Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Phsyio in Vancouver. We're talking about elbow injuries today. How you doing Wil? 

Wil: I'm doing well. Thanks. Yeah. I wanna talk about elbow injuries and elbow pain with rock climbing. 

Mark: So is there something different about elbow injuries from rock climbing?

Wil: Yeah, well, I think one of the things that we need to appreciate, and our team of physios see this quite often with rock climbers that come into our clinic, is that rock climbers actually bear a lot more load in their arms when they're climbing. In terms of like the repetitiveness of it and also the power and the nature of climbing itself is quite stressful on the forearms. And so there's typically two types of overuse injuries that can occur. And they're very synonymous to the ones that are probably familiar and that are out there and basically the first one is what I like to call it climbers elbow.

And so climbers elbow is when you get like an overuse, to the inside of the forearm muscles. So those are the forearm flex. And as you can tell with climbing, there's a lot of this sort of motion where you're using those for our muscles. And it's important to identify that and I think quite often, like when we're climbing, your arms really burn right out and you really wanna attune yourself to how your arms feel at the end of each climbing session. And even the next day. Because sometimes we have hard climbing sessions where we're either training or we're just climbing for fun or whatever, but then they start to feel sore and they're like, Oh yeah, that was because I climbed really hard. But if it's still hard and usually if you just touch, then you'll start to feel the pain in there and that's not necessarily normal. 

And the other rock climbing elbow injury that you can get is basically on the outside. So that's on the extensor part. So quite commonly, the inside one is called golfers elbow, that we all know about. And then the outside one is tennis elbow. And so the reason why both of these can happen with climbers is because when you're climbing there's a lot of like, so with the gripping, but then if there's also different types of holds that you're using. So if you're using holds that are larger and there's all of the antagonists, all those opposing movements. And so that can get overused. And we see this quite a bit. 

And I think the biggest thing with rock climbers in terms of preventing these from happening is really looking at warmups, doing a proper warmup. And really not jumping back into climbing if you've taken a lot of time off. Or if you're a beginner climber, trying to pace yourself at the beginning, because we see this a lot with beginner climbers, where they jump into the sport and they climb way too much.

And then part of that too is then learning how to recover. Understanding what recovery is because and once again we see this quite a bit too. We see either beginner climbers or climbers that have taken some time off and they jump right back into it and they don't start to incorporate recovery into their training, into their climbing sessions. So recovery means looking at doing things to, you know self release, mobilize and get things moving and really like allowing it to rest as well. 

If you have a climbing session in the morning, or you do a climbing session at night and you go to do your computer job, that's a lot of repetitive strain. So that means you have to take extra care and time to focus on mobilizing and getting things working in terms of the movement and blood flow and all that stuff after your climbing session.

Mark: If you're having elbow pain from your climbing sessions, don't just ignore it. Don't just tough it out. Get in and see some experts about what's going on to see if there's help that you can get to train properly, to recover properly, to make sure that you're not getting that repetitive stress type of injury that will affect your climbing for a long time. Insyncphysio.com is where you can book for either the Vancouver office or North Burnaby. You can call them at (604) 566-9716 in Vancouver or in Burnaby (604) 298-4878. Thanks Wil. 

Wil: You bet. Thanks Mark.

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio and Sports Physiotherapists in Vancouver and North Burnaby. And we're going to talk about rock climbing injuries, specifically elbow injuries. What's the cause of this Wil? 

Wil: Yeah. So first of all, like rock climbing injuries with respect to elbow injuries, it's the second most common type of injuries that you see in rock climbing.

And usually it's an overuse chronic type of injury. So there are some sort of more acute sort of traumatic type of injuries, you know, where you get from like a fall or something like that. Those are far and few versus the chronic type of overuse ones. They can sometimes mimic what people also call it golfer's elbow or tennis elbow.

The other one is I guess it's related to the shoulder, but it can also happen down closer to the elbow, is biceps. So depending on where the injury starts to happen or where you start to get problems and symptoms or whatnot, then you can start to get a biceps overuse injury. And it's the very common thing to happen. 

Mark: So what are the symptoms of an elbow injury from rock climbing? 

Wil: Yeah, it can start off as the soreness that you get from a workout and you think that it's just, oh yeah, I had a hard workout. You know, when you push it in the gym and you feel sort of that delayed onset muscle soreness. And then it continues and it doesn't go away. It can be really sort of a low lying nagging thing too.

And that's the thing that tricks most people. So it starts off as just this little lowing, like ache that's totally tolerable, and you end up like, trying to climb through it and it just doesn't go away. And then like, you know, a few days turns into a week and a week turns into like two weeks and several weeks.

And then quite often I'll see some climbers in here that ended up like, Yeah, it happened like four or five months this has been going on for. And either it's not getting any better or it's getting worse. And so there's a few factors involved with that as well, in terms of, you know, like what contributes to these types of injuries.

And usually one of the biggest ones is just over-training. Over-training, overloading it and not enough rest and recovery. So I'm actually treating a young rock climber right now actually. He's only been climbing for three years, just coming on three years now this summer. And he's basically five days a week in the gym.

That's a lot of training and he's basically all high intensity. Every time he goes out, he givers. And so as a result, he's not really resting. And as a result, he's having such a big overload in his elbow and his forearms that that's why he's getting problems. And actually it's been leading to some hand injuries too. So it kind of trickles down. 

So the other interesting thing about someone like this too, is he's a student. He's first year engineering student and he's on the computer a lot. So now you're compounding all that climb training and all the things that you do on, you know, like already overloading in terms of a physical activity perspective.

And now you look at, okay, you know, so let's say he has a job or another person that has a job that's on the computer. Same thing. Now you've got all got all this repetitive strain happening in the forearm. So that's definitely a huge factor.

Mark: So is just getting the client history, is that your main form of diagnosis of this injury?

Wil: Well, that's a big one, initially for sure. I mean, it automatically points me to direction of what I'm thinking of and looking for. But obviously in the exam I need to rule out other things. I need to rule out like is there any trauma? And what else is going on? Like, you know, if there's other structures involved, like, so if there is like stuff in the hand, for example, is it like a pulley or a tendon or is it a ligament or is it a tendon in the elbow? So it really helps us like kind of focus in on our objective exam, when we take a really thorough history. 

Mark: And once you've diagnosed, what structure in the elbow or leading to the elbow is the problem? What kind of treatments are you, options do you have? 

Wil: Yeah, so usually like with golfer's elbow, it's similar to like on the inside of the elbow where you can get a lot of overused stuff happening around where the points of where that muscle attaches just above the elbow there. And on the outside, which is the tennis elbow. And it can be the exact same area on the upper part of the elbow. And so basically the first important thing decrease the load. Like take the intensity down, take down like the aggravating factors.

You know, if work, in school, you cannot, then obviously you're looking at the loads of like, okay, well, let's look at your training. Your training five days. Let's get you in the gym and what are you doing? You're doing hard every day. Okay. Let's get you in the gym three days a week.

And instead of doing three hard days, let's just do like for the first week, let's just do easy stuff. And then we're only going to do a couple of days that are a lot more moderate and then an easy day. And build it back up. Because ultimately what we want to do if there's any kind of acute chronic type of swelling, where there's sort of like, it's kind of a low lying, but then you climb and you do something and it flares up a little bit, then that's what I mean when I say acute chronic.

That you sort of have this like continual thing happening and it's there, but then now you're aggregate it even more. So you got to settle down that acute stuff. So when it's swollen, you got to sell it down with basically the RICE principle for the first 48, 72 hours. So don't do much, ice, compress, elevate.

So that's important. And then once you got that going, and then you'd move into the, you know, basically trying to get that healing phase. After 72 hours, up to a week is sort of that middle phase of that healing. Where it's laying down, you know, the collagen. Collagen is the basic building blocks of the muscle, tendon and soft tissue.

And then, there's the what's called the final stage, which is called re-modeling, which we want to really work at specific type of exercises. Now that's not possible if you have a lot of other stuff going on where it's not even allowing you to activate that. So this starts to become, oh, well, what caused this?

So we want to really look at, are we addressing the root cause of this first? And so that's how our treatment will be guided because if we can figure out what the root cause of the elbow issue. So maybe there's an issue in the neck. And actually with this individual, he has a neck issue. It doesn't hurt, but he did get in an accident and he had whiplash like when he was younger, but it doesn't give me any problems now, but he's really imbalanced.

It doesn't have any neck complaints per se, other than the fact that it's tight, normal tight. And so that can actually compromise a lot of the, what we call the normal movement patterns of that whole like shoulder, neck, elbow, forearm, our hands and fingers. So then what ends up happening is that that movement pattern is now like totally off.

And so we have to retrain that. And so part of looking at what we needed to retrain that is we've got to also look at what's imbalanced. So things are pulling, you know, and we can get into it a little bit more of that, especially when we look at shoulder. But you get that into the elbow as well. So there's all of these imbalances that happen all the way up. 

Mark: And what sort is the typical treatment timeframe to get that retraining underway so they can get back going five days a week. 

Wil: Yeah. So it depends on how ingrained chronically it is. If it's something that's just started and people come in right away, it will be relatively quicker. And I say this relatively quicker. And so this quotations, like the retraining part will still take a good several weeks, a few months and then ongoing sort of retraining it. And, it's like, if you don't use it, you lose it. And so if it's more ingrained, the dysfunctional movement pattern, then the longer you got to retrain it.

So I'm working with some climbers that have been working for quite a few years now where we've been trying to help them retrain your functional patterns for over a year, year and a half. It gets better, but they climb hard and they forget to do their exercises and the recovery stuff sometimes.

So we had to reset it. And so they come back into the clinic and see us, and then we actually have quite a few rock climbing physiotherapists here that work at the clinics that can help with that too.

Mark: So if you have elbow pain and you're climbing, you need to get it looked after, it's not going to go away by itself, especially if you're climbing hard. Guys to see in Vancouver are Insync Physio, you can book online at insyncphysio.com for both locations. In Vancouver, you can call them and book as well at 604-566-9716 or in North Burnaby, 604-298-4878. Get in there and get some help. Get started on your retraining. Thanks. Will.

Enter your text here...

Start by sitting on a balance ball. Hold a lacrosse ball in your hand with your elbow up and forearm parallel to the ground. Keep your shoulder down. Remember to engage your core stability muscles of your lower back to keep your posture in neutral.

Open your palm releasing the ball and quickly rotate the forearm backwards and then quickly rotate it back to catch the ball with your hand. It’s important to only pivot through the elbow and not the entire arm and shoulder.

Repeat this for 30 seconds doing 3 sets for each side daily.

This is a great exercise to strengthen and functional rehab your lateral elbow pain overuse injuries. If you have any pain or difficulty doing this exercise, consult your local physiotherapist before continuing. 

Hold a dumbbell in each hand. To target the biceps specifically begin with the palms facing the midline of your body. Lift the weight and turn your palm facing upwards, or into supination position, as you flex the arm keeping the elbow pointed down.

Then lower the weight back down reversing the motion to the original start position. Perform 3 sets of 10 reps on each side.

When done correctly this exercise helps with the recovery of your elbow injuries. Your elbow is weaker, usually after a strain or ligament injury. The biceps muscle helps to facilitate support and stability to the dynamic nature of it.

If you have any pain or are unsure about the exercise please consult your local Physiotherapist before continuing.

Mark: Hi, it's Mark from TLR. I'm here with Heather Camenzind and of Insync Physio in Vancouver. We're going to talk about lateral elbow pain or tennis elbow. How are you doing Heather?

Heather: I'm good thank you. So yeah, I've been getting some clients in with lateral elbow pain. So there's two in particular, one's a mountain biker that he is getting elbow pain just on like the outside of the elbow, more below the elbow joint. But he's getting at when he's gripping his handlebars and just absorbing like the force is going through his arm as he's going down the mountain.

And then another one is an office worker. That's getting it just with computer work. And they're very similar in that they're two different mechanisms that are causing their pain. But the reason why they're getting a pain is actually quite similar. So it can relate to a lot of people. 

Mark: So what's the cause? 

Heather: So, the main is a breakdown, is an overuse injury of the muscle and the tendon. So there's the tendon at the elbow and the muscles come up the arm and they attach into the arm. So it can break down in three different places. So it varies from person to person. Sometimes it's a breakdown of where the muscle meets the tendon. Sometimes it can be mid tendon or sometimes it can be where the tendon meets the bone.

It's all treated the same. We figure out where it is. But as physiotherapists, we just have to know that there could be potential breakdown and disruption in any of those three places. So it's overused, those muscles or tendons are getting overused. They're overworking and they're not able to recover in time before we stress them again.

Mark: And what does it feel, what is it presenting? Where they came in and say, my elbow is sore and it goes away sometimes or comes back or how does it present? And then what's the treatment protocol? 

Heather: It presents is something that often, it's painful with use. So like for the mountain biker, when he's mountain biking in particular. With the office worker it's painful with using mainly the mouse or with typing, but it's also things that it hurts them when they lift, like if they're cooking and they're lifting the kettle and they're rotating or cooking and moving a pot, or sometimes even opening like a doorknob or something, just the twisting action can be painful on the arm.

Mark: Toothbrush?

Heather: Toothbrush, sometimes driving. So it's mainly something that you're gripping and then having to move your arm. Typically people are okay at rest and normally when they're just resting their arm, the pain goes away. So it has a very mechanical nature in that when you're using it, it hurts. When you're resting the pain goes away.

The interesting thing about this injury is that it is a breakdown of the muscles and the tendon in the area, but it can often be something contributing from the neck, actually. So, this is where it kind of gets a little bit complicated and that sometimes we treat tennis elbow or lateral elbow pain, and we're just treating the elbow and it's just not going away.

And what has to happen then is we have to look higher up in the chain. So in your neck, you have all your vertebrae and then you have your nerves that come out of each vertebrae at the holes. And the ones that innovate the elbow are mainly, we labeled them C5, C6. And so often there's something going on at that level that is compressing those nerves a little bit or irritating them and contributing to the breakdown that you're getting lower down in the limb. 

So we often have to treat the elbow itself, but also looking higher up the chain to figure out what the true source of, why are those muscles overworking on one side of the body manly versus the other side? That's often a common question I get is why is it this side? Not the other side. And it's due to something higher up in the chain. 

Mark: So, I guess with mountain biking, could it also be that you're using one hand, the rear brake, if you're going downhill a lot more.  

Heather: Absolutely. So it can just be that you're using it more. Maybe it's the position of your neck a little bit. Some people when they look up, if you're mountain biking, you're looking up, you might have a little bit loss of range in your neck. And so you're looking a wee bit tilted. You might just not realize it. And you're compressing the nerve roots there a little bit and contributing to the discomfort that you're getting down in the neck or down in the elbow, sorry. 

Mark: Okay. How do you make it better? 

 Heather: Million dollar question right? So like I said, you have to treat the elbow. So there's different things that we treat or we teach the patient to do, is some stretches. So those are simply just kind of stretching out your arm, stretching out the muscles, as long as it's pain-free to stretch, it's safe to do.

The other thing that we get people doing is some strengthening exercises specifically for those muscles. And so we want to restrengthen them and why we want to do that is we want to put some loading and some force through those muscles. So then they start to heal in a proper way. So that's what the elbow treatment, then the physiotherapist will often feel your neck and do some manual therapy to try to maybe facilitate some movement through those joints a little bit more and to open things up a little bit.

So just create a little bit more space for those nerve roots. And often that can just be some like massage in the area to help to decrease the muscle tone at those segments. So it's not like you're cracking your neck or anything like that. It's just that you're releasing the discomfort at that local level.

Mark: What about EMS or heat or any kind of the massage hammering types of guns, Theragun, that sort of stuff. Any usefulness there? 

Heather: It definitely can. Heat is often just more of a pain, if it's painful, you can put heat, you can put ice on it. It doesn't necessarily make it heal any faster, but it's more for pain. So you use it just, if it's painful and it's bothering you and you want it to go away. Then you can put some heat or some ice on no problem there, and you could put it on your elbow or put it on your neck. Either is fine. 

In terms of like the Theragun, lots of people are starting to have those. The neck is like, I've never tried one on my neck, so I don't know what it feels like. I think it might be a little bit too much, too strong for it, but if it feels good and it's not hurting, it doesn't feel like it's hurting you. Maybe you could try. But often just getting in there with like yourself massaging with your hands, or even like a tennis ball or a lacrosse ball or something like that. And you just sort of lay on it and just can gently kind of massage your neck there, would be good. 

Mark: And what about electro muscle stimulation? 

 Heather: Not as useful in this case for this injury.

Mark: And the kind of exercises that you would prescribe anything specific?

Heather: Yeah, so we're looking at trying to do what we call is eccentric contraction. So we think the breakdown is happening in a tendon in particular. eccentric contractions have been proven to be more useful in helping the tendon to heal.

And so what an eccentric contraction is, is it's actually a contraction when the muscle is lengthening? So if you can see my arm, so a concentric contraction is one where the muscle is shortening. So these muscles are getting shorter to pull my wrist up. That, and then an eccentric contraction is when you're lowering the wrist and these muscles are lengthening out.

So we get people to do, what's called an eccentric contraction. So you basically have your arms supported on a desk or something like that. And then you pull your wrist up and you're holding a little weight in your hand, and then you slowly lower it down. And then you raise it up and then you can slowly lower it down.

And you build up the amount of weight that you're holding in your hand and try it also in different positions. Not just kind of with your elbow 90, but maybe straight out, depending on where you're getting your pain. Everybody's a little bit different. 

Mark: And it's going to take what kind of timeframe to get better? I imagine first is you got to lay off a little bit of what's making it hurt, but then what's the recovery protocol.?

Heather: Yeah, So it can always vary from person to person. The longer something's been there, unfortunately the longer it takes to go away. So typical timeline would probably be about like six to 12 weeks can be a typical timeline. Sometimes it can be a little bit quicker if people kind of catch it really early and it's maybe not too, too bad. Then it can go away a little bit sooner, but you have to do a little bit of a rest period. And then rebuilding the strength, rebuilding the muscle. 

Mark: So the underlying message is don't tough it out.

Heather: No a lot of clients ask, like when should I come in? Like when do I know to come in for physiotherapy? And so if someone's injured themselves and if they've trying to do something about it, maybe they're, they're trying to rest, or they're trying to stretch and they're taking measures to help it recover. And there's still no change or it's still getting worse after about seven to 10 days. It's definitely time to come and seek some help and see a physiotherapist for some additional advice.

Cool. So don't tough it out. Go see Heather at Insync Physio, you can book your appointment online, insyncphysio.com. Lots of opportunities there. So they have two locations as well. If you're in North Burnaby, they have a location there. Or you can call them. The Cambie office is (604) 566-9716. They'll book your appointment for you. Thanks, Heather.

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto. He's the owner. He's the chief physiotherapist of Insync Physio in Vancouver. Two offices, one in North Burnaby, one on Cambie Street in Vancouver. Many time winners of best physios in Vancouver and Wil himself, has been voted best physiotherapist in Vancouver, numerous times by, all of that coming from their customers. And we're going to talk about elbow problems today. How are you doing Wil? 

Wil: Yeah, I'm doing great. Thanks Mark. So probably the most common type of elbow injury or elbow dysfunction is this thing that everyone's heard of, it's tennis elbow. And so it's funny because really only 5% of people that have this type of injury or dysfunction, actually get it from playing tennis.  And I think the majority of it is from other sports, like other racket sports. 

And when you actually break it down to the three main things is like even like your job, like what you do for work. So if you have a job where you're lifting. And more than like, I think what they say, like two to five kilograms of weight  repetitively, like 10 times even just 10 times a day, you know, as your full-time job, that can actually be one of the risk factors.

 To even just a repetitive use of your hand and arm doing things like typing. To even like, if you're using tools that are basically handheld tools as your main implement for your job, then that's going to be another big risk factor. So there's a lot of things when you're looking at what causes it, but really 5% of it is really from actual tennis.

Mark: So, is it a tendon problem, a ligament problem, muscle strength problem. What's kind of the root cause of kind of things that are more common that all of us do. Lifting five to 10 kilograms isn't very much, honestly. So how come that causes elbow problems? 

Wil: Yeah. It's the tennis elbow. Yeah. So really it's the overuse and the overloading, which then causes the inability of the actual tendon that attaches. And so the tennis elbow is on the outside of the elbow. And so basically the issue arises where you start to get this overuse and wear and tear. And I'll say like, so I'll save the name, but basically, the common name when you look it up on the internet, it's lateral epicondylitis.

And so with this overuse issue, you have the degeneration that's happening in the tendon and what in effect happens is that then you start to not be able to heal as fast and you keep like doing things that basically say what's your normal load and because you have this ongoing issue, then you're actually going into overload. So you have to dial it back a little bit. And then there are things that you want to do to be able to start to actually you know, get it better and rehab it. 

But essentially what it is is it's like an injury to the tendon. It starts off as an overuse, but then it becomes a degeneration of that actual tendon. And that's basically what it is. 

Mark: So patient comes in, outside of their elbows hurting. You diagnose they've got tennis elbow. How do you treat it? What's the normal protocol? 

Wil: Well, the first thing that and I'm just thinking about a couple of clients that I'm seeing right now, and it's really important that you actually diagnose what's causing that elbow pain.

I mean, first of all when someone comes in with that kind of pain, it's usually like a gradual onset. So you can get traumatic like tennis elbow or the lateral epicondylitis. I've seen that before, too. Like working with hockey players, you get whacked with a hockey stick or lacrosse players get whacked or some kind of trauma in that area. But that's actually very uncommon. The more common thing is sort of that, Oh, you know, like it just gradually started happening. 

And so in part of that ascertainment of what's going on, you know, the history of what the individual does, is sort of complete that picture a little bit more. It gives us more of a bigger picture of what is causing this. 

And now the other thing is that when we're assessing it, we're also looking for a few different things. Like we're also making sure that, okay, so this isn't like an entrapped nerve. So that's important to also assess. And that this isn't possibly some kind of you know, degeneration of the joint, like an arthritis because when you're looking at the lateral elbow, right. 

Or if it's coming from the neck, so that's actually really important too, because is it like a disc thing that's causing a pain down in your lateral elbow or even a shoulder thing. And so those are really important things that we need to be able to clear first, before we condense and say yeah, you know, this is like a tennis elbow thing. 

And so then when we look at treating it, so if we have like a tennis elbow and quite commonly, what happens is that they may actually have a neck issue that's referring down. And so maybe like a double whammy. So they have a neck issue that probably precipitated a dysfunction in the elbow, and in this deficiency, which then led to now a breaking down of that tendon in the lateral elbow. So now they have two things going on. So in order to actually treat the tennis elbow, you also have to start treating stuff happening in the neck.

So I was telling you about this one patient that I saw who actually has just that. Where their issue in their neck you know, they just with the pandemic and everything that's going on, they're doing a lot more work on their computers, sitting and, you know, admitted his posture wasn't great. And he's also a pretty active guy, you know, he likes to hike, does mixed martial arts and his activity level took a bit of a backseat, but essentially he was doing a lot more computer work and mousing. And then the thing that also made it a little bit more complex was that he had a  previous injury in his elbow, like 15 years ago, but that kind of all cleared up. But that seemed to be something that was kind of pretty vivid in the back of his mind, so he brought that up. 

Mark: So what was the treatment? 

Wil: Basically when we looked at it, we had to treat both his neck. Basically the nerve was being affected. And he had a lot of nerve tension going along that whole segment related to the outside of his elbow. So we had to really start to mobilize that system and work on mobilizing his neck, but then the actual injury to the elbow we also had to treat too.

So we had to actually work on, there was some stiffness in the joint. But it was related to, I think, this overuse issue that he was having. And so we started doing some specific manual therapy to mobilize that. And actually the literature shows that that's actually really effective and in my clinical experience you know, combining that with specific exercises, which is really the key in terms of rehabbing this to be able to get this stronger. So there's a few key things and exercises that I can go over here with you after too.

Mark: So let's jump in. What kind of exercises? 

Wil: Well first of all I guess like one of the main things is how really acute it is. If it's really super bad, then we wouldn't be jumping into too many things to strengthen too much right away. But some of the things that we really want to work on the concept of isometric strengthening. So what isometric strengthening is, basically strengthening a muscle in constant tension without moving it. 

So basically if you break it down there's three types of movements when you look at muscles, like let's take the biceps for example. So if I'm shortening and if I'm doing this and I'm shortening, that's called concentric. And if I'm lengthening, that's called eccentric. So I can do concentric strengthening and eccentric strengthening of my biceps or isometric, where I'm just holding the weight.

Same thing applies with the elbow. So I have a three pound weight here, and if I'm working on isometric strengthening, I want to just support that on a table. And I just want to hold it. I want to just hold it for you know, depending on how acute it is, you know, 10 seconds is usually a good start and you want to work up to like 15 seconds. And just like, a couple sets of 10, once a day to start and building it up to like a couple of times per day.

So that's a really good start to just to get the strengthening in that actual tendon. So studies have shown that that's actually really beneficial. And then you can start to move into a little bit more eccentric contraction. Which is the lengthening of the muscle. 

Now, a couple of other really interesting implements that I have with me here. I want to show and go over with you guys is basically how to recover. So I'm thinking about this client of mine, who is a rock climber, but also does a lot of computer work and has been working exclusively from home. And his workstation is not that great. And he also plays a little bit of tennis as well, which is kind of funny combination tennis and rock climbing.

So a really important part of making sure you manage this is having enough rest and recovery, but also how you do that. So if you're doing a lot of activities, even if you have a job where, like I was mentioning earlier where you're handling tools all day long. Or you're lifting stuff repetitively for two hours or you're lifting things that are around two kilograms, at least 10 to 15 times a day. Then you want to do things to relax the muscles because the muscles get really shortened and tight and it actually causes more tension and fatigues the tendon a little bit more, because the tendon is always the weaker part. 

So before I actually showed the two implements there, I just want to give a full disclosure that I don't actually have any sponsorships or getting the gratuities from these companies of the products that I'm going to actually talk about.

So the first one is this device called the Rolflex and I love this thing for myself personally. Because as a rock climber myself and doing a lot of things with my hands and arms, I get really tight. And it's a really relatively inexpensive little tool and device that you can purchase for under a hundred bucks.

And I use this every time after do any kind of physical activity, like rock climbing or even gardening, I'll do like a couple of hours of gardening. And what it is is just basically a self massager for your arm. And you can use it for other parts of the body, but for the forearm it's so amazing. It's got two foam density pads here, one flat one here, like cylindrical. And then one that has like three different types of beads. And they're high density foam. And they're really super durable. I've had this thing for over two and a half years, and it's still almost looks brand new. And I use it like every day. 

And so basically how this guy works is you can adjust it depending on how big your arm is. And then what you do is you basically have a little lever here that you hold with the other hand. And then if you want to work the lateral arm muscles or the outside arm muscles, then you're just basically squeezing the top grips here. And then you're sliding your hand through and going nice and slow. And you're giving yourself a nice, good little arm massage. You can do a minimum of five to seven minutes up to 10 to 15 minutes, if you want. Hitting a few key muscles in your forearm, basically. And you can do that also for the inside of the arm as well. So this is the Rolflex. 

And then the second thing that I have here is a little bit more pricey, but it's a device that I just got recently and it's called the Theragun. And so the Theragun is like a little bit more of a luxury type of self massager. And it's got like four power settings and I can demonstrate it here for a little bit in a second. It's got like a high density foam knob and this is the basic model and it runs for around 400 bucks. But it's quite good actually. 

I'll show you the first setting here. It's actually the lowest setting and it's pretty  powerful just on the low setting. So all I have to do is just run through certain angles onto the four muscles on the front and on the back. And you can do as little as like five to six minutes. And it is a good way of self massaging the arm. 

So those are two little tools, little implements in terms of what I do for recovery. Now, obviously there's other specific type of exercises and stretches that you can do. But I wanted to just kind of show that because I think those are neat little tools and toys. 

Now the other thing that you can also do to really help support that forearm, is to get a brace. You can get a little tennis elbow brace. So it can be like a neoprene type of brace that fits over the arm like a sleeve or like basically a little cup. So you want to just find one that fits you and that you're comfortable with. And usually the best test is that when you try it on and then you try and do the thing that would aggravate it, it's actually not painful. 

And the idea behind those braces is that it actually absorbs the force. So instead of your tendons and your muscles taking on that force, which when the muscle takes on the force, it transmits it back up to the tendon. Then the brace itself actually absorbs that force and impact. So yeah, essentially those are the things that you can do to really help in addition to the exercises that I had talked about. 

Mark: If you got tennis elbow, if you have pains in your elbows, you have pains anywhere in your body. The guys to see Insync Physio, call them to book an appointment. (604) 566-9716 in Vancouver. Or in North Burnaby, (604) 298-4878. You can also book online, very convenient, very easy, insyncphysio.com. You can pick and find which therapist you want to see. Massage therapists. Physiotherapists. They got them all. They'll look after you. They'll get you feeling better and happy and back doing your favourite activities as fast as possible. Thanks Wil. 

Thanks Mark.

Mark: Hi, it's Mark from Top Local. We're here with Wil Seto of Insync Physio. He's the owner. He's the boss. He's the man. He's one of the top rated physiotherapists in Vancouver. One of the top three. How are you doing today, Wil?

Wil: Yeah, I'm doing great. Thanks. Yeah. Thank you. 

Mark: Golfer's elbow is what we're going to talk about. So this is similar to tennis elbow, isn't it? 

Wil: Yeah, very similar, except just on the other side. A really good way to describe and explain what it is exactly is, we had a client that came in earlier this week, who was presenting with some pain on the inside of his elbow.

So he was a 27 year old, a rock climber, doesn't even play golf, slash computer programmer. So he's on the keyboard, like pretty much nine to five, five days a week kind of thing. Right. It's a lot of repetitive strain, and then, you add him being an avid rock climber to the mix of that. 

So he was complaining about the pain that he was getting and it started just as he started doing more climbing again and training and training was involving like three to four days a week. He's a pretty avid climber.

As we looked at it, he was getting some overuse and issues going on in his medial aspect of his tendons. It's an overuse syndrome involving the tendons, where it becomes weaker and there's different degrees of severity that you can get with golfer's elbow from mild, moderate to severe, where, when you get really bad swelling it's a pretty severe tendinopathies developing into there.

That's essentially what it is, is an overuse syndrome. And you can get a lot of overdeveloped strength in the forearm muscles that basically ended up causing a lot of pulling onto those tendons. When you have sort of this imbalance where the muscles are stronger, it can actually pull on those tendons a little bit more.

So what happens with his situation? Because he's also a computer programmer, he's not actually resting his arms, he's always using them, he's overusing them. And one of the other components of this that came out in his history and what he was telling me was that he wasn't stretching enough, he wasn't actually recovering. That's actually really important, too, because part of that recovery allows those muscles to relax. So when those muscles in the forearms, if your muscles are really super tight, then what happens is that things shorten and then it ends up causing a lot of stress and strain into the tendons.

If you start to do things really quickly, too fast, and you get strong too quickly, too fast, then your weakest points is usually when you get these kinds of injuries, are your tendons. Because your muscles will get strong, faster than your tendons, and then you ended up injuring them and then they become strained. So that's basically what it is. 

So the other interesting thing, is that if you have a preexisting injury in that arm and he had an issue with his finger before, cause he's an avid climber, so he was already prone to having that. That's the other thing to look out for. 

So if you've had stuff happen in your arm before and you are an avid golfer or a climber or a racket player, then you gotta be really careful in doing those recovery things for it. Right. That's good to keep up with. 

Mark: What was the treatment protocol?

Wil: When we actually looked at what was going on, the other interesting thing, was he didn't have any neck issues, but he had some neck stiffness too. That wasn't the main issue, it was just causing things to creep up in the neck. So we had to treat a little bit of that as well. 

We looked at three main things. Loosening up that area of the muscle in the forearm.  I'll spare the details there, the names and the terminology, but in the forearm muscles, we needed to actually relax them. They were always like this, so we needed to find a way to help them to be able have them in a state of relaxation. He was always like this with his forearms, always, even when he was relaxed. So that was the first thing. 

The second thing was helping settle down that actual irritation.  Referring him to the doctor, cause it was actually quite inflamed and getting something to settle down the inflammation or icing it. Having some kind of a brace... He really wanted to keep climbing, that was the problem. I'm not gonna say no, you know, I did say that it's a good idea not to, so we gotta give him more brace to absorb the excess forces and the tension that he's going to actually be using on his arms. 

The third thing too, is like, so how I was saying, that he has all this stuff going on higher up. His nervous system was all triggered, all tight, and tense.

So we needed to start to mobilize all of that, and we needed to make sure that the mobility component was really big. Really looking at increasing the mobility and that whole, not just the arm, but the neck area and the nervous system, and just really making sure that everything is moving well and the muscles, and then also the strength component, making sure that now we have other aspects of the antagonizing strength or the opposite muscles that he never uses get stronger.

Finally, the main thing here too, is educating him again. You know your job, this is what you do. You gotta work on stretching and you gotta work on doing certain things to recover in that forearm, not just after you climb, but after you work or even after you do something simple as gardening, and you're doing stuff with that arm.

So some simple stuff to really help them look at keeping that arm in a good state, because he likes to push himself. 

Mark: Right. And so it's really indicative when you get a strain in one area of your body, it will magnify across other places as you try and compensate, basically.

Wil: Yeah, you can. For sure. The other interesting thing is that we got, as we get him the rehab and doing a lot of home exercises to reinforce other mobility and especially strength on this right side. You need to do it on the opposite side. And then also working on sort of this, like, you're saying this core strength for the upper extremity.

Mark: There you go. If you want expert help, if you've got pain in your elbows and you don't know what's going on, and you want somebody who can really diagnose it and get you going well, Insync Physio are the guys to get, having a look at what's going on with your body and get you feeling right again. You can check out the website at insyncphysio.com. You can book online. They have two offices, one in North Burnaby, and one on Cambie street in Vancouver. Or you can call them and just book. 

In Vancouver, (604) 566-9716 to book your appointment or in North Burnaby, (604) 298-4878. They'll look after you and you will be feeling better really quickly.

Wil: Thanks, thanks Mark. I hope that helps.

Mark: Hi, it's Mark from Top Local. I'm here today with Insync Physio, Adam Mann. Insync has won many times Best Physiotherapist in Vancouver. And we're going to talk about tennis elbow. How are you doing today Adam?

Adam: Great Mark. Good to see ya. 

Mark: So we're going to go through a client's injury history. What was going on with this client's problems. 

Adam: Yeah. So this client was basically a middle aged woman who had an office job and about a month ago started attending a group exercise class where they were just going through different weights and different circuits. And basically about a week before I assessed her, she was doing a motion called a cling and press where she kind of, are lifting up a bar weight, flipping your wrist, and then just extending your arms up. And it wasn't a whole bunch of weight, but she just felt a really sharp snapping pain in her forearm. And basically the first couple of days, it was pretty sore. And so she, iced it, she kind of rested it for a little bit, but yeah, it just wasn't getting better. And at nighttime, it kind of created this dull ache, which was from burning and nagging. And basically when she was holding out her arm in certain directions, and she was carrying anything, even a cup of coffee, she felt like a weakness and she wasn't able to actually lift that cup of coffee.

And so at that point, when she couldn't have her coffee, that's when we assessed her. 

Mark: How do you go about doing an assessment on a client when they come in with issues like this? 

Adam: So first off we do a history where we just really figure out what's going on, what the mechanism of injury was. So we kind of find out the movement that caused the injury.

And then we basically take a look at some objective measurements. So we'll look at somebody's grip strength. We'll make sure we'll look at their range of motion. After we finished talking to them, we had a general idea of, and what the tennis elbow was. That it was tennis. So, but we also take a look at the neck and we look at it, the shoulder and we sort of make sure that we're not missing anything else.

 So I did ask in particular about neck pain, because there's a bit of research that shows that compression at the level of the neck can make some of these forearm muscles more sensitive to injury. So we do what's called an upper body scan where we just kind of look at the range of motion and strength of the neck, of the shoulder, of the forearm.

We look at the joints in the forearm to make sure that there's no other fractures or anything like that. And then we come up with the diagnosis. 

Mark: So somewhere in there, I think you mentioned nerve tension. What do you mean by nerve tension? 

Adam: So, yeah. Good question. Nerves, exit the spine and travel through a bundle of bundles called the brachial plexus, and basically any nerves higher up at the level of the spine, at the of the neck, the shoulder or the forearm that may be compressed, can cause basically a bit of sensitivity, lower down, sort of like a hose that has a bit of compression. At the level of the neck would make sure that the flow of the nerve which does muscle strength, does reflexes, does sensitivity can actually just not function properly and that can lead to more people to have more prone injuries in that area.

Mark: So what was the course of treatment? 

Adam: So at first with any injury, we talk about education. We talked a little bit about rest, certain motions that would have caused more pain. We talked a little bit about her workplace. So in particular, making sure the keyboard was the right height. 

We did a bit of soft tissue work. So we did some mobilization, active mobilization where she was moving the wrist. And we were doing some basically soft tissue work on the forearm. And of course we did some exercises. Now, the first exercise that I gave her was to work on some of that neck tension and that nerve compression. So we gave her, what's called a nerve glide where she's moving the neck, she's moving the forum, she's moving all of these tissues together to try to release any compression.

Mark: And so what was the course of treatment? And how did it all work out for the client? 

Adam: Absolutely. So of course with anything, we start with a graded, it's a tendonitis injury. So with anything, what we do is a graded exercise program. So we start with adding a load, but making sure that that tendon doesn't get too angry. We add sort of an isometric compression on the tendon where we're just going to hold the tendon in a certain position with a bit of a load. And then we sort of increase that load with move motions that are, where we take the tendon to a little bit more of a compressed position, and then we add movement and we add rotational motions.

And basically we start to address some of the motions and range of motion restrictions in the neck at the same time. But yeah, at that point we got her grip strength back up to snuff, and we got her back into the gym, made sure that the pain was under control. And after about a month and a half, she was completely discharged and back to doing everything she liked doing.

Mark: So there you go. If you have some tennis elbow issues and you want people who dig deep into exactly what the cause is, not just where the pain's happening, but where it might be coming from upstream, so that you get relief fast. You want to go see Insync Physio, Adam Mann. You can book online at insyncphysio.com in Vancouver at 604-566-9716. You can call and book. Or you can book online. Thanks Adam. 

Adam: Have a good one, Mark.

Hi my name is Matt and I’m a Physiotherapist with INSYNC. Today we’re going to go over a couple of drills for warm before a tennis match. These will focus on lateral movements and movements toward the net, so it’s all about foot work.

Hi my name is Iyad and I’m a Physio here at INSYNC PHYSIO. So today we’re going to go over some exercise drills to help warm up your upper body.

Sometimes I see injuries like tennis elbow or shoulder injuries happen when there’s kinetic chain deficits, A.K.A. - when the rest of the body’s not involved in the tennis stroke or the serve. So this a nice warm up to get the w hole body ready for the serving motion and even the rally point after. You just need a resistance band. You’re going to lunge forward and extend your arm with a straight elbow. And then you could alternate legs. 

What is “Golfer’s Elbow” ?
Not to be confused with tennis elbow, golfer’s elbow is caused by damaged muscle tissue at the medial epicondyle, (inner part of the elbow), whereas tennis elbow is as a result of damage to the
lateral epicondyle (outer part of the elbow). It occurs when more force is applied to this area than the normal healthy tissues can handle. Although this is most commonly found within the golfing community, it can also appear as a result of any activities requiring the lifting, throwing, or a hitting motion. This includes racket sports, such as tennis, throwing sports, weight training, or any forceful, repetitive occupational movements.

Symptoms of golfer’s elbow include pain and tenderness, usually felt on the inner side of the elbow, stiffness, weakness, and numbing or tingling that radiates into the fingers. This pain can come on suddenly or gradually, and can worsen with certain movements such as swinging a golf club. 

Prevention?
Strengthening your forearm muscles
  · Use light weights
  · Squeeze a tennis ball
Fix your form
Using proper equipment
  · Ex. Ensuring your racket has proper grip, or a lighter head
Rest at first sign of elbow pain

Perform stretches before your activity such as the following:

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Martin, E.A., & McFerran, T.A. (2017). A dictionary of nursing. Retrieved from http://www.oxfordreference.com.ezproxy.library.ubc.ca/view/10.1093/acref/9780198788454.001.0001/acref-9780198788454-e-3672