Should I see a PT after spraining my ankle? 

Ankle sprains are a common injury and can occur for a variety of reasons such as sports, unideal footwear, or walking over unstable surfaces. A sprain is an injury to a ligament which attaches a bone to another bone. Oftentimes, a lateral ankle sprain will occur from rolling on the outer edge of your foot. This may result in an injury to the anterior talofibular ligament or ATFL for short which is the most commonly injury ankle ligament. There is a grading system for ankle sprains from grade I which is minimal damage, grade II as moderate damage, and grade III which is severe damage to the ligamentous fibers. Your provider will help classify the extent of your injury based on multiple factors including the way your foot moves and the mechanism of injury. 

Rhon et. Al. performed a retrospective study of the US Military Health System with regards to care following an ankle sprain over 4 years (1). The researchers sought to determine the influence of time to begin physical rehabilitation on injury recurrence and subsequent medical care. The results of the study found that delayed rehabilitation was linearly associated with increased probability of recurring ankle sprains and greater number of ankle-related medical visits. Thus, this study suggests the importance of seeing a physical therapist following an ankle sprain to decrease the risk of re-injury. 

Physical therapy for this type of injury can vary depending on the extent of injury and the patient’s goals to get back to different activities. The first step in healing an ankle sprain is to decrease the swelling with rest, ice, compression, and elevation (RICE). You may also be instructed to wear an ankle brace to promote optimal healing of the ligamentous structures. Promoting ideal healing is important so that the ligaments do not heal in an overstretched position as this could lead to re-injury. The next steps will focus on gaining appropriate pain free motion in the foot, so that it can move in optimal directions when walking or standing. Your therapist may also focus on strengthening the smaller muscles in your foot also known as intrinsic muscles to promote controlled loading between the various bones in your feet. As you progress with physical therapy, we will also work on balance and discuss appropriate footwear to decrease the risk of reinjury. Due to the varying degrees of ankle injuries, the course of physical therapy will change from person to person. The goal after finishing therapy is to have a toolbox of stretches and exercises that you can continue to use to prevent another ankle sprain and have in the case of re-injury. 

If you have experienced an ankle injury and need an evaluation, give us a call at 360-329-7052 to reach our Port Orchard Office or 360-625-9161 to reach our Silverdale Office, both located in Kitsap County

Click here to request an appointment and one of our staff will reach out to you. 

Jill Hoffman PT, DPT is a physical therapist specializing in treating orthopedic conditions.

 

1. Rhon, Daniel I., et al. “Delayed Rehabilitation Is Associated with Recurrence and Higher Medical Care Use after Ankle Sprain Injuries in the United States Military Health System.” Journal of Orthopaedic& Sports Physical Therapy, vol. 51, no. 12, 2021, pp. 619–627., https://doi.org/10.2519/jospt.2021.10730. 

 

Electrical Stimulation to Improve Blood Flow

After surgery, it is common to have a neuromuscular electrical stimulation (NMES) device or intermittent pneumatic compression (IPC) device to improve blood flow in the legs. The NMES includes electrodes that are stuck over specific motor points to cause muscle contraction. The IPC device typically goes around the lower leg to squeeze the vessels and push the blood back to the heart. The role of both of these is to improve blood flow in the lower extremities and decrease the risk of blood clots. While early ambulation after surgery is becoming standard practice to promote natural pumping of blood back to the heart through muscle contraction, this is not feasible with every surgery. In addition, the patient may be able to walk, but the duration and frequency of physical activity may be limited due to fatigue, side effects of medications, and overall deconditioning. 

Bahadori et al performed a study to compare the effects of NMES to IPC and their effect on enhancing microcirculatory blood flow in the thigh (1). A Laser Speckle Contrast Imager was used to measure the superficial blood flow on the leg. They compared three different scenarios: IPC, NMES with a visible muscle contraction, and NMES without a visible muscle contraction. Compared to baseline blood perfusion, the NMES with a visible muscle contraction increased blood flow by 399.8%. The NMES without a visible muscle contraction and IPC elicited 150.6% and 117.3% increase in blood flow respectively. Thus, they concluded that the NMES device was superior to the IPC device. More research is still needed since this was a small sample size and only tested on healthy males. However, we can take this information to propel further research in the use of modalities post-surgery. In the outpatient PT setting, an NMES device may be recommended by your therapist if you are non-weight bearing for a long period of time to promote muscle activation and superficial blood flow in a seated position. 

Jill Hoffman PT, DPT is a physical therapist specializing in treating orthopedic conditions.

1. Bahadori, Shayan, et al. “The Effect of Calf Neuromuscular Electrical Stimulation and Intermittent Pneumatic Compression on Thigh Microcirculation.” Microvascular Research, vol. 111, 2017, pp. 37–41., https://doi.org/10.1016/j.mvr.2017.01.001. 

 

Physical Therapy After an ACL Reconstruction Surgery

According to data from 2012, approximately 200,000 ACL injuries occur annually in the U.S., and in turn, 100,000 ACL reconstruction surgeries occur per year (1). As you may suspect, this surgery is one of the most common orthopedic procedures. While the surgery addresses the anatomical injury in the knee, the rehabilitation before and after surgery plays a big role in postoperative outcomes and return to prior level of function. In this post, we will discuss the common progressions to expect with physical therapy following an ACL reconstruction. 

Before we begin talking about the rehab after surgery, it is noteworthy that preoperative rehabilitation is becoming more common to gain optimal strength and mobility. The primary goals before surgery are to reduce swelling and pain, restore full range of motion, promote normal walking pattern, and prevent loss of muscle tissue. The emphasis on motion is to decrease the risk of post-surgical stiffening of the repaired tissues also known as arthrofibrosis. Approximately 21 days before surgery is a sufficient timeframe and gives the patient an opportunity to build a relationship with their physical therapist. Wilk et. al. have found that patients who begin physical therapy prior to surgery are able to progress more easily in the post-operative phases. 

Initially after surgery, the first focus is restoring motion and returning to a normal walking pattern. Typically, the patient will be able to bear full weight on the surgical limb right after surgery. Patients will use crutches during the first week and progress to walking independently in the first 10-14 days. In the initial postoperative phase, knee extension or straightening of the knee is addressed to promote normal joint mechanics. In addition, your therapist will perform manual techniques to improve mobility of the knee cap or patella since it needs to glide atop the knee during walking and standing. Icing and compression is another important aspect of the beginning stages to reduce inflammation.  

Strengthening of the affected limb begins small, targeting all the muscles around the knee to wake them up after surgery. Your therapist may use electrical stimulation to promote firing of the quadriceps muscles which are on the top of the thigh right above the knee. This stimulation feels like small pin pricks and is set to each person’s tolerance. This muscle group is especially important to target as the quads oftentimes turn off in the presence of knee pain and swelling. They also play an important roll in walking, standing up from a chair, and most sports-related activities.  

Next, your physical therapist will begin to address knee proprioception or awareness of the limb in space. This is especially important in promoting optimal body mechanics to reduce excessive stress on the new ACL and decrease the risk of re-injury. This may begin with double leg squatting mechanics and progress towards single leg balancing. The higher levels of neuromuscular control include single leg activities over unstable surfaces while also completing a task with your arms. In addition to improving muscle firing and body awareness, neuromuscular re-education also includes instilling confidence in the surgical limb as not to favor the knee. 

Your therapist will continue to make clinical decisions and progress the applied loads as tolerated. As therapists, we are looking for pain ratings before, during, and after an activity and any signs of inflammation since these signs may indicate an overaggressive approach to rehab. While there are week-by-week guidelines, each progression is individual to the patient with their return to function and sports-related goals in mind. Typically, full return to sports occurs between 9 and 12 months after surgery. Each injury is unique and different, so it is important to talk with your surgeon and physical therapist regarding your own specific treatment and goals. 

Jill Hoffman PT, DPT is a physical therapist specializing in treating orthopedic conditions.

1. Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. Recent advances in the rehabilitation of anterior cruciate ligament injuries. J Orthop Sports Phys Ther. 2012 Mar;42(3):153-71. doi: 10.2519/jospt.2012.3741. Epub 2012 Feb 29. PMID: 22382825. 

 

Physical Therapy for Parkinson’s 

Most people have heard of Parkinson’s and probably even know about famous cases like Michael J. Fox. But what is Parkinson’s, and what can be done to help people with this disease who have very serious functional limitations? I’d like to go over some of the evidence-based treatment recommendations for patients with Parkinson’s and explain about a program called LSVT BIG TM that we offer at Pacific Physical Therapy. 

Parkinson’s Disease is a brain disorder. Symptoms generally include tremors, stiffness, balance deficits, changes in speech, and difficulty with coordination and walking. Patients often experience a gradual worsening of symptoms over time. There is currently no cure for Parkinson’s Disease, although the fictional Gray’s Anatomy doctors seem to be getting close😉. Parkinson’s is diagnosed by a neurologist and is generally treated with medication. Patients with more severe symptoms will sometimes have brain surgery to implant a deep brain stimulator device to help control difficulties with movement.  

One of the main difficulties with Parkinson’s is that there is a disconnect between perception of amplitude of a movement and actual amplitude. What does this mean? Well, without Parkinson’s, you could place a pencil on a table in front of you, close your eyes and with relative accuracy, reach for and grab that pencil without needing to feel around on the table. With Parkinson’s, patients often have a reach that falls short of their anticipated distance. The same is true for step size. This disconnect can make walking, reaching and regular daily tasks much more difficult to complete.  

An Evidence Based Program

There have been many studies done to look at various exercise treatment options for patients with Parkinson’s. Tai Chi has been shown to reduce fall risk. Forceful exercise (high speed stationary cycling with 60-80% max heartrate) is shown to improve global motor function. LSVT BIG TM has been shown to result in improvements in walking speed, balance, trunk rotation, activities of daily living and Unified Parkinson’s Disease Rating Scale. 

So how is LSVT BIG TM different from traditional physical therapy? Many PT offices see patients for 2-3 visits per week. An LSVT BIG TM protocol is a more intensive program with 4 consecutive days per week with daily carry over assignments and hour-long sessions. Before becoming certified in this program, I had patients who had been receiving PT treatments for long periods of time because of the degenerative nature of Parkinson’s with slower than desired progress. With this BIG program, the standard protocol is 4 weeks, with an allowance to continue up to 6 weeks if appropriate. I have personally seen rather impressive improvements in patients in the shorter, but more intense timeframe. Of course, as with most PT programs, the home exercises are extremely important with this protocol. 

LSVT BIG TM exercises are very specific with emphasis on large amplitude of movement, trunk rotation and high energy throughout sessions. The exercises have options for standing, standing while holding a chair, or sitting depending on the level of safety of each individual patient. Each session also includes a large portion focused on patient specific functional tasks. The activities may seem repetitive at first, but this high repetition helps to retrain or “calibrate” the brain to make these larger movement patterns feel normal.  

LSVT BIG TM is a well-researched program and LSVT global continues to promote further research to advance treatments for patients with Parkinson’s. LSVT BIG TM was modeled after a program called LSVT Loud TM, a Speech Therapy program for improving voice control. LSVT Global require therapists who are certified with them to undergo continued training as new updates and information becomes available to ensure the most up to date treatment recommendations are being utilized. 

Feel free to watch a video from LSVT Global and watch the rehabiliation program in action. Click Here

At Pacific Physical Therapist, we currently have two therapists who are certified in LSVT BIG TM treatment. Alicia Gilfoy, PT, MPT has been certified since January of 2016 and Caitin Terryll, PTA became certified in October 2021 after joining our team earlier this year. 

If you or someone you love suffers from Parkinson’s reach out to our Port Orchard clinic at 360-329-7052 or Click here to request an appointment and one of our staff will reach out to you. 

Alicia Gilfoy PT, MPT is a physical therapist who has been treating in the outpatient orthopedic setting since 2007.

Understanding the Biomechanics of Running 

Biomechanics is studying the mechanical breakdown of how someone moves. This can be performed for a variety of movements including bed transfers, lifting, walking, and running. Today, we will focus on the optimal biomechanics of running. As a disclaimer, while there are optimal running mechanics, one size does not fit all in this case. A successful biomechanics analysis is not checking all the boxes, rather it is prevention of injury and improvement in sports function.  

There are three components of distance running that we will focus on today: overstriding, bounce, and compliance. Overstriding is taking too large of a step forward which in turn leads to a braking force during each step. Bounce is the amount of vertical displacement that occurs when running. Excessive bounce is an inefficient running technique because you are using energy to move up and down rather than propelling forward. Compliance is the amount of elastic deformation in each step. Thus, you want to be able to react to the ground and propel during each step. Rather than compliance, you want to have muscular driven stiffness. 

As therapists, we usually treat individuals who already have an injury and eventually want to return to running. However, the information from this post can also be applicable for injury prevention. Let’s discuss the comparison between running demands and physical capacity. We will think of running demands as mileage and terrain, and physical capacity as strength, flexibility, and alignment. Ideally, we want our running demands to meet our physical capacity. However, most recreational runners have high running demands while training for a race and decreased physical capacity. This imbalance between training factors will lead to increased risk of injury. 

So, now the question is “what is an ideal running pattern and how do I get there?” Well, the research has shown that increasing step rate and cadence will help decrease stride length, decrease bounce, and decrease the risk of bone stress injury (BSI). A 1 step/min increase in cadence was associated with a 5% decreased risk of BSI (Kliethermes et. al 2021). Increasing cadence should not happen overtime as this will result in a drastic change in biomechanics which could lead to a compensation injury. Rather increasing your cadence by 10% of what you are currently running at will allow a safe gradual change working up to 160+ steps per minute. Oftentimes runners will use a metronome or music to a specific beat to initiate an increase in cadence. While cadence is the easiest modifiable factor to make appropriate changes to your biomechanics, you want to eventually be able to maintain that cadence without an audio or visual cue to ensure you have improved your mechanics independently. In summary, an increase in cadence can positively alter your running mechanics to decrease overstriding, excessive bounce, and excessive compliance which are all factors related to increased risk of injury. 

Jill Hoffman PT, DPT is a physical therapist specializing in treating orthopedic conditions.

References 

1. Kliethermes SA, Stiffler-Joachim MR, Wille CM, et al  

Lower step rate is associated with a higher risk of bone stress injury: a prospective study of collegiate cross country runners 

British Journal of Sports Medicine 2021;55:851-856. 

Rehab Post Tommy John (UCL Reconstruction) Surgery  

What is the ulnar collateral ligament (UCL)? It’s the “deltoid” ligament of the elbow. It’s comprised of a bundle of ligaments, posterior, anterior and transverse that maintain congruency of the elbow, specifically the humerus and ulnar. It resists valgus stresses through the elbow when throwing, carrying (baby carriers for example) and lifting. Essentially anytime the elbow is closer to the body than the hand, that group of ligaments is helping stabilize the joint.  

When one hears Tommy John surgery, they usually assume it’s a baseball player or other overhead throwing athlete. However, the UCL can be torn in a number of ways, lifting heavy boxes without shoulder stabilization for one. Repetitive stresses through the medial elbow will eventually lead to tissue break down and failure.  

What to expect with surgery 

There will be two incision sites, medical elbow and harvest site. The UCL is essentially replaced with an autograft tendon from either the hamstrings, palmaris longus or other site. Commonly the graft tendon is threaded through the humerus and ulnar in a figure 8 pattern. Complications include temporary or permanent damage to the ulnar nerve due to its close proximity to the UCL. This is can occur at the time of injury, where the nerve is overstretched. At discretion of the surgeon, it may also need to be moved from being looped around the medial condyle to the front of the elbow. 

Rehabilitation  

Elbow will initial be placed in a sling or brace to keep at 90 degrees for tissues to heal. Physical therapy can be started at this time. Your therapist will give exercises that work surrounding areas to prevent atrophy and maintain ROM. Then progressively work on elbow extension with safe full extension by 4 weeks. Full ROM usually takes 2-4 months. Average return to competition for high level athlete is about 9-12 months. Less time if not returning to sport.  

Cardiovascular and lower body/core training is important to maintain for conditioning and overall healing. Your therapist may also evaluate ROM and strength at the shoulder and scapula, as deficits here may manifest themselves with the elbow out of commission. These areas are also prone to guarding and over compensating when other areas are injured.  

Goals of Physical Therapy 

• Protect the reconstruction of both the primary site and graft site 

• Progress ROM and Isometric strengthening with progression to Full ROM and active strengthening through full range based on post-surgical protocol 
• Scapular and shoulder strengthening for improved stability and reduced strain through elbow 
• Cardiovascular training for enhance healing and conditioning maintenance 

Brianna Cook PT, DPT is a physical therapist specializing in orthopedic conditions.

Resources: 

https://www.uwhealth.org/files/uwhealth/docs/sportsmed/SM-254408_UCL_Repair_Rehab_final.pdf 

Sportsmed.org//aossmimis/Members/Downloads/AM2021/Handouts/IC108/Erickson.pdf 

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tommy-john-surgery-ulnar-collateral-ligament-reconstruction 

What is Mechanical Traction? 

Mechanical traction is a tool that physical therapists have for the treatment of low back pain. The idea behind traction is distracting the joints in the spine to relieve pain and decrease any radiating symptoms down the leg. The patient lays on their back or stomach during mechanical traction. The machine is set to specific settings in relationship to one’s body weight. Then, the machine pulls the patient’s body gradually to distract the spine. It is important to understand the basic anatomy of the spine to further understand this treatment tool. 

The anatomy of the spine consists of our vertebrae stacked on top of each other with a disc in between the vertebral bones. In addition, various nerves leave our spine to provide sensation and muscle contractions to our arms and legs. One cause of low back pain is when a disc bulges and irritates the nerves leaving the spine. The thought process is that traction may help the disc return to its intended position in the spine. It is important to remember that each case is different and the amount of disc bulging can affect the extent of radicular symptoms. The intensity and duration of symptoms will affect the possible the benefit of traction. 

Thackeray et.al. performed a study in 2016 to determine the effects of mechanical traction with targeted positional exercise compared to positional exercises alone (1). The researchers discovered that there is no significant change in disability or pain with the addition of mechanical lumbar traction. While some patients may find relief from traction directly after treatment, the research has shown that there is no significant long-term benefit. While traction is a feel-good treatment, gravity will inevitably return and compress the spine once you sit up afterwards. 

Traction is just one tool that physical therapists have, but it is not our primary focus in treatment for low back pain. To maintain improvements in low back pain, it is important to address increased core strength. The deep core muscles act as a corset to stabilize your spine. The specific muscle is called the transverse abdominus. It is activated through an exercise called core breathing. Your physical therapist will spend time during your sessions to ensure proper activation of this muscle for long term improvements in back pain. Carrying on with these exercises to reduce the risk of recurring back pain is essential in long term benefits from physical therapy. 

At Pacific Physical Therapy we have traction tables at both of our locations in Port Orchard and Silverdale, located in Kitsap County. If you feel like traction could ease your back pain and would like to have an evaluation from one of our Physical Therapists. Please contact our offices at 360-329-7052 to reach our Port Orchard Office or 360-625-9161 to reach our Silverdale Office.

Or click here to request an appointment and one of our staff will reach out to you. 

Jill Hoffman PT, DPT is a physical therapist specializing in treating orthopedic conditions.

1. Thackeray A, Fritz JM, Childs JD, Brennan GP. The Effectiveness of Mechanical Traction Among Subgroups of Patients With Low Back Pain and Leg Pain: A Randomized Trial. J Orthop Sports Phys Ther. 2016 Mar;46(3):144-54. doi: 10.2519/jospt.2016.6238. Epub 2016 Jan 26. PMID: 26813755. 

 

Should I have physical therapy for my headaches? 

If you’ve experienced a painful headache or migraine at some point in your life, then you are aware of how debilitating this can be. Even mild and moderate headaches can significantly limit function. When these headaches become frequent and persistent, it can really impact your life. So how do you know if physical therapy is something that can help with your headaches? 

First of all, it helps to classify the different types of headaches to determine the cause. The two main classifications are Musculoskeletal Headaches and Non-Musculoskeletal Headaches. Both of these categories can be divided even further into subcategories. Musculoskeletal Headaches can include tension headaches and cervicogenic headaches. Basically, the tension headaches are caused by muscle spasms in the head, neck or face. They generally feel tight or throbbing, but don’t completely prevent normal daily function. Cervicogenic headaches are caused by joint dysfunction in the cervical spine which can cause nerve irritation. These headaches are generally more moderate to severe lasting longer than two hours and are made worse by neck movements and poor posture.  

Non-Musculoskeletal Headaches

Non-Musculoskeletal Headaches can have various causes, but generally fall into 3 categories with the exception of illness or medical emergency head pain such as flu, stroke, or aneurism. Migraines are not just severe headaches. They are classified by having at least one of the following: Nausea, vomiting, light sensitivity, or sound sensitivity. They must also have at least two of the following: Present on one side, pulsating, moderate to severe intensity, and causes the person to avoid their normal daily activities. They also last from 4-72 hours. Migraines may be caused by vascular reasons, but they will often have warning signs that can include musculoskeletal headaches that can trigger them. 

Cluster Headaches

Cluster Headaches often occur at night with sharp pain in the back of the eye. They can last from 15 minutes to 3 hours and are often associated with sinus symptoms. These are more common in men and sufferers will often avoid laying down with this type of headache. Secondary headaches can have a variety of causes including dehydration, caffeine withdrawal, and medication changes. 

At Pacific Physical Therapy, we typically treat musculoskeletal headaches, but these treatments can often be beneficial for migraine sufferers who have a tension headache trigger. Initial treatment will typically focus on improved joint mobility and reduced muscle spasms. The key to lasting relief, however is to address the underlying reason for the restrictions. Postural stabilization exercises and activity modification are two methods for reducing symptoms long term. So, if you are ready to say goodbye to your headaches, or if you want to know more about if physical therapy is right for you, talk to your doctor and schedule an appointment. 

If you are experiencing headaches and need an evaluation, our clinics in Port Orchard and Silverdale do an injury screen to help you know what is the best way to address your injury.

Click here to request an appointment and one of our staff will reach out to you. 

Or give us a call at 360-329-7052 to reach our Port Orchard Office or 360-625-9161 to reach our Silverdale Office, both located in Kitsap County

Alicia Gilfoy PT, MPT is a physical therapist who has been treating in the outpatient orthopedic setting since 2007.

What is an assistive device? 

Assistive devices are items made to help a person perform a specific task. Some commonly used devices are crutches, canes, and walkers. There are various reasons why your provider may recommend using a device including pain, weakness, or poor balance. Sometimes people use an assistive device consistently throughout the day, especially if they’ve just had a surgery and are unable to bear weight on a limb. However, most times, people use their assistive device only as needed such as walking longer distances in the community, ambulating over uneven surfaces, or negotiating stairs. When first learning to walk with an assistive device it can be challenging to coordinate a new walking pattern. 

Which arm should I use to carry my device? 

As a general rule, one should carry their cane or single crutch in the opposite hand of the injured leg. This allows the cane to offset some of the forces on the injured leg while walking. By balancing these forces, the assistive device may help improve balance and decrease pain. The main goal of walking with an assistive device is to perform a normal stepping pattern including stepping through with each foot. This means that with each step forward, the foot in front should step past the opposite foot. This will improve the efficiency of walking and provide more symmetry with each step. During your therapy session, your therapist may focus a portion of your treatment on gait training to improve coordination when using a device. There are specific patterns of walking with the device to improve efficiency and safety. It is important to remember that everyone has different needs with their own therapy, so these are simply guidelines rather than set rules.

How do I carry groceries? 

Even when rehabbing after an injury, individuals still need to carry on with life including running errands and carrying bags or groceries into their home. Adding another object to carry can further complicate walking with a painful or weak leg. It is quite important to be sure that you have appropriate balance before adding a carrying exercise into walking. Kinesiologists have broken down the components of one’s body weight, use of a cane, and the external weight of a bag in relationship to the forces placed on the hip joint. Carrying a bag using the same arm as the weak leg can help decrease the forces on the hip joint and facilitate walking. Ultimately, physical therapy will assist in strengthening the hip musculature to support one’s body weight and any additional external weight. However, while one continues to recover, carrying a bag on the same side as the involved leg can be helpful in decreasing hip pain when walking.  

Jill Hoffman PT, DPT is a physical therapist specializing in treating orthopedic conditions.

What is Golfer’s Elbow? 

Golfer’s elbow is also known as medial epicondylitis, and it typically involves pain in the inside corner of your elbow. This is the insertion point for the muscles that flex and pronate your wrist. Although it is called Golfer’s elbow it is also a common injury in throwers. The stress placed at the elbow during the cocking phase into the acceleration phase of a high velocity pitch puts a lot of tensile stretch at the medial elbow. In addition, when the thrower transitions from a bent elbow to fully straight, without proper control, it can lead to various elbow injuries with medial epicondylitis as one example.  

In people who have an acute onset or more recent pain in their elbow this is likely epicondylitis. The suffix “-itis” refers to inflammation, specifically at the tendinous insertion. The treatment for this condition will focus on decreasing pain and inflammation with gradual progression to improve muscular strength. Some initial treatment may include ice, rest, NSAIDs, stretching, and light strengthening. The initial goal is to stimulate the repair process. Then, your therapist will gradually guide you to return to daily activities without overstressing the elbow. If the patient’s goal is to return to sports such as pitching, they will slowly progress back into sport specific activities with an interval program. 

In other cases, individuals who have been experiencing pain for a while may be experiencing epicondylosis rather than epicondylitis. The primary difference between the two is that epicondylosis is a more chronic condition that leads to neurologic inflammation rather than microtearing or macro tearing of the tissues themselves. Neurogenic inflammation is the release of neurologic inflammatory markers leading to increased pain signals without increased damage to the tendinous tissues. Treatment differs with emphasis on transverse friction massage, stretching, and eccentric strengthening to promote tendon regeneration in epicondylosis. 

Your therapist will determine the most accurate diagnosis with a thorough history and assessment. In summary, the treatment for tendonitis will emphasize decreasing inflammation, and the treatment for tendinosis focus on tendon regeneration. To decrease the risk of reinjury in both cases, your therapist may watch your throwing or golfing mechanics and discuss minor changes to promote optimal ergonomics. 

Jill Hoffman PT, DPT is a physical therapist specializing in treating orthopedic conditions.

References 

1. Wilk KE, Reinold MM, Andrews JR. Rehabilitation of the thrower’s elbow. Clin Sports Med. 2004 Oct;23(4):765-801, xii. doi: 10.1016/j.csm.2004.06.006. PMID: 15474234. 
2. Waugh, Esther J. “Lateral Epicondylalgia or Epicondylitis: What’s in a Name?” Journal of Orthopaedic & Sports Physical Therapy, vol. 35, no. 4, 2005, pp. 200–202., https://doi.org/10.2519/jospt.2005.0104.