Golfer's Elbow

Medial epicondylitis - otherwise known as Golfer’s Elbow - is a common overuse injury of the elbow.

It is caused when the wrist flexor tendons - the muscles that flex your palm towards your forearm - become injured and inflamed near your inner elbow from overuse. It is seen in avid golfers, but can also be seen in throwing athletes, tennis players, or people who work in jobs that require excessive and repetitive arm use (ex. Construction, plumbing).

In golfers, medial epicondylitis is usually caused by improper warm-up/practice habits, poor swing mechanics, and inadequate strength and flexibility of your elbow and forearm muscles. Symptoms include pain and possible swelling near the inner elbow, most commonly at the top of the backswing to just before impact. You may also notice stiffness and weakness of your elbow/forearm/wrist musculature.

Common at-home remedies can include rest, ice, and over-the-counter anti-inflammatories. However, if the symptoms persist, our physical therapist can perform a thorough examination of your injury, and provide you stretches, strengthening exercises, and provide manual techniques to help you get back on the course!

Women's Health Physical Therapy

What is women’s health physical therapy?

Have you wondered that? Maybe you were too embarrassed to ask?

Women’s Health Physical Therapy is a specialized area of physical therapy that is comprised of A LOT of various diagnoses women may experience throughout our lives.

 A women’s health physical therapist enrolls in additional training after their college education and licensing in order to evaluate and treat conditions specific to women. These conditions can include:

• Incontinence or “leaking”

• Pain lifting a child or even a bag of groceries

• Pain during sexual activity

• Issues during menopause

• Issues during pregnancy and post-partum

One of the things we learn in the specific women’s health training we take is to perform a pelvic examination in order to assess the muscles of the pelvic floor. Just like any other muscle in your body we are checking for weakness which can cause leaking, instability of pelvis/hip girdle, and organ prolapse. We are checking to see if muscles are short and tight-which can cause a restriction in range of motion and/or pain. We can also assess levels of pelvic organ prolapse.

While an internal exam may be part of your treatment, it does not necessarily need to be. It’s all depending on your needs and what you are comfortable with. Make sure you talk this through with your therapist. This is extremely beneficial in understanding your condition and creating a plan of care specific to you!

The goal of women’s health physical therapy is to restore normal function, relieve your pains, restore your confidence, and get you back doing the activities you enjoy.

Who can benefit from a women’s health physical therapist?

A wide range of things can affect you pelvic floor strength. It is a group of muscles after all and things that affect all the muscles in your body affects the pelvic floor muscles too. We women who are athletes, who are post-childbirth, women who are post-menopausal, and every stage in between.

We see patients following a car accident, a surgery, or sports injury. Luckily pelvic floor rehab can provide relief.

WHAT IS THE PELVIC FLOOR?

The pelvic floor is a group of muscles that attach from your pubic bone to the coccyx (tailbone) and in between your ischial tuberosities (“sit bones”). It makes up the “floor” of your core, so it has an important role in:

• Supporting our pelvic organs

• Closing the urinary and anal sphincters

• Sexual function

• Posture

These muscles can become dysfunctional (weak, tight, inhibited, etc.) for a variety of reasons. Dysfunction of the pelvic floor muscles can cause some of these issues:

• Urinary incontinence

• Bowel incontinence

• Pelvic organ prolapse (prolapse of bladder, uterus and / or rectum)

• Pelvic pain

• Constipation

• Issues during pregnancy and post-partum

• Low back and/or SI joint pain

• And many more diagnoses!

All of these conditions are common, but they are not NORMAL, and they can be treated with physical therapy by a women’s health physical therapist.

WHY IS THIS IMPORTANT?

Pelvic Floor Dysfunction can interfere with your everyday life and prevent you from participating fully in it. The good news? Women’s Health Physical Therapy in one of our 3 locations can help! There’s no need to be embarrassed. Pelvic Floor Dysfunction is common and treatable. Get relief. By addressing the cause and its symptoms, we can restore strength to your pelvic floor and ultimately free you from the symptoms that keep you from living your best life.

Give us a call to set up an appointment at one of our clinics nearest to you:

Whitman Physical Therapy (781) 447-3060

Hingham Physical Therapy (781) 740-4900

South End Physical Therapy (617) 262-7555

Intrinsic Foot Strengthening (or The Foot Core)

Intrinsic Foot Strengthening (or The Foot Core)

The small muscles of the foot (a.k.a the foot core) are often overlooked when we rehabilitate a lower extremity injury. However, recent evidence has shown that strengthening these muscles can provide dynamic support to the foot and ankle in all standing activities. Many foot and ankle injuries benefit from increasing strength of the foot core: below are three exercises you can try.

A physical therapist can help individualize these exercises in addition to creating a treatment plan for you and your injury.

1) Short Foot Exercise. GOAL: to bring the ball of your foot closer to your heel by lifting the muscles in the arch of your foot. 

2) Toes Spread Out.  GOAL: maintain a short foot posture while lifting and spreading out all your toes, then placing only the big and little toe on the ground.

3) Toe Yoga. GOAL: maintain a short foot posture while alternating between picking up your big toe and picking up all your littles toes

Images from McKeon PO et al, 2015 and Lee DR et al, 2019.

References:

1. Sauer LD, Beazell J, Hertel J. Considering the Intrinsic Foot Musculature in Evaluation and Rehabilitation for Lower Extremity Injuries. Athletic Training & Sports Health Care. 2011: 3(1); 43-47. doi:10.3928/19425864-20100730-02

2. Lee DR, Choi YE. Effects of a 6-week intrinsic foot muscle exercise program on the functions of intrinsic foot muscle and dynamic balance in patients with chronic ankle instability. Journal of Exercise Rehabilitation. 2019;15(5):709-714. doi:10.12965/jer.1938488.244

3. McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015;49:290. doi:10.1136/bjsports-2013-092690

4. Jung DY, Kim MH, Koh EK, Cynn HS, Lee WH. A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch angle during toe curl and short foot exercises. Physical Therapy in Sport. 2011;12: 30-35. doi:10.1016/j.ptsp.2010.08.001

5. Ferrari E, Cooper G, Reeves ND, Hodson-Tole EF. Intrinsic foot muscles act to stabilise the foot when greater fluctuations in centre of pressure movement result from increased postural balance challenge. Gait and Posture. 2020;79:229-233. doi:10.1016/j.gaitpost.2020.03.011

6. Kelly LA, Cresswell AG, Racinais S, Whiteley R, Lichtwark G. Intrinsic foot muscles have the capacity to control deformation of the longitudinal arch. J. R. Soc. 2014: Interface 11; doi./10.1098/rsif.2013.1188

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome

The thoracic outlet is formed by the first rib, the clavicle, and the superior border of the scapula. TOS occurs when there is compression of the brachial plexus, subclavian vein or artery. Compression can occur between the anterior and middle scalene, the first rib and the clavicle, or between the pectoralis minor and coracoid process.  It can be due to shortening of the surrounding musculature, hypertrophy of the musculature or trauma to the area.

Common Causes:

• Poor posture and rounded shoulders 

• Constant overhead motions 

• Weightlifting

• Whiplash

• Cervical rib (3% of population

Signs and Symptoms:

• Upper extremity paresthesia/weakness

• Neck pain

• Shoulder pain

• Pain with overhead movements 

• Atrophy of intrinsic hand muscle (in extreme cases)

Special Tests:

• Adson’s Test

• Wright’s test

• Military test (costoclavicular maneuver)

• Roo’s test

Goals for Treatment:

• Mobilization of first rib and shoulder complex

• Posture correction

• Stretch muscles that close the thoracic outlet (anterior & middle scalene, pectoralis minor & major, SCM)

• Strengthen the muscles that open the thoracic outlet (middle & lower trapezius, rhomboids, serratus anterior, latissimus dorsi) 

  • We want high reps & low weight

  • Prone I’s, T’s, Y’s

  • Serratus punches

  • Scapular retractions

  • Scapular retractions arm raises with looped theraband

References:

1. Borstad, J. D., & Ludewig, P. M. (2006). Comparison of three stretches for the pectoralis minor muscle. Journal of Shoulder and Elbow Surgery, 15, 324-330.

2. Collins E, Orpin M. Physical therapy management of neurogenic thoracic outlet syndrome. Thoracic surgery clinics. 2021;31(1):61-69. doi: 10.1016/j.thorsurg.2020.09.003.

3. Hibberd E, Myers JB, Pexa B, Jo Rucinski T, Prentice WE, Schneider R. Rehabilitation of Shoulder Injuries. In: Hoogenboom BJ, Voight ML, Prentice WE. eds. Musculoskeletal Interventions: Techniques for Therapeutic Exercise, 4e. McGraw Hill

4.  Jones MR, Prabhakar A, Viswanath O, et al. Thoracic outlet syndrome: A comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther. 2019;8(1):5-18. doi: 10.1007/s40122-019-0124-2.

5. . Levine NA, Rigby BR. Thoracic outlet syndrome: Biomechanical and exercise considerations. Healthcare (Basel). 2018;6(2):68. doi: 10.3390/healthcare6020068.

6.  The Cervical Spine. In: Dutton M. eds. Dutton's Orthopaedic Examination, Evaluation, and Intervention, 5e. McGraw-Hill; Accessed June 18, 2021. 

The Shoulder Complex. In: Prentice WE. eds. Principles of Athletic Training: A Guide to Evidence-Based Clinical Practice, 16e. McGraw Hill; Accessed June 27, 2021.