Category Archives for "Elbow Pain"

Golfer’s Elbow

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 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.

Adam Mann Tennis Elbow

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 in Vancouver at 604-566-9716. You can call and book. Or you can book online. Thanks Adam. 

Adam: Have a good one, Mark.

2 Simple Exercises For Tennis – North Burnaby Physiotherapists Show How To Warm Up

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. 

Golfer’s Elbow (Medial Epicondylitis)

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. 

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

Elbow Pain: Forearm Flexor Stretches

This is stretch will help ease the tight forearms! Start with the elbow in a bent position. With the opposite hand, fully extend the wrist and fingers. Then straighten out the elbow and hold this for 30 seconds and repeat 3 sets. The overuse tendinopathies that occur in the medial elbow can be caused by overly tight forearm flexors. This is very common in rock climbers or golfers. If you have pain or unsure about doing the exercise, consult your local physiotherapist before continuing.

Elbow Pain: Forearm Extensor Stretches

This stretch will help ease the tight lateral forearms. This condition is commonly called “Tennis Elbow”. Start with the elbow in a bent position. With a closed fist, fully flex the wrist and rotate it outwards with assistance from the other hand. Then straighten out the elbow and hold for 30 seconds and repeat for 3 sets. Lateral elbow pain can be caused by overly tight forearm extensor muscles from sports or repetitive strain activities such tennis, racket sports, rock climbing and prolonged computer desk work. If you have pain or unsure about doing this exercise, consult your local physiotherapist before continuing.

Elbow Strain: Median Nerve Mobility Exercise

Place your hand onto your opposite shoulder to help prevent it from hiking up. Then turn your head to the opposite side and abduct the shoulder to 90 degrees. Together, extend the elbow, wrist and fingers out fully. As you start to feel a pull into the right side, turn your head to look towards the extended side. Repeat this by looking to the opposite side and extending the entire arm, wrist and fingers while turning again towards the extended side. Do it for 60 seconds, 4 sets two times per day. This is a great nerve mobility exercise biasing the median nerve. It’s important to regain full mobility in the nervous system when you are rehabbing from elbow, forearm, hand and finger tendon & muscle strains. Whether you’re an elite, avid to recreational athlete or just use your arms and hands a lot for work or activities of daily living, having the mobility you need in your muscle skeletal system will help optimize your overall function! 

Elbow Pain: Biceps Stretch

Place the thumb side of your hand facing forward firmly against a door frame or corner at the level of your hips. Keep the elbow bent to start. Then straighten the elbow and hold for 30 seconds doing 3 sets. The biceps muscle attaches just below the elbow and tightness here can sometimes be a source of pain for this area of the elbow. If you do activities or sports involving repetitive elbow flexion with twisting then this could be a source of pain in your elbow. If you are unsure about your elbow pain or about this exercise please consult your local physiotherapist before continuing.