Category Archives: Tennis Elbow (lateral epicondylitis)

Tennis Elbow (lateral epicondylitis)

Top Tips on How to Play Your Best Tennis Game

Recently, we interviewed Suzie Freeman, one of the leading clinicians who keep tennis players in top shape, and got some really useful advice:

What is your experience treating tennis players?

I picked up recreational tennis in my late 40s after not playing since High School.  Tennis is a very social game, so once other players heard I was a Physical Therapist, they began to come to me with their tennis-associated injuries.  This gave me a lot of experience in treating both acutely, as well as in the rehab setting with more stubborn injuries.  As an “older” player myself, I also experienced a variety of aches and pains, which gave me firsthand experience as to what treatments really worked and what didn’t.

What are the most common injuries you see with recreational tennis players?

For the upper body, of course, lateral epicondylopathy (aka “tennis elbow”) is very common, as is shoulder pain. Rotator cuff tendinopathy can be seen in both male and female players, though a number of women can get frozen shoulders. For the lower body, I see anterior knee pain, Achilles’ tendinopathy, and plantar fasciopathy. The professional players tend to suffer from injuries related to the high forces of their games and the season’s intensity. For the recreational players, injuries often come down to poor technique or inadequate training regimens. This can be a good thing because many of these biomechanical issues can be corrected, allowing the athlete to continue to play well into their “later” years.

Do you have any tips regarding injury prevention for the recreational tennis player?

Off-court physical training can make or break a tennis player’s performance. However, it is especially critical for the recreational player who is 35 years or older. That point in life appears to be a time where our bodies seem less-forgiving to physical stresses like start-and-stop running on cement and explosive movements with our arms. Off-court training can be broken down into 3 categories: cardiovascular, strength training, and flexibility.

Cardiovascular training is always a good idea, as we all tend to lose our form as fatigue happens. Loss of form and control can definitely be a precursor to injury. One can make cardio work more tennis-specific by adding interval training:  short bursts of increased speed and/or resistance, interspersed with prolonged moderate work. I believe the “best” cardio training is whatever prolonged activity a person doesn’t mind doing. One can use any of the machines at a health club, or just take a brisk walk outdoors and try to include hills in the route.

That leaves strength training and flexibility.  Are they equally important?

Strength and flexibility are both important. However, I realize that tennis players have only so much time and motivation to perform exercise outside of the game. In my practice, I have concluded that in general, most women need to put more emphasis on strength training, and most men benefit from a focus on flexibility.

In terms of upper body injuries (especially the shoulder), I see that male recreational players often derive most of their power from their shoulders and upper arms, which can lead to over-use of the rotator cuff. If a male player is able to hit the ball utilizing proper trunk and scapular motion, this will help to unload their rotator cuff. Look up your favorite player online: how much does he rotate his trunk before he hits the ball? Is that how you look on the court? Or does your chest face the net for most of the game? Here’s a quick test for trunk mobility: Stand with your arms out sideways (shoulder height), feet apart, wider than your shoulders, but with your toes turned in. Start facing a wall so that your trunk and hips are parallel, or in-line with the wall. Now, rotate your trunk to the right as far as you can. Can you rotate far enough so that your left arm is now perpendicular to the wall? Now, try to rotate your neck to the left:  is your face directed squarely at the wall?

See the end of this interview for a series of off-court stretching exercises that address common areas of tightness. These stretches are for both male and female players.

And the ladies?

Stretching is still important for the women players. In my practice, however, I have found that women might need to put more emphasis on strength training. A number of upper body and neck injuries can arise from the poor stability of the shoulder blades. An easy way to train that would be to do plank-type exercises. With tennis, our arms are more commonly outstretched. So, I like to do planks with the elbows straight, weight-bearing on the palms vs. weight-bearing on the forearms with the elbows tucked into our sides. When performing plank exercises, it is critical to brace the abdominals, keep the shoulder blades pulled down, and maintain good cervical posture so that our chins are pulled in and back.

In terms of pre-match warming up, I believe it’s better to do your flexibility and strengthening work outside of match play. Some studies show a temporary decrease in strength after you stretch a muscle, and you certainly don’t want to go into a match with muscle fatigue from lifting weights. See below for instructions on several exercises that can be done right on the court as a pre-match warm-up. Also, please be sure to take the time to do the traditional tennis warm-up before you play. Even a 5-minute warm-up can go a long way to prevent injuries.

How has Astym treatment impacted your tennis clients?

Bringing in Astym treatment has been a huge benefit for my tennis clients.  I can now resolve many injuries that were previously considered “unresolvable”.  Also, their recovery time is cut in half – or more. On average, my “tennis elbow” clients are back on the court in 2 weeks, with competitive play at 3 weeks. I see a few players who “pop” their calf muscle. From the day of injury to back to playing full-force is two weeks. And these are middle age players.

Astym therapy also helps me find the source of the problem. Most people with tennis elbow point to the “bone” as the source of their pain. However, with Astym treatment, I can find different muscles around the elbow that are showing signs of dysfunction. For example, when it hurts lower on the epicondyle, it can often be related to not changing your grip when performing a slice. What about pain in the central part of the bone? I have seen that occur when the grip is too forceful…or sometimes it could be choice of strings. Pain more in the fleshy part of the arm? I often see that in players who strike the ball at serve with a slightly flexed elbow.

Has Astym therapy helped you as a player?

All the time. I have managed to consistently play 3-4 times per week with a stiff, arthritic shoulder.

What should injured players do if their therapist doesn’t understand tennis?

One of the great things about being a Certified Astym Provider is that you have a means of connecting with other therapists who specialize in a certain sport. In most cases, the standard Astym treatment is all most people need, but for unusual cases, outside help is available.

Check out the Astym-Certified Provider Directory on the Astym website and find a certified clinician in your area who can get you back on the court and help to keep you there! If you can’t find an Astym-Certified Provider near you, have one of your local physical therapists visit www.astym.com to sign up for certification training.

Clinician Interviewed: Suzie Freeman, MPT, OCS, Astym Cert

Post Warm-up/Work-out Tennis Stretches

For the Dynamic Stretches: take each position to a comfortable end range, pause, and then stretch the opposite side.

For the Static Stretches: hold a comfortable end-range position for 30 seconds, making sure to breathe normally.  Repeat 2-3 times on each side.

 

Lying on Back:

 

Dynamic Hip Crossover

Starting with arms out in “T” position, feet flat on the floor, and knees bent and together brace your abdominal muscles and roll both knees to the right side slowly, controlling the lowering of your legs, letting the weight of your legs pull to end range. Repeat 2-3 times on each side.

 

Dynamic Leg Overs

Starting with arms out in “T” position and legs straight on the floor, engage abdominals. Lift left leg up as high and straight as you can. Then, cross it over your body towards the floor. Contract your abdominals and return to starting position. Repeat 2-3 times on each side.

 

Lying on side:

 

Static Pretzel Stretch

Laying on your side flex hips to 90 degrees and hold the top ankle with the hand on the same side. Slightly roll pelvis inwards to prevent rounding of the lower back. Take the heel of the weight-bearing leg and place it above the kneecap of the top knee. Use that heel to push the top knee back and towards the table. You should feel a stretch in the quadriceps or the lateral thigh.

 

Static Thoracolumbar rotation stretch

Start on your side, lying with the hips stacked and flexed to 90 degrees. Rotate your trunk to face the ceiling and abduct your shoulder to 150 degrees, allowing it to rest on the floor. Stabilize your knees with the opposite hand.

 

Lying on Stomach:

 

Dynamic Scorpions

Start with arms out in “T” position and legs straight on the floor. Flex the left knee to 90 degrees and lift the leg up and over towards the opposite shoulder, not allowing the left thigh to contact the right leg. Pause and return to starting position. Repeat 2-3 times on each side.

 

Dynamic Press-ups

With your hands under your shoulders, press up one vertebral level at a time while keeping low back and buttocks relaxed. Go as far as you comfortably can, pause, then return to starting position. Repeat 2-3 times.

 

From Quadruped:

 

Modified Prayer Stretch

Sitting back onto your chest, round your back, tuck in your belly button and pull in your chin to your chest.  Allow your palms to face the ceiling. Hold this pose to feel a stretch in your lats (upper back).

 

Static Pigeon Stretch

Starting on hands and knees, lift one leg up and over the opposite ankle, sliding foot down and back.  Keep hips squared up until you feel a stretch on the outside of the hip on your bent leg.  Hold for 30 seconds to one minute, and repeat on the opposite side.

 

From a Plank:

 

Dynamic Sprinter’s Stretch

From a plank position, walk hands backward, moving into a pike position. Bend one knee to achieve a stretch through the opposite calf.  Repeat 2-3 times each side.

 

Static Deep Lunge Stretch

Walk hands forward to assume a plank position. Move one foot forward and next to hand on the same side. Pause, then return to the plank position and repeat on the opposite side. Repeat 2-3 times each side.

 

On Court Warm-Up

Tall march with knee hug

Maintain vertical posture and focus on balance. Raise up on toes as the knee is pulled to the chest.

 

Lunge steps

These can be performed with the rear leg either dropping straight to the ground (first photo) or with it stretched behind and the knee maintained in extension (second photo).

In both cases, make sure to keep your torso perpendicular to the ground. Avoid rounding your back.  

 

Lateral lunge steps

While maintaining a “sternum up” posture in the torso, weight is shifted first to the right and then the left followed by a pivot which leaves you facing the opposite direction and the shift is repeated.

 

 

Soldier march/skip

Lift right leg to outstretched left hand while maintaining an upright posture. As you warm up, increase the velocity and height of the kick, progressing up onto the toes of your standing leg. Alternate feet for 5 repetitions on each side.

 

Sprinter’s stretch

Kneel on the right knee with your left leg in front of you with your foot flat on the ground. Place hands on the floor to support yourself. Straighten left hip and knee slowly, keeping foot flat. Hold for a count of 1-2 seconds, lower, and repeat five times in a slow pumping motion. Repeat stretch with left foot turned out, and then with left foot turned in. Perform the same stretch with right leg in front.

 

Heel cord stretch/Big toe rocks

In pike position with both hands on the floor, lift one foot to the heel of opposite foot. Next, lift heel off the floor to achieve a toe extension, then slowly lower back to the floor giving pressure in a downward direction with the opposite foot from behind. Repeat 3 times to each side.

 

Spiderman

Lunge forward onto right leg, bringing the right arm to the inside of the right leg and lower hips toward the floor until you feel a stretch in the left hip flexor; pause and then reach forward with opposite leg – like Spiderman – to the same position with the opposite leg. Repeat 3 times on each side.

 

 

Twister

Starting with arms straight and to the side in a “T” position, bend forward at the hips keeping back straight similar to the setup position in golf. Keeping knees pointed straight ahead, rotate your trunk and swing arms from side-to-side, letting the weight and momentum of your arms pull you to end range. Then, slowly start to raise up to an upright position while maintaining arm swinging motion. From an upright position, continue arm swing but now bend elbows to 90 degrees. Then, slowly straighten arms to overhead position while continuing arm swing motion. Slowly lower arms through each position back to the starting position—the whole time maintaining arm swing motion.

 

Hug world/Hug self

Wrap arms around trunk by crossing them in front while in a forward bent/back straight position (similar to golf set-up position) emphasizing spreading shoulder blades apart. Then, while coming to the upright position, squeeze shoulder blades together as if hugging the world; then back to the “hug self” position, etc Repeat 3 times.

Dynamic flexibility handout provided by Performance Dynamics, Inc. Program developed from the contributions of Amy Goddard, PT, DPT, OCS, CSCS and John Zanas, PT, CSCS, PES

 

Able to Sleep Without Pain Again

When I first started doing physical therapy I had trouble lifting grocery bags, reaching behind me, lifting various objects and sleeping without pain. Since coming to physical therapy and doing Astym therapy my symptoms have improved so much. My lifting is much, much better and I’m sleeping through the night without pain. Thank you Amy and Andrea.

Lisa Zachwieja

Treating Clinic-
Diamond Physical Therapy,
Algonquin, IL, 60102

http://www.dptrehab.com

Treating Tennis Injuries and Tendinopathy: Advice From an Expert

By:  Lisa Chase, PT, OMPT

Tennis elbow, plantar fasciitis and rotator cuff tendinopathy are common injuries that can plague a tennis player. The last thing an athlete wants to hear is, “You must rest and stop playing tennis.”  Soft tissue injuries can be painful, limiting conditions that are slow to heal, which is particularly challenging to a tennis player who wants to get back in the game.

Many athletes seek advice from primary care and sports medicine physicians when they have tendon pain and then are often offered anti-inflammatories, injections, and told to rest.  Typically, this common regimen only offers temporary relief and may not be the best method to heal a tendinopathy. Astym therapy targets the underlying cause of many soft tissue problems, rather than just trying to relieve symptoms.  It is unmatched in its ability to resolve tendinopathies, and often works even after other approaches fail.

WHAT IS THE DIFFERENCE BETWEEN TENDINOPATHY, TENDINITIS AND TENDINOSIS?

The word “tendinopathy” actually means “disease of a tendon,” and is a broader term for two conditions known as “tendinosis,” or degenerative tendinopathy, and “tendinitis,” or acute, inflammatory tendinopathy. Although “tendonitis” is used often, most cases of tendinopathy are not associated with significant inflammation and thus don’t respond well to anti-inflammatory medications.

WHAT CAUSES TENDINOPATHY?

Tendinopathy can be caused by overuse or improper loading of the muscle-tendon unit. It can also be caused by degeneration of soft tissues due to injury, age or other reasons. Repetitive strain on a tendon may cause tiny tears that accumulate over time. These tears may result in pain and can eventually change the structure of the tendon resulting in acute inflammation and/or degeneration that can lead to pain, tissue adhesions, movement impairment and eventually loss of function.

HOW PHYSICAL THERAPISTS HELP HEAL TENDINOPATHY

ADDRESS THE CAUSE

  • Astym therapy addresses the underlying cause of tendinopathy and other soft tissue problems by engaging the body to regenerate healthy soft tissues (muscles, tendons, etc.), and eliminating unwanted scar tissue that may be causing pain or movement restrictions.
  • Correct poor footwear
  • Assess or change equipment, for example choosing a racquet with a larger sweet spot will help reduce load on the arm.
  • Correct stroke mechanics, for example bending knees at least 10 degrees during the service motion will lessen the load on the shoulders and elbows.
  • Identify proper training loads and recovery to avoid overuse injuries.
  • Incorporate proper warm-up or cool-down for tennis.
  • Develop a balanced training program for tennis to include stretching, strengthening, speed, core stability, agility, balance and coordination.

WHY ASTYM THERAPY IS SO SUCCESSFUL

Astym therapy, evidenced to engage the regenerative mechanisms of the body and promote the healing of soft tissues, has repeatedly been shown safe and effective in controlled clinical trials, clinical study, and large population outcomes data.  A new approach to soft tissue treatment, Astym therapy resulted from a large, groundbreaking research endeavor supported by major hospitals and universities.  It is used in settings ranging from therapy clinics to hospitals to industrial rehabilitation to elite/professional athletics, and has been proven to be more effective than other available treatments.

Astym-certification is advanced training and not everyone is qualified to perform this higher level of care.  In order to become Astym-certified, a clinician must undergo intensive training and testing.  Doctors often prescribe Astym therapy for their patients because it is safe, high quality care that has been proven to be effective.  To find or confirm a clinician is certified in Astym therapy, visit the Find a Provider section of the Astym therapy website.

Lisa Chase

Lisa Chase, PT, OMPT, Astym Cert is an internationally recognized physical therapist, educator, lecturer and published author with specialty in rehabilitation and wellness. She received her Bachelor’s Degree in Physical Therapy from the University of Pittsburgh in 1991, a postgraduate certification in advanced orthopedic manual therapy in 1995. She is Polestar Pilates trained, Certified Kinesio Tape Practitioner, Certified MELT Instructor as well as Astym Certified.  She currently runs her own practice Back 2 Normal Physical Therapy, Inc. where she provides expertise in integrative physical therapy with particular interest in comprehensive and holistic manual physical therapy treatments and prevention of spine, sports and orthopedic injuries.

Lisa has worked one-on-one with world-class athletes, coaches, medical and fitness specialists around the world to help prevent injuries, decrease recovery time and optimize performance. She has brought her expertise to WTA Tour (Professional Women’s Tennis Association), ATP Tour (Professional Men’s Tennis Association) AVP U.S. Pro Beach Volleyball, LPGA, Major League Baseball, the English Premier Soccer League and covered the 2004 Olympics in Athens Greece.

Lisa lectures nationally and has been an Adjunct Clinical Professor at Michigan State University, in the College of Osteopathic Medicine, since 1998 and Assistant Instructor for SFMA and FMS Systems since 2010. She is a published author of several books on aquatic rehabilitation and published coauthor in the British Journal of Sports Medicine. Lisa is also the founder and co-owner Rehab Links, a unique exercise software for medical, health and fitness professionals.

 

 

Finally, Tennis Elbow Relief with Astym Therapy

My pain began about 3 months prior to receiving the Astym treatment. I had limited mobility in my right elbow and sharp pains as well. After a few months I sought treatment from a chiropractor. Unfortunately this did not relieve my pain. My chiropractor referred me to an orthopedic surgeon, and this is where I was diagnosed with tennis elbow. I received a cortisone shot and began occupational therapy. During therapy I was given the Astym therapy. It was painful at times but my mobility began to increase, and I was able to use my right arm again. I am grateful for this typ of therapy because I am right handed and use my arms so much throughout the day when I teach, do household chores and many other activities. With this therapy I was able to go back to my normal life. Thank you so much!!!

Emily
Treating Clinic:  Memorial Hospital and Health Care Center
800 West 9th Street, Jasper, IN 47546
Phone: 812-996-0682 Website: www.mhhcc.org

Following injury and surgery, my elbow pain finally gets relief from Astym therapy

About 12 years ago I damaged my right elbow. Three surgeries later I still cannot fully straighten or extend my right arm. I have learned to live with this (as well as my arthritis) but this means there is a great deal of stress placed on my right wrist, elbow and shoulder to compensate. Periodically I get flare-ups of tennis elbow and elbow joint pain. I had been having a particularly bad one for a couple of weeks and decided that I needed physical therapy. Ginger Haley at ATI in Kirkland recommended I try Astym therapy because she said she’d had good results with it. I saw improvement from the first session! My pain was eased almost immediately and the flexibility and strength training Ginger also added to the Astym treatment over the next few sessions have made my arm feel better than it has in years. The change has been remarkable, I have had to deal with this issue for a long time, so I know what a normal cycle of flare-up and calming down is. This accelerated the healing process phenomenally even though I was having one of my worst flare-ups in years – I am doing things now with no pain that I know would have triggered a flare-up in the past. I can’t say enough about this treatment, how well Ginger applied it, and how well it worked!

Marty Alekiss
Treating Clinic: ATI Physical Therapy-Kirkland
11821 NE 128th Street Suite C
Kirkland, Washington 98034
Phone: 708-227-1497

Astym® Therapy Shown Effective in the Treatment of Tennis Elbow – Again!

More support for Astym therapy has just been published.  A large, randomized clinical trial showing Astym therapy to be highly effective for tennis elbow, and also demonstrating Astym therapy’s impressive efficacy on recalcitrant tennis elbow, has just been published in a peer-reviewed journal.

This large scale clinical trial demonstrating the effectiveness and safety of Astym therapy gives even more reason for referral sources and patients to seek out certified Astym providers.  Large controlled clinical trials are very important contributions to the literature, and we are pleased that Astym therapy has joined the rare, elite rank of treatments that have quality clinical trials supporting effectiveness and safety.

Please feel free to download and share this clinical trial:   https://peerj.com/articles/967.pdf

Astym therapy is one of the most researched and effective interventions available – it is unmatched in its ability to resolve a wide range of soft tissue dysfunctions.  

 

Tendonosis of the elbow: Astym therapy gave me results when nothing else would work!

After two months of trying to heal my extremely painful elbows on my own, i was diagnosised by my physician with tendonosis. I had stopped working out with a personal trainer. I also stopped my yoga practice that my husband and I had been doing regularly for many months. The doctor said it was a very lengthy healing process, because tendons have little blood flow, which is what is needed to heal. I tried several different things to heal my degenerating elbows including self physical therapy excerises, taping, bracing, acupunture and injections. None of those gave me the results i received with Astym therapy. I am still healing, but I am anxiously excited with my results. My left elbow is mostly healed and my right is getting there. I truly apprecitate Heidi, my therapist. She encourages continuing the treatment and it is working. Thank you.

Machelle Timmermans
Treating Clinic: Heidi Carstensen, DPT, SERC of Liberty
1512 NE 96th Street, Suite A
Liberty, MO 64068
Phone: 816-792-0775  Website:  www.serctherapy.com

Tennis Elbow – amazing results from Astym therapy

After 12 years in the military my left elbow had enough, The pain was so bad i couldnt even pick up a coffee mug. I was extremely skeptical Astym treatment would be effective but gave it a try. Here i am 3 weeks into treatment and its amazing how much better i feel.

James Miller
Treating Clinic: SERC of Warrensburg
540 East Young Suite E
Warrensburg, MO 64093
Phone: 660-262-4795  Website www.serctherapy.com

Tennis Elbow: Astym therapy works!

I had been suffering from tennis elbow for about 8 months. I tried using the the tennis elbow band you put around your arm which usually works for me but it wouldn’t even touch it. I am a firefighter and work construction part time so everything I did was killing me. My grip strength was half of what it usually was and I had constant sharp pains radiating from my elbow. It got so bad at night I could hardly sleep. I had no time to give my elbow rest so I was taking Aleve to dull the pain. I started astym therapy and it stayed the same and then got even worse which is normal from what I was told. Then it just started getting better very quickly. My therapy has been finished for two weeks now and I feel just a slight bit of pain. My strength is at 95%. I continue to do the exercises I was given and hope to be pain free. Astym therapy can be painful but well worth it. I truly believe astym therapy works and have already recommended it to a friend of mine with the same problem.

Chris Conover
Clinic: Via Christi Rehabilitation Services, Wichita, Kansas                       Website:  www.viachristi.org

Tennis Elbow Bringing Me Down – Astym therapy was what I needed

The pain in my elbow was not getting any better. Actually, I was beginning to experience limited use of my whole arm. Opening door knobs, cooking, drying my hair and writing were beginning to be affected because the inflammation caused by my tennis elbow was so bad. After the Astym therapy I began to regain use of my arm. Then we were able to discover exactly what was causing my problem, which was the way I slept on my arm. Astym therapy was exactly what was needed.

Andrea Greene
Carolina Orthopaedic & Sports Medicine Center Physical Therapy & Rehab 620 Summit Crossing Place Suite 305 Gastonia, NC 28054
Phone: 704-833-3103 Website: www.carolinaorthopaedic.com