What is Tennis Elbow and How Can Physical Therapy Help?

By Nick Mazzone, PT, DPT, CSCS

What does tennis elbow mean?

“Tennis elbow” is the nickname given to a condition known to the medical community as lateral epicondylitis (also seen ending in -osis or -algia). This name describes the region from which the pain originates on the outside of the elbow. The lateral epicondyle is the part of the upper arm bone that serves as the origin for all of the muscles that extend the wrist.

What causes tennis elbow?

Tennis elbow is considered an overuse injury. It typically occurs after repetitive stress to the involved region over time, however one traumatic incident such as a fall or work accident may also cause inflammation in this region. Tennis elbow got its name because it is a common overuse injury seen in those who play the sport. Tennis players tend to hold a tight grip on their racquets while producing powerful forces with their wrist extensor muscles. In certain cases, this may be a recipe for inflammation. Another common population that tends to get tennis elbow is the office worker. Being in a position of wrist extension while typing for prolonged periods may cause repetitive stress to the outside of the elbow.

Here is an example of what your posture should look like while in front of your computer:

How Will Physical Therapy help me?

Your physical therapist will design a specific treatment plan tailored to your needs based on your background and activity level. The program will consist of soft tissue mobilization to assist in the healing process, stretching/mobility training, functional strengthening of eccentrics (the muscle’s ability to control movement from wrist extension to wrist flexion) and grip strengthening, training of ergonomics and posture, and education on how to prevent the condition from reoccurring.

Your specific program will depend on how you acquired the condition in the first place. An office worker will be trained to alter their desk setup in order to decrease the stress on the wrist extensors. A tennis player may be prompted to consider changing the thickness of their racquet handle or the tightness of the strings. Both of these variables may help contribute to the repetitive stress that occurs during the sport since more force production is necessary to produce the desired effect when these conditions are not optimal.

This picture shows one way to stretch the wrist extensor muscles.

Click here to find out more information about physical therapy for tennis elbow

Check out this video for 3 simple exercises to help with your tennis elbow:

About-

Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources 

Main photo retrieved from https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987

Photo of bones of arm retrieved from http://cruxcrush.com/2014/06/26/climber-problems-elbow-injury/

Picture of wrist and finger extension retrieved from http://www.militarydisabilitymadeeasy.com/images/handmuscles/

Picture of ideal desk posture retrieved from xhttps://www.microsoft.com/accessories/en-us/support/ergonomic-comfort

Photo of wrist extensor stretch retrieved from https://www.therapeuticassociates.com/athletic-performance/golf/stretching-for-golfers/

What is Assisted Stretching and How can it help me?

Nick Macaluso

Stretching is kind of like flossing... everyone knows they should be doing it, but who really does it? It’s one of those things that we’re all going to start making into a habit tomorrow, but somehow tomorrow never comes. To our credit though, when we get that cramp in our thigh, or piece of spinach in between our teeth, we know exactly what we need to do. But how do we identify the exact muscles that tend to cramp or spasm, and prevent it from happening? How can we isolate and stretch the muscles we hold the most tension in to prevent and alleviate pain? How can we most effectively just enhance our mobility for a higher quality of life? The answer, Assisted Stretching.

What is Assisted Stretching?

Assisted Stretching is a hands-on method of stretching in which a person is gently supported through a series of stretches by a trained practitioner. Assisted Stretching is more effective than stretching by yourself because the practitioner stabilizes your joints in positions that allow you both to isolate and stretch one muscle at a time while expanding your fullest range of motion. The benefit to being able to isolate and stretch individual muscles is to give both you and the practitioner a better understanding of where exactly your body may be out of alignment. Perhaps your low-back pain is just a result of tight hamstrings, or your sciatica is just a result of tight glutes. Both of which can be relieved from general stretching, but without the assistance of a trained practitioner, it is nearly impossible to isolate the exact muscle and relieve its tension.

Why is Assisted Stretching so productive?

Aside from being able to realign your body by isolating the muscles being stretched, Assisted Stretching is an opportunity for you to relax and repair your body and mind while still using your time constructively. Many of us after long days or weeks want nothing more than a massage to take the tension out of our backs, necks, shoulders, or hips, but aside from the relaxation, what is the massage doing to prevent that tension from returning? Most of the time, tension builds in areas of our bodies that are either overactive or misaligned due to habitual poor posture. While massages are great, if you’d rather spend your time relaxing AND simultaneously preventing the tension from returning, Assisted Stretching is for you.

Stretching is one of those things that people spend their lifetime studying and writing about because of its incredible complexity and near infinite amount of benefits. But instead of wasting your time with all that, experience the hype for yourself by scheduling a 20 minute Assisted Stretching session with Nick Macaluso at Evolve Physical Therapy. Sessions run in 20 minute increments and can last anywhere from 20 minutes to 2 hours depending on how long you would like to be stretched. While this service is open to the public, all active patients of Evolve must first speak to their therapist to ensure an Assisted Stretch is right for them.

For more information or any questions, give us a call at 718-258-3300 or contact us today!

How Can PT Help My Spinal Stenosis?

By Nick Mazzone, PT, DPT, CSCS

Spinal stenosis is one of the most commonly diagnosed conditions that affects the lumbar spine (lower back). It is common for people with stenosis to feel tightness and pain that radiates from the low back and buttocks down into both legs.

It is estimated that only about 5% of people with spinal disorders actually require surgery (Eidelson, 2018). So, what are the other 95% of people expected to do? This is where physical therapy comes into play. There are many methods your PT will use in order to help address the issue causing your pain and discomfort. This includes but is not limited to therapeutic exercise, soft tissue mobilization, manual stretching of the hips and spine, and postural re-education.

What is spinal stenosis of the lumbar region?

As you can see from the picture above, stenosis of the spine involves a narrowing of the canal in which the spinal cord sits. This leads to increased pressure on the spinal cord as well as the nerves that branch from it. This is the reason why people feel pain in the buttocks and legs; the region of pain stems from a specific section of the spinal cord that is under pressure. For this reason, two people with the same condition will present with different symptoms.

How can physical therapy help with this problem?

The treatment plan will be specifically tailored to each patient with stenosis. The main objective is to help decompress the spinal cord and its nerve branches by using techniques that create more space in the spinal canal. Bending backward, also known as extension of the lumbar spine, will decrease the space in the spinal canal due to the way the joints of the spine are oriented. This may increase pain and symptoms in a person with spinal stenosis. For this reason, the treatment plan will be focused on utilizing and improving spinal flexion, more commonly known as bending forward. This will help to widen the canal and decompress the inflamed structures, effectively providing relief of symptoms.

A comprehensive treatment plan will help you find positions of maximal comfort and give you more drug-free and surgery-free options for taking care of your lumbar spine and preventing pain in the future.

Please check out this brief video that provides 3 simple exercises to help decrease symptoms due to lumbar spinal stenosis, or click here to find out more information about physical therapy for spinal stenosis.

Resources

Eidelson, S. G., & An, H. S. (February 2018). Spinal Stenosis Center | Lumbar, Cervical, Symptoms, Exercise, Surgery. Retrieved March 18, 2018, from https://www.spineuniverse.com/conditions/spinal-stenosis

Picture of person with low back pain retrieved from http://www.omegapainclinic.com/spinal-stenosis-pain-treatment-utah

Pictures of stenosis in lumbar region retrieved from https://www.spineuniverse.com/conditions/spinal-stenosis

Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.

What Does Foam Rolling Do for Me?

By Nick Mazzone, PT, DPT, CSCS

Foam Rolling has become one of the more popular health and fitness topics over the past few years or so. These tools can be found in many different shapes, sizes, and colors with varying textures and firmness to fit everybody’s apparent need. If you google this, you will find claims that foam rolling can help you improve range of motion, muscle strength and performance, and decrease pain. It is also often used as part of a warm-up and cool-down within an exercise program.

Who do I believe?

Well, unfortunately there are very few studies on foam rolling and its effects on our muscles and connective tissues. The following bullet points can be used as a summary of the current body of research on this topic:

Positive Effects of Using a Foam Roller

·      Increased blood flow

·      Increased tissue temperature

·      Better short-term improvements in range of motion versus static or dynamic stretching

·      Decreased sensation of pain

What Foam Rolling Will NOT do for You

·      Increase strength or power output

·      Give lasting improvements in range of motion when used as a stand-alone treatment

·      Lead to complete resolution of pain/symptoms when used as a stand-alone treatment

Let’s Discuss these findings…

As you can see, there are some benefits to using a foam roller, however I feel it is important that we clear up some of the common misconceptions on the topic…

Many people who use a foam roller use it in isolation as a method of improving their mobility. I understand why people want this to be true; foam rolling is much easier and less strenuous than stretching. Unfortunately, you will not receive lasting effects from foam rolling alone. While foam rolling will only provide temporary improvements in range of motion, we can take advantage of this temporary improvement by proceeding to perform static or dynamic stretching. With consistency, this can help to improve range of motion on a more permanent basis (although more studies are needed on this topic).

There is also no evidence that foam rolling increases strength or explosiveness during your workout, however one may argue that by utilizing a foam roller you are increasing blood flow to the area, and therefore, helping to facilitate contraction of specific muscles during exercise.

Foam Rolling may also help decrease pain by working to desensitize the area through repetitive stimulation and can help promote tissue healing by improving local blood flow.

How do you suggest I use the foam roller in my daily life?

·      In conjunction with a stretching program for improving range of motion

·      As part of a warmup routine, especially for activities that have high mobility requirements

·      As an alternative to pain killers for temporary pain relief

·      As a method of soothing sore, painful muscles after a physically demanding workout

Check out this video for a brief introduction on how to use a foam roller:

For more information or any questions, give us a call at 718-258-3300 or contact us today!

Resources:

Su, H., Chang, N., Wu, W., Guo, L., & Chu, I. (2017). Acute Effects of Foam Rolling, Static Stretching, and Dynamic Stretching During Warm-ups on Muscular Flexibility and Strength in Young Adults. Journal of Sport Rehabilitation,26(6), 469-477. doi:10.1123/jsr.2016-0102

Cartoon depicting man foam rolling retrieved from https://www.gq.com/story/foam-roller-tips

Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.

How Do I Warmup Prior to Lifting Weights?

By Nick Mazzone, PT, DPT, CSCS

The warmup phase is easily one of the most forgotten components of an exercise program these days. Would you intentionally leave it out if I told you that it could lead to increased performance and results during your workout?

Traditionally, people have used static stretching (long holds in a position that lengthens a muscle) before workouts to help decrease their risk of injury, however there is no evidence that this is the case. Static stretching before exercise has actually been shown to decrease maximal force production, jump height, and sprint speed while increasing reaction time and impairing balance (Perrier et. al).

Rather than static, long holds in the lengthened position of a muscle, dynamic movement involves actively moving through a joint’s range of motion without holding at the end point. A study by Perrier et. al found that dynamic movement including skipping, shuffling, and calisthenics of increasing intensity that were chosen based on the movements that would be performed during training led to improved athletic performance versus static stretching and no stretching at all.

Dynamic movements that mimic the exercises you will be performing help to prepare the central nervous system for physical activity. By activating specific muscles prior to exercising, we are facilitating proper muscle activation patterns and therefore, “priming” the nervous system.

Suggestions for a proper warmup routine

·      15-20 minutes of dynamic movement

·      Must make an effort to mimic the activities that will be performed in the exercise  program

·      Must include enough intensity to elevate heart rate

·      Should not approach more than 30% of your maximal effort to prevent muscle fatigue

Example of warmup routine prior to squatting or deadlifting

·      Bridging with a resistance band 3 sets of 15-20 reps

·      Marching with a resistance band 3 sets of 15-20 reps

·      Body weight squatting with a resistance band 3 sets of 15-20 reps

·      Lateral Band Stepping with resistance band 3 sets of 10 steps in each direction

Example of warmup routine prior to overhead pressing or bench pressing

·      Banded shoulder external rotation with retraction 3 sets of 12-15 reps

·      Wall Angels 3 sets of 10-15 reps

·      Overhead Arm Raise at Wall 3 sets of 10-15 reps

·      Banded Wall Climbs 3 sets of 8-12 reps

For a preview of upper and lower body warmup routines, check out these videos:

For more information or any questions, give us a call at 718-258-3300 or contact us today!

Click here for more information about sports physical therapy and how a personalized physical therapy program may just be your best bet…

Resources

Perrier, E. T., Pavol, M. J., & Hoffman, M. A. (2011). The Acute Effects of a Warm-Up Including Static or Dynamic Stretching on Countermovement Jump Height, Reaction Time, and Flexibility. Journal of Strength and Conditioning Research,25(7), 1925-1931. doi:10.1519/jsc.0b013e3181e73959

Warmup picture retrieved from https://www.hosmerchiropractic.com/blog/7-ultimate-dynamic-stretching-exercises/

Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.