I was asked to perform health consultations for a multinational company. The purpose of the health consultation was to empower individuals to adopt an active approach to their health. Emphasis to be placed on a health lifestyle including diet, exercise, posture and stress prevention. Individuals had their body composition measured and reviewed. After measurements were taken, a 1 to 1 consultation took place to go over results, make recommendations and help set goals.
Are you tired? Feeling out of shape? Poor posture? Body aches, pain or sports injuries? Come in and get your physical health consultation in our office or have us come and visit your office and assess and treat your staff or clients.
Wimbledon Tennis Championships is underway and it reminded me to touch on the dreaded “tennis elbow” diagnosis. I hear this all the time from people who complain of lateral elbow pain (pain on the outer elbow) but don’t even play tennis. I always ask “did you hurt your arm playing tennis?” If not, then you don’t have “tennis elbow”. Patients then claim to have some kind of tendonitis or lateral epicondylitis . Unfortunately, you most likely have a tendonosis or epicondylosis. I spoke with some Crossfit and basketball athletes last week who have battled “tennis elbow” before without ever playing tennis. “Tennis Elbow” affects not only sports people but office workers and labourers as well.”
“”Tennis Elbow” affects not only sports people but office workers and laborers as well.”
My doctor or therapist said I have “tennis elbow”, I guess I have some kind of tendonitis or tendonosis. What is the difference?
Tendinitis is the active inflammation of the tendon. The mechanism usually occurs due to micro-tears that occur with repeated heavy or sudden overload. Tendonitis occurs overs a few days to weeks and time to recovery can be anywhere from 4 to 6 weeks. The key for this diagnosis is that there has to be an inflammatory, chemical, component. Unfortunately, research has shown us that more often than not, there is NO active inflammatory component in long standing cases of “tennis elbow”.
Tendonosis is more degenerative in nature. The injury occurs due to the tendon chronic overuse. Without adequate rest, even light, repetitive strains can result in a tendonisis. Tendonosis occurs typically over 7 to 10 weeks and time to recovery can take even longer, between 3 to 6 months. This tendonisis has a degenerative component over an inflammatory one.
Why is the diagnosis important?
Depending on what process is going on will depend on what treatment will best affect your body.
Depending on what process is going on will depend on what treatment will best affect your body. Inflammatory tendonitis requires an initial anti-inflammatory treatment protocol. By trying to give strengthening or stretching during this phase could hinder your recovery. Less conservative approaches, such as anti-inflammatory medications, and corticosteroid injections, may not be particularly effective if you do not have an active inflammatory component in your injury. In some cases, corticosteroid injections risks have been shown to increase the degeneration of tendons, risk of recurrence and therefore, make the tendon at risk for rupture.
Degenerative tendonosis requires an approach that addresses rebuilding the tendon as quickly and safely as possible. Specific exercises like those prescribed by FR and FRC practitioners can target the muscles and tendons without causing further degeneration. Diagnosis is also important to know when to rest and when do proceed with more advanced exercises like eccentric training. Modalities such as shockwave therapy, to help with proper neovascularization (big word meaning blood vessel supply) may be used. Blood vessel formation in tendonosis problems tends to be poorly done by the self-healing body which can lead to pain and slow healing. Other modalities such as dry needling and supportive taping can help improve pain control and support other tissues.
Coaching proper technique for the specific tasks is required for both diagnoses. Supportive bracing may also be recommended to reduce load on the elbow tissues.
How do I know which one I have?
See a health professional, like a Chiropractor, that can provide a detailed physical exam. The physical exam should consist of a general history of your complaint and specific palpation, muscle and orthopaedic testing. Your health practitioner should be able to discern the trouble muscles. Is it ECRL, ECRB, common extensor,blah blah …. All important structures involved in any “tennis elbow” complaint need to be thoroughly examined by hand.
In addition to the elbow, I would look at the wrist, shoulder and neck. There may biomechanical problems that need to be addressed to take pressure off of the affected tendon.
Are you in Hong Kong and suffer from elbow pain or “tennis elbow”?
Contact me for a healthy conversation. Perhaps I can help.
In Hong Kong and elsewhere, athletes of all sports are at a risk for concussion.
This week I have observed a couple head or collision injuries while playing and watching sports. I have observed that many event staff, coaches, parents and players are not sure of what to do when one occurs. Collisions, clashes of heads and falls can cause head and neck injuries. One of the most serious injuries that can happen is a concussion. Some of the most recent events where concussions have occurred can be observed below:
Does your HK league or facility have a plan when a concussion occurs?
What is a Concussion?
Concussion is considered a brain injury. A concussion is defined as “a complex pathophysiological process affecting the brain, induced by biomechanical forces”. (From à McCrory P, Meeuwisse W, Aubry M, et al.. Consensus statement on concussion in sport—the 4th International Conference on Concussion in Sport, held in Zurich, November 2012. Clin J Sport Med. 2013;23:89–117.)
A concussion is defined as “a complex pathophysiological process affecting the brain, induced by biomechanical forces”
The consensus statement goes further and gives 5 main criteria that defines a Concussion:
Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘‘impulsive’ force transmitted to the head.
Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes to hours.
Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged
What happens to the Brain when a Concussion occurs?
This video from the NCAA has an excellent summary of what happens to the nervous system and brain when a concussion has occurred.
I am a Coach/ Player/Organizer and I have seen an event that may have caused a head injury/concussion.
What should I do?
After observing a head injury (excluding or ruling out a spinal injury), it all starts with a side line assessment. All organizers, coaches or captains should familiarize themselves with the POCKET CONCUSSION RECOGNITION TOOL (CRT). The pocket CRT has all the basic questions needed to suspect a concussion. If a concussion is suspected, the player is referred to a health professional such as a physician or Chiropractor, for diagnosis and guidance as well as return to play decisions. This form, seen below, is the most basic way to know the signs and symptoms of a concussion and to perform a brief assessment.
“All organizers, coaches or captains should familiarize themselves with the POCKET CONCUSSION RECOGNITION TOOL (CRT)”
Pocket CRT is a MUST HAVE for all coaches, captains, athletes and organizers.
“If a concussion is suspected, the player is referred to a health professional such as a Physician or Chiropractor, for diagnosis and advice for return to play. “
Other things to watch out for:
Symptoms—somatic (eg, headache), cognitive (eg, feeling like in a fog) and/or emotional symptoms (eg, lability);
Physical signs (eg, loss of consciousness (LOC), amnesia);
Behavioural changes (eg, irritability);
Cognitive impairment (eg, slowed reaction times);
Sleep disturbance (eg, insomnia).
Remember, if you are not sure if you, or your player has sustained a concussion, it is best to be cautious and remove them/yourself from play. A player with suspected concussion should not be allowed to return to play on the day of injury. A detailed assessment should be provided for the injured athletes as soon as possible
“If you are in doubt, sit them out!”- CDC
Once the player is removed, what next?
The SCAT3 and/or other sideline assessment tools should be completed by a licensed healthcare provider in as quickly as possible. A full physical, compete with an neurological assessment should also be completed. Also, don’t leave your friend or player alone. Help them home and check on them over the first few hours following their head injury. Monitoring the signs and symptoms is essential over the initial few hours following a suspected concussion.
“Monitoring the signs and symptoms is essential over the initial few hours following a suspected concussion.”
Ordering advanced imaging (CT/CAT/MR/MRI) may be required to rule out any fractures, bleeding on the brain or significant damage. Research has shown that brain CT or MRI contributes “little to concussion evaluation” . If a patient is going through prolonged or worsening, signs and symptoms, imaging may be required.
A concussion has been ruled out by my doctor, yet I still experience neck and headaches, what could be the problem?
Other soft tissue conditions may be contributing to your neck and headaches. The “whiplash” type mechanism of a head injury can cause injury to the soft tissues: muscles, tendons, joints, bones and nerves. Chiropractors can help determine if you have a concussion as well as other soft tissue injury.
Does your school / football / basketball / boxing / jiu-jitsu / rugby league have a concussion plan in place?
Chiropractors can help educate your students, parents, athletes and members on what to do in case of a suspected concussion. I am able to provide presentations on signs, symptoms and management for concussions in Hong Kong and Asia. Do not hesitate to contact me if you have questions on education or treatment of concussions.
I was both a volunteer and injury consultant this past weekend for the mini Copa de Hong Kong Jiu Jitsu Tournament. I had a couple athletes ask, “what is the most common condition I see from combat athletes?”. In the past, I saw many lower back pain patients but most frequently it has been all neck injuries. I believe this is because athletes now train their core, abdominal and back strength much more frequently. As well, strength and conditioning for the lower back is a staple in many general body programs. Neck strength, conditioning and mobility is generally forgotten and currently this leads me to see more neck pain patients.
“Neck strength, conditioning and mobility is generally forgotten and currently this leads me to see more neck pain patients.”
Neck pain from both combat (jiu-jitsu, boxing, wrestling, muay thai, mma, football, basketball) and non-combat sports (basketball, football, tennis, golf, badminton) are quite common. Neck pain from combat sports can be particularly difficult to treat. This is due to the fact that sports typically involve techniques that strain the neck during training. Common injuries tend to occur in hyperflexion, rotation, traction and compression. The most common form of neck pain I see is from flexion based injuries from getting your neck snapped down, being pulled in a thai plum, being stacked while playing guard or being choked and head locked.
Neck pain is usually felt in the highest portion of the spine, the cervical spine area. The cervical spine area, has 7 vetebrae. When the area becomes moved beyond the normal functional range of motion both passive (bone, disc, ligament, capsule) and active tissues (muscle, joint, tendon) can become injured. The neck and upper back area has both superficial to deep areas of soft tissue that covers vertebrae (see below). Neck injuries may also cause pain into the mid back or shoulders and many times is mistaken for problems in those areas.
I have neck pain from a jiu-jitsu, wrestling, boxing and/or muay thai, what can I do?
Having your neck pain evaluated by a Chiropractor will help determine the extent of the injury and what your prognosis (the forcast of your condition) will be. If you have already recovered from a previous neck pain or injury, prevention of the next one should be what you are thinking about. Having your neck and body assesed is the best way to know how your body is moving and how painful or dysfunctional issues have affected the function of your joints.
In my clinic, if a person reports pain then I perform an SFMA, neurological, orthopaedic and palpatory assessments. Your Chiropractor should locate the dysfunctional issues and tissues (tissue Extensibility, Joint mobility, chemical pain, motor control issues, or vestibular issues). A skilled practitioner should be able to palpate using a layering technique like Functional Palpation before performing any Functional Release or Active Release techniques. Many Chiropractors possess the skill to palpate specific structures and are experts to do so. The type of treatment administered will be based on what will provide the quickest neck pain relief and return to function.
I have recovered from a neck pain and injury, what is a safe and effective exercise I can peform to help strengthen my neck?
Many athletes will typically stretch to get rid of pain and improve passive range of motion. Is that enough to prevent injury? Just stretching in order to allow your body to get into a range of motion is not enough.Aquiring strength and control in ALL RANGES (short and long ranges of motion) will help prevent injuries. This means having active ability in these ranges of motion.
Below is a video from my colleague and mentor, Dr. Andreo Spina. Featured on Jits TV, our functional range conditioning exercise will help prevent neck pain injury. This exercise is also beneficial for those who just want general conditioning for there neck.
There are other great conditioning and neck strengthening execises that a qualified personal trainer or strength and conditioning coach can give you to help prevent neck pain. Just be sure you have all the prerequesites for doing the exercises by seeing you Chiropractor. They can determine if your neck is prepared for more difficult movements.
Do you practice brazillian jiu jitsu (BJJ), muay thai, boxing, wrestling, or judo and get neck pain? See a Chiropractor for an evaluation and improve your joint health and mobility.
I volunteered to help with setup, weigh-ins and sports injury consultancy for the tournament. Do you have a sports event coming up? Judo, boxing, wrestling, football, jiu-jitsu, muay thai? Have sports and spine health on-site. 🙂
