Tennis elbow, medically named lateral epicondylitis, is an inflammatory condition affecting the outside of the elbow.

This elbow pain is due to tendonitis and periostitis (inflammation of the outer layer of the bone) where the tendon for the common wrist extensor muscles attaches to the humerus. This results in pain with any activity involving the contraction or moderate stretching of the wrist extensor muscles.

These activities would include writing, typing, lifting objects while the palm is turned down, or using a screwdriver. The pain usually has a gradual onset with no visible swelling. Stiffness or pain in the elbow is usually evident after prolonged periods of rest.

One of the tests for tennis elbow is to attempt to hold on to the top of a book with the palm turned downward. If this proves to be painful in the outside of the elbow, you likely have tennis elbow.

This condition is ultimately due to overuse of the wrist extensor muscles. These muscles attach to the humerus just above the elbow joint on the outside of the elbow. The muscles then continue down the back of the forearm. The tendons then travel across the back of the wrist and hand and connect onto the fingers. These muscles contract to help extend the wrist moving it toward the back of the hand.

If this muscle group tightens too much, it will lead to a decrease in joint space in the elbow thereby resulting in an increase in pressure and inflammation in the joint. This results in pain in not only the epicondyle, but the radial-humeral joint as well.

Conventional treatment of this condition may involve the use of anti-inflammatory medication and muscle relaxants along with temporary lifestyle modification. Physiotherapy modalities that may be employed include laser therapy, TENS, interferential current, or ultrasound.

Chiropractic techniques that work well with this condition include soft-tissue therapies such as active release technique, Graston, or cross-fiber friction massage. Chiropractic adjusting of the lateral elbow, including the proximal radial-ulnar joint and the radial-humeral joint, appear to be quite beneficial.

With adjusting, the two joint surfaces are spread apart an estimated one to three millimeters momentarily. This leads to an increase in volume and decrease in pressure in the joint. This will assist in the decrease in pain from the pressure built up in the joint from the condition of lateral epicondylitis. Adjusting of the wrist may be of some benefit as well.

The theory is that since the muscles involved with this condition help to move the wrist, it should aid in the speed of recovery if the wrist motion is maintained. If the wrist tightens, the muscles need to work harder to move the wrist. This results in tightness in the wrist extensors which then exacerbates the condition.

The use of a tennis elbow band may also prove effective in decreasing symptoms. This works by forming an artificial origin for the muscle before it crosses the elbow. This allows a decrease in tension of the wrist extensor muscles as they cross the elbow which eases tension on the lateral epicondyle and decreases pressure on the elbow.

Also, though rest would be ideal, there may be times when lifting is needed to be done. In this case, one should only attempt to lift with the palm of the hand turned upward. This uses the wrist flexors more than the wrist extensors.

Limiting salt intake may be beneficial as well as it will help to reduce water resorption in the body. Supplementing with vitamin B6 has also been found to be helpful in some cases.

Overall, if you suspect you may have this condition, it is best to have it assessed by your chiropractor and/or medical doctor in order to have the proper treatment plan started that will assist in accelerated recovery.

Before we can explain what Plantar Fasciitis is, it is helpful to know where it occurs; therefore we need to understand the anatomy of the foot.

There are a total of 26 bones in the foot. The toes contain 14 of these bones with three per toe, except the big toe, which only has two bones. These bones are arranged into three different arches which assist the foot in negotiating alterations in terrain. These arches are labeled as the transverse arch and the medial and lateral longitudinal arches.

The main arch associated with plantar fasciitis is the medial longitudinal arch located along the inside of the foot. The plantar fascia is a thick, wide ligament which attaches to the calcaneus (heel bone) and travels to the metatarsal heads (balls of the feet) and into the toes.

If the plantar fascia is placed under an increased amount of strain, the ligament begins to over-stretch and tear. If the foot is not weight-bearing for a prolonged period of time, such as while sleeping, the body begins to lay down scar tissue in order to try healing the tear. When the person stands up again, the plantar fascia begins to stretch and the newly formed scar tissue tears. This results in the notion that the first step out of bed in the morning is when the pain is at its worst.

There are two main methods for the plantar fascia to undergo an increase in tension. One situation that increases tension is weight gain. This may be due to inactivity, an increase in caloric intake, or pregnancy. The weight gain puts more strain on the bottom of the foot causing a stretch of the medial longitudinal arch. This results in over-stretching of the plantar fascia, leading to plantar fasciitis.

The second method of increasing plantar fascia tension is due to poor foot biomechanics. The proper gait cycle (walking pattern) has the outside of the heel striking the ground first. This is why it is normal for the outside of the heel to wear down first on footwear.

As we move forward, the weight should be distributed mainly along the outside of the foot. This should occur until the opposite leg swings forward, upon which the weight distribution should shift toward the inside of the foot (pronation), followed by pushing off with the middle of the big toe.

One of the most common problems discovered with foot biomechanics is the overpronation syndrome. This entails the person rolling over too much onto the inside of the foot. This puts excessive strain on the medial longitudinal arch and can cause tearing of the plantar fascia. This excessive strain on the inside of the foot can result in over-stretching of other ligaments in the foot leading to flat feet (pes planus). If this condition persists too long, a heel spur may form where the plantar fascia attaches to the heel.

To treat plantar fasciitis, it is best to decrease the weight gained if possible. If not, rolling a golf ball lightly under the foot will help to strip down the scar tissue. It is important to not press too hard on the golf ball in order to avoid bruising the foot. Having the foot adjusted by your chiropractic professional often helps with the symptoms as well.

The heel has two main directions in which it can move: diagonally forward or diagonally backward. Usually the heel moves backward due to tension from the Achilles tendon and from weight-bearing pressure. By adjusting the heel forward, it will relieve tension in the plantar fascia and can relieve symptoms.

If these methods do not seem to offer benefit, it may be necessary to have a pair of prescription orthotics made for your feet. These are custom-fit insoles which offer support to the feet to help ensure a proper gait cycle thereby reducing the amount of strain on the plantar fascia.

Osteoarthritis, currently defined as degenerative joint disease, is essentially the long-term deterioration of the integrity of a joint, including the articular cartilage and bone surfaces. 

Although the suffix “-itis” refers to an inflammatory state, this is considered a misnomer.  Degenerative joint disease radiographically is not an inflammatory condition.  This is the reason “degenerative joint disease” (DJD) is currently being used to describe this condition. 

Clinical features of degenerative joint disease may include crepitus (grinding sound), pain, stiffness, and deformity.  The stiffness associated with degenerative joint disease often goes through a “gelling” period.  What this entails is stiffness upon waking from sleep then, as the person moves around, the stiffness begins to subside. 

There are two main categories of degenerative joint disease: primary and secondary. 

Primary DJD means that the degeneration has no direct link to an incident of trauma or other disease process.  The degeneration has an insidious onset. 

Secondary degenerative joint disease entails a known cause for the onset of the DJD.  This may be the result of trauma or another disease process. 

It is speculated that the main cause of primary degenerative joint disease is dysfunction in motion of the joint.  This includes both too much and too little movement of the joint.  Too much motion of the joint (aberrant motion) occurs with the ligaments around the joint, including the joint capsule, becoming overstretched.  This can result from things such as poor posture or chronic stretching of the joint, such as when someone “pops” their knuckles repetitively. 

This results in deterioration of the integrity of the joint as the joint cartilage receives too much wear, quite similar to having a loose wheel on a vehicle.  The cartilage slowly begins to roughen causing a grinding sound (crepitus), and decreases the shock absorption of the joint.  This, in turn, then leads to greater wear on the joint and increased deterioration.

If a joint is moving too little, degenerative joint disease may set in due to a lack of nutrition to the internal components of the joint.  Since there is no direct blood supply to the inside of a joint, the body relies on motion to allow a transfer of waste product and nutrition across the joint capsule. 

If motion is restricted in a specific joint for a prolonged period of time, the joint is unable to attain nutrition and the joint slowly degrades.  It is for this reason that the health care field does not recommend long term traction unless absolutely necessary. 

This essentially leads us to the conclusion that the best practice to help decrease the risk of degenerative joint disease is to maintain proper joint motion to the best of our abilities.  This entails having proper treatment of injuries with a health-care professional and following an adequate stretching routine. 

By strengthening muscles around a joint whose ligaments have been torn, we are better able to avoid aberrant motion. 

By stretching muscles around a joint that is stiff and having that joint adjusted by a chiropractor, we are better able to maintain the motion needed in the joint for the proper transfer of “waste products” and nutrition for the internal joint. 

Although these steps may not eliminate the risk of degenerative joint disease, they will help to either delay its onset or slow the progression of the disease process.

 

Dr. Steven Trembecki, D.C. is an exceptionally busy and talented chiropractor working in Brooks, Alberta, Canada.

Carpal tunnel syndrome is defined as a condition involving numbness, tingling, weakness, pain and/or muscle wasting of the hand along the distribution of the median nerve.  This relates to the thenar or thumb-side of the hand.  Although surgery is often the choice of treatment, it is the most invasive form of treatment and is not the only treatment available.  To better understand this, one needs to better understand the different causes of carpal tunnel syndrome.

The carpal tunnel is made of two rows of four bones, called carpal bones, which sit in a semi-circle at the back of the wrist.  This forms one side of the tunnel.  The opposite side of the tunnel is formed by a strong ligament, the flexor retinaculum, which completes the carpal tunnel.  There are then a few structures that travel through the carpal tunnel into the hand.  These include some of the flexor tendons for the wrist and the median nerve.  With carpal tunnel syndrome, the median nerve undergoes too much pressure being exerted on it, known as compression, leading to a decrease in electrical conductivity in the nerve.  This nerve innervates the palm side of the hand over the thumb and first three and a half fingers.  It also innervates the backs of the fingertips over this same area.  Therefore, compression of the median nerve can only result in irritation over this area of the hand.  If the trouble area is over the back of the hand or over the little finger, it is not carpal tunnel syndrome. 

It is ultimately the compression of the median nerve that leads to carpal tunnel syndrome.  Medical testing for carpal tunnel syndrome usually entails the use of an electromyelogram (EMG).  This entails putting one electrical probe into the median nerve on either side of the carpal tunnel.  An electrical current is then put into the nerve on one side and checked to see if it is picked up by the probe on the other side.  If the current is diminished to a great degree, it is deemed that carpal tunnel syndrome is present.  The surgery for this condition would then include cutting some of the flexor retinaculum to allow less pressure on the median nerve by essentially expanding the carpal tunnel.  This procedure may often help to decrease the symptoms of carpal tunnel syndrome, but is it the only option?  Absolutely not. 

There are two main reasons for carpal tunnel syndrome to present itself.  The first is a deterioration of the joints between the carpal bones leading to a collapse of the carpal tunnel.  The second reason is a swelling of the tendons which pass through the carpal tunnel taking up too much space resulting in compression of the median nerve. 

The problem with using solely EMG to determine the presence of carpal tunnel syndrome is that it doesn’t differentiate between the two causes.  This leads to a lack of differentiation of treatment which may, in turn, result in unnecessary surgery.  If the problem is arising from tendonitis, I believe it is much better to treat the tendonitis.  The way tendonitis occurs is from having too much strain or tension placed on the tendon for too long of a time.  The most common way for this to happen is to have the muscle tighten too much due to repetitive use of the muscle.  Since the tendon is responsible for connecting the muscle to the bone, if the muscle tightens up, so does the tendon.  This can result in the tendonitis which can cause the symptoms of carpal tunnel syndrome. 

If the symptoms are due to tendonitis in the wrist flexor tendons, the treatment may include stretching, the use of physiotherapy modalities, nutritional support, ergonomics, soft tissue manipulation, and/or adjusting the arm and wrist.  These protocols are much less invasive and may have fewer side-effects than surgery.  This does not mean that surgery is not a viable option.  My preferred method, of course, is to begin with the least invasive form of therapy.  If these options do not bring relief of symptoms, then surgery can be looked at.