons converge to form a common tendon. This tendon attaches to the bony prominence and they permit movement of the hand and wrist (Fig 1).

Figure 1: (http://www.bristolhandsurgery.co.uk/wp-content/uploads/2015/03/tennis-elbowjpg.jpg )

Health professionals will define tennis elbow as an extensor tendinopathy; this refers to pain and possibly inflammation around the lateral epicondyle.  Another common term used to describe pain around the elbow, is ‘golfer’s elbow’.  This is referring to pain on the inside of the elbow (medial epicondyle) and is also known as flexor tendinopathy.

Tennis elbow is prevalent on the side used for repeated gripping, high levels of resistance and movement at the wrist. This is why the condition most commonly affects people on their dominant side, though, can occur in both arms 2.

Symptoms of Tennis Elbow

Symptoms vary from person to person, common presentations include:

  1. An ache or pain experienced during or after gripping or squeezing objects

Aching or pain around the area of the lateral epicondyle may slowly develop over time. The onset of pain can also occur quickly, though this is not common

  • Aching or pain is worsened by forcefully moving the wrist. Some activities may include handling kitchen utensils like:
  • Using a knife to cut firm vegetables
  • Opening a jar or a door
  • Turning on the taps
  • Using carpentry tools or gardening tools that require you to grip or twist
  • Cleaning tables and windows.

Who gets Tennis Elbow?
Tennis elbow has been found to affect between 1% and 3% of the population and the incidence for repetitive tasks is 30% and among tennis players has been extremely high, with up to 40% of tennis players being affected during their careers 1 .

Tennis elbow more commonly occurs in men than women and is frequently present between the ages of 30 and 50 years. However, Tennis Elbow can affect people of any age 3.

Despite being highly prevalent among tennis players, Tennis Elbow may affect anyone who participates in work or leisure activities involving repetitive use of the elbow, hand and wrist. The likelihood of tennis elbow occurring from these other activities is increased by the force during gripping as part of the action.

How is Tennis Elbow diagnosed?

Tennis elbow can be diagnosed by your Physiotherapist. During the consultation, your Physiotherapist should ask you a number of questions about your symptoms before they take you through a series of tests to determine the source of pain.

Only a small proportion of people require other imaging such as an ultrasound or CT.  This will typically be because the symptoms may not fit the expected diagnosis. Other structures may be involved, or a person may not be responding to the usual management of the condition.

Treatment

Tennis elbow is successfully managed with Physiotherapy treatment and a rehabilitation program. Other possible treatment includes cortisone injections, and in severe cases, surgery if there is no improvement with conservative means.

The management of tennis elbow is tailored to an individual and will be influenced by your medical history, pain levels, hand and wrist function and other medications you are currently taking.

The goals of treatment are to:

–              decrease and eliminate pain, swelling and inflammation

–              promote healing around the muscle and tendon

–              change or modify the loads on the elbow

–              restore function, movement and strength to the elbow, forearm and wrist

How to Reduce Pain and Promote Healing of Tennis Elbow

Some modalities to reduce pain would include:

  • Regular application of ice to the area
  • Taping the elbow, or using a brace, as per your Physiotherapist’s instructions
  • Taking anti-inflammatories (NSAIDS), in consultation with your GP
  • Avoiding movements that cause unnecessary pressure or stress through the forearm muscles and elbow

When the pain and discomfort have begun to subside, your Physiotherapist will take you through some specific exercises to stretch and strengthen the muscles and tendons surrounding the elbow. There will be specific movements that you will be advised to avoid. This will include any activity that causes pain to the elbow either during or afterwards.

Your recovery may also be assisted with taping of the elbow / forearm or the use of a specific brace fitted by your Physiotherapist.

What is the recovery rate for people with Tennis Elbow?

Generally, 95% of people will make a full recovery with Physiotherapy treatment and management. Around 5-10% of people require surgical intervention to repair the muscle and tendon around the elbow. In the 5% who undergo surgery, 80-90% experience pain relief and restoration of function 1.

Written by Sophie Halsall-McLennan, Fresh Start Physiotherapy

  1. Bisset,L.,  Vicenzino, B.,  Sesto, M., MacDermid, J. (2013) Tennis Elbow: The Evidence, The Science And The Clinical Experience 
  2. Brukner, P., & Khan, K. (2009). Clinical Sport Medicine (revised 3rd Ed.). McGraw-Hill, North Ryde.
  3. Skirven,T., Osterman, A., Fedorczyk, J., & Amadio, P. (2011). Rehabilitation of the Hand and Upper Extremity (6th). Elsevier. Philadelphia

 

About The Author

Sophie Halsall-McLennan is the owner of Fresh Start Physiotherapy and has a special interest in Hand Therapy and Shoulder Rehabilitation.  She has a Bachelor of Physiotherapy from Charles Sturt University, over 13 years of clinical experience as a Physiotherapist and is registered with AHPRA. She is also a lecturer at Deakin University.

Arthritis And My Hands: Can A Hand Physiotherapist Help?

Hands are very important tools in our daily lives. We use them to dress, do housework, put food in our mouths, work to earn a crust, use them as part of our body language to express our emotions. However, when we have pain, stiffness, swelling and an altered appearance, our lives can become very challenging.

Arthritis is a term to describe over 100 forms of a condition where a person may experience symptoms including:

– Stiffness
– Inflammation
– Damage to the joint cartilage (tissue that covers the ends of bones)
– Swelling

These symptoms can result in deformity of the joints, joint weakness, joint instability and weakness of the surrounding tissues such as ligaments and tendons. So, enough of the doom and gloom.

Hand Physiotherapy Can Help You

A Hand Physiotherapist will be able to assess your hand function, including the range, stability and quality of your joint movement, the strength and length of all of the muscles in your hand and has the ability to order and view your x-ray when they are appropriate.

From here, your Hand Physiotherapist will be able to determine your key problems and discuss a tailored management plan with you.

Moderate Your Activities

Quite often, joints of the hand and wrist are overused with repetitive movement and become highly inflamed and very painful. Your Hand Physiotherapist can advise you of how to moderate your activities, so you can use your hands without experiencing these flare ups.

A Resting Splint

Sometimes, a joint may need a rest. A resting splint may be custom made to enable the joint to be protected from excessive movements if it is unstable, or rested if it is very inflamed and painful. Splints are a great way of managing your symptoms and protecting your joints.

Exercise

You may also require exercises for strengthening weak muscles of the hand and wrist, or you may require hands on treatment and exercises to optimise the movement of your joints. All of these factors will be thoroughly addressed by your Hand Physiotherapist during your consultation.

Finally, the word “management” is the key, when addressing arthritis. We can’t reverse the arthritic changes that have already occurred, but a Hand Physiotherapist is able to help you to slow down and further prevent joint destruction, reduce your pain, improve your strength and joint movement by providing you with a tailored hands on treatment program, home management program and information during your journey.

If you are experiencing pain or issues with your hands, it might be time to visit a Hand Physiotherapist who offers hand therapy.

Written by Sophie Halsall-McLennan, Fresh Start Physiotherapy

References:
www.arthritisaustralia.com.au

About The Author

Sophie Halsall-McLennan is the owner of Fresh Start Physiotherapy and has a special interest in Hand Therapy and Shoulder Rehabilitation.  She has a Bachelor of Physiotherapy from Charles Sturt University, over 13 years of clinical experience as a Physiotherapist and is registered with AHPRA. She is also a lecturer at Deakin University.

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Sophie Halsall-McLennan is a mother of two, has a passion for rowing, skiing, classical ballet and spending time with her family.

Staying continually up-to-date with the latest evidence-based practice, including treatments and rehabilitation programs keeps Sophie at the forefront of Physiotherapy. With these skills and knowledge, she can equip her clients with the best available information and treatment.

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