In article „Pain in the elbow area - tennis elbow and javelin thrower’s elbow” we focused on clearing up this problem, causes of formation and describing the differences between single diagnosis. In this article we will focus especially on therapy. The goal of the article is to emphasise on the need of complexive therapy for effective removal of the pain and restricting the return of the problems.
Tennis elbow and javelin thrower’s elbow is categorized into enthesopathy - painful syndromes that are caused by inflammatory processes close to the attachments of the tendons, ligaments and joint capsules. These inflammatory processes are usually formed on the basis of long term overloading of the muscles and this overloading is then transferred on the tendons of the muscles and their attachments. Overloaded muscles in the area of the elbow usually has deeper relations in the more distant areas such as cervical spine and muscles of the shoulder girdle.
PHYSIOTHERAPY AND ITS PROCESSES
Effective and well performed physiotherapy is always reflecting from a thorough kinesiological examination, which is determining the causes of the problem. Kinesiological analysis is inspecting the body posture and it will reveal muscle chains, which are very important as well as their effect on the general body posture. Our musculoskeletal system is complexly interlinked and the dysfunction of one muscle affects not only surrounding muscles, but also more distant areas. That means that wrong body posture in the area of the cervical spine and shoulder girdle, often caused by muscle dysbalance between the overloaded rhomboid major muscle of the shoulder blades and weakened lower rhomboid minor muscle, gradually leads through the muscle chains to overloaded muscles of the shoulders, arms, forearms and it could result in enthesopathic pain in area of the elbow. Quality modern physiotherapy is therefore on the basis of results trying to regain back the balance between single muscle groups.
Another goal of the therapy is optimization of the posture of single segments for securing the correct posture of the musculoskeletal system. Apart from techniques of the soft tissues and various mobilizing techniques it is important to incorporate into the therapy compensating exercises - ideally exercise on a neurophysiological basis such as: Kabat method, DNS method according to Kolář, sensori motor skills exercise with propriomed (bioswing), BOSU, exercising with thera bad etc…
THERAPY WITH SHOCK WAVE
Therapy with shock wave is during the treatment of enthesopathic diseases crucial and successful therapy cannot be often performed without it. The best treatment method for javelin thrower’s elbow or tennis elbow is highly energetic focused shock wave therapy which penetrates directly in the affected area, which can the client feel very wel. The focused shock wave has an anti-inflammatory effect thanks to the high energy, which is applied into the affected area, usually 2 to 3 applications are enough once every 10 to 14 days.
The client can feel relief already after first application. The focused shock wave which is applied directly into the place of the attachment of the overloaded muscles, is afterwards also supplemented with very effective radial shock wave. Radial shock wave is applied on the whole length of the overloaded muscles and thanks to high frequency of waves it relieves the muscles and the pain fades away. The whole therapy is supplemented with a deep tissue massage with the V-Actor headpiece, which helps to relieve the muscles.
For increased effect of the therapy, we apply functional tape on the muscles of the arms. Thanks to its characteristics it helps to relax the affected muscles and at the same time it can relieve the painful place. Our clients welcome the option of having kinesio tape and they value it.
As a supplement to the therapy, kinesio tape helps especially in acute phase of the painful elbow to relieve the muscles even after you leave our facility.
THE RESULT OF THERAPY
As it was written above, the improvement comes often already after first application of the shock wave - the pain in the elbow is lower and the movements of the wrist is not accompanied by sharp pain anymore. After several weeks after the shock wave therapy , the pain in the elbow is fading away, client feels significant relief and mobility in the elbow and wrist is completely painless. Return back to the painless sport and work life is however important to be connected with the correct body posture and correct optimization of the muscle tension not only in the area of the elbow.
We prepared for you video example of the PNF method for arms, which we use for removing the pain from shoulder, elbow or wrist, neurological problems in the arm.
- Tennis/Javelin thrower's elbow
- Exercises during elbow pain
- Exercises for strengthening and stabilization of the elbow
Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic