True tennis elbow is a tendinitis of the extensor muscles and that tendon group originates on the humerus above the elbow. When there is pain that is below the elbow, and is in the lateral forearm, it might actually be an annular ligament sprain with a minimally subluxed radial head. The neck, just below the radial head (radius bone) is 2 to 3 fingers below the lateral elbow joint. It can be exquisetely tender when isolated. there will be a reduction of proximal supination, though oftentimes missed as the distal supination increases and compensates. However, careful over pressure comparing both forearms will be indicative. Traction to the radius will be lacking on the painful side as the mechanism of injury may be repetive trauma or a heavy lift that tractions the radius bone inferiorly. You will note less space between the end of the radius and the wrist. The radial head is round with a flat edge where the annulkar (ring) ligament wraps around it. So a traction injury is a bit like pulling a funnel down, because part of the ligament is significantly stretched, being pulled beyond the neck into the radial head..
Treatment? Gently grasp the radius, stabilize the upper arm, oscillate with moderate force after taking up the slack, 30 reps. Very effective and long lasting. Of course other rehab things can be pursued, this part addressed the primary restriction and positional ligament strain. If you unyielding tennis elbow, do have the above joint evaluated. Best Wishes, Jerry
I just uploaded some new videos to my YouTube account. They are on various topics and may be worthwhile to familiarize yourself with the video library.
Here's a link to my channel http://www.youtube.com/user/JERRYHESCH?feature=mhee
I welcome any comments.
When I evaluate feet and ankles and note very different function side to side, and see 2 identical orthotics, I am puzzled. When I see the same but 2 very different orthotics; I am pleased. Before getting for for orthotics it is ideal to have all of the joints of the foot and ankle evaluated and treated. There are several movement restrictions that are treatable and can distinctly improve the function of these joints. Long ago I learned that the orthotics do not make much change in the transverse plane, (where rotation occurs) they do affect frontal (front and back view of foot) and sagittal planes (lateral view). These joints are very strong, so they can take some abuse, and in fact do. They may or may not have local pain, but the body reflexively compensates elsewhere and this distal area over time may become symptomatic. It is not unusual to find muscle imbalances in the presence of joint restrictions, and these reflexively restore when the joint, ligament, tendons and muscle are balanced. Treat all. Per above, rotation in the transverse plane must be treated, especially at the subtalar joint. It can be very rewarding, one treatment, and the clinet should then know self management. Terms like pronation can be misued, most clients I see have been told they pronate (too much) and I find they do so only at the forefoot. Why? Because the rear foot and mid foot supinates excessively, in fact remain in supination. So the joint mobilization addressthe supination and restores functional pronation of the rear foot and mid foot, and then the forefoot pronates, less, now normally. If foot and ankle joint dysfunbction persists it can alter forces and movements at the knee, the hip, the pelvis and reflexively; as far as the neck. If "whole-body" is important, incorporating foot care in the paradigm provides a good foundation, literally and figuratively. Happy Friday! Jerry
This was a very remarkable presentation. A poker player cam to see me for headache and neck pain and low back pain. I was astonished at how very tight and unyielding his upper cervical spine was (occipito-atlantal) where the head and neck connect. Nothing I did there was effective so I knew to find the cause elsewhere. His hip were extremely tight bilaterally and I previously thought that this was simply the way they developed; concluded on a false positive for a hard bone-on-bone end-feel. Nothing else seemed to explain his presentation. This was the tightest upper cervical I had seen for some time, and sitting at the poker table and at his business computer would only compound the problem as the posture induces flexion throughout the spine but hyper-extension in the upper neck.
I treated both hips for 10 minutes, using a fulcrum to induce a very gentle force.
His neck released and in 2 visits, neck was normal with more hip range of motion, much less pain and muscle tightness. He was taught self-treatment, so he will be able to keep these gains, does not need to "keep coming back...".
Releasing the hips released the neck.
This is an example of the Hesch Method; treating the cause, not "the pain". Or perhaps worded better; treating the pain very effectively and efficiently by treating far away, treating the source.
Rule: When you cannot achieve gains in one part of the body, go elsewhere, typically below. If unilateral, go to the opposite side, below.
Thanks for visiting my blog.
I see this so frequently. The body has its own wisdom and we need to tap into it. I screened a sports physical therapist last year, and concluded that she had a sacroiliac joint restriction, a stuck rib joint and her AC joint was stuck. Then I pondered it and said: "I must be missing something, because the body always has a compensation and all 3 of these make the body orient to the left." The body has to orient to the right somewhere.
So I slowed it down, rescreened the body, which was easy as I knew that it most likely was in the hip or below. She had a reduction in ankle motion in which the talus was stuck in anterior glide and plantarflexion by 15-20 degrees, in the left foot effectively orienting the lower leg to the right, subtle though. Still very functional, the ankle did not hurt and she was completely unaware of it. It did provoke a mild muscle inhibition involving the tibialis anterior, but she was also unaware of it.
I restored normal motion in her SIJ, her rib joint, and her AC joint. I never touched them for treatment, just to reeval.
What did I treat?
I treated the ankle complex. The rest was her body's way of compensating reflexively. The stuck motion above was reflexively controlled by muscle, nothing was "out of joint" except one thing; her ankle!
Yes to whole-body evaluation and treatment, yes to everything is connected, etc.
This is a difficult and emotional topic. Some folks with low back pain have muscle guarding which causes their pelvis to be asymmetrical. Does that mean that their sacroiliac joints are misplaced and need an adjustment? NO! While some do feel better after a maneuver that enhances symmetry, it does not mean that the treatment corrected a sacroiliac joint dysfunction such as the ilium moving on the sacrum and getting stuck. Some clinicians and clients believe that if they have difficulty keeping their pelvis symmetrical; that their sacroiliac joint is unstable. Some go through extensive strengthening and stabilization only to have their pelvic landmarks remain uneven. What is at work here? The pelvis moving in 3-dimensional space is a separate matter. If a person experiences the problem of continued asymmetry, gets an adjustment, applies a very tight sacroiliac belt and still
has asymmetry with various tests; are they unstable in the sacroiliac joints?
NO! There are many things that contribute to the final posture and mobility of the pelvis. The above scenario speaks to this matter, this example may be in a client who has muscle imbalances, joint imbalances in the hip, the foot and ankle, the lumbar spine, upper back etc.
The latissimus dorsi muscle extends from the ilium to the upper arm and therefore upper arm asymmetry can affect pelvic posture.
The foot can do same.
Try this: Stand with your hands on the front of your pelvis, twist your lower leg so that your foot flattens (pronates) and then take it in the opposite direction as far as you can comfortable go.
What happens to the pelvis?
Next, have someone squeeze your hamstring muscles just above the knee, placing one hand in front and the other in the back of the thigh. Bend forward, then backwards, side to side, then twist left and right.
What happens to the pelvis?
Let me guess; it moves asymmetrically. Now do the same tests on someone who has had a bilateral sacroiliac fusion. Same results! I presented on these concepts at a national and international conference in the early 90's. Other researchers have validated this, using markers inside the sacroiliac joint.
This is a complicated concept, so the best I can do is in little pieces.
How do I evaluate and treat the SIJ?
I evaluate the whole body and do so in various positions, such as fully flexed, fully extended. I evaluate and treat some far-away joints that are not painful, but that do not work properly. I treat foot and ankle, hip, pelvis, sacroiliac, lumbar, all the way up to the neck. By the time someone is diagnosed with SIJD, they have several significant compensations throughout the body. All of these should addressed at the very beginning, not 3 years later, not after they have had some radical procedure done, etc.
Note: When I do find sacroiliac and symphysis pubis joint dysfunction, whether stuck, or unstable, or flavors in-between, I do treat it, very thoroughly. Many times it is the external structures that are painful causing referred pain or causing biomechanical dysfunction of the pelvis. Caution is key, and knowledge is power. I had a severe injury to my sacroiliac and symphysis pubis with instability. I fixed it using my method which I developed. I am very fortunate and hope to help others, especially by teaching other clinicians.
Probably enough blog for now! I will continue this thread from time to time. I advise caution when someone tells you that your sacroiliac is unstable. Proceed cautiously. It is the only SIJ you have (one left and one right SIJ).
Dr. Jerry Hesch, DPT, MHS, PT
Married with 4 grown kids. Earned my Doctorate at A.T. Still University in Tempe, AZ, MHS at the University of Indianapolis and my BS PT at University of New Mexico. I enjoy working with my hands and particularly making glass objet d'art.