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.