Information on Rehabilitation

Rehabilitation Quick Tips

What you asked…

I would like to know if keyboard and/or mouse use leads to or exacerbates lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow) or both. Also, is muscle pain associated or not associated with the tendinitis? If you have related personal or "scientific" evidence, please pass it on. Thanks.

What We Figure…

There are a number of ways that epicondylitis can be aggravated by keyboarding or mousing. Extended wrist postures are common in keyboarding and mouse technique. These postures create constant loads on the extensor muscles of the forearm, which originate at the lateral epicondyle. Splinting can also aggravate it because the individual's wrist becomes nearly fixed and when they extend their fingers or wrist (both important for typing) they work against the splint. The splint acts to fix a segment that used to be a joint.

Working off of wrist rests can produce these problems because the wrist is always pivoting off of the support which loads the only tissues available - extensors of the forearm. More fluid movement of the full arm and shoulder allows dynamic dissipation of forces across many joints and prevents the horrors of static long term muscle contractions.

Hope this helps!


What you asked…

Leanne asked about rotator cuff (RC) problems and the relationship to RSI.


What We Figure…

This is a long and complicated issue but the short answer is that RC damage does occur in non-acute episodes. I just recently completed a partial literature review on this topic for a paper I am writing. The key muscle/tendon structure that becomes damaged is the supraspinatus. In submaximal reaching tasks (to only 60 degrees of flexion at the shoulder!) this muscle is recruited at levels exceeding 30% of maximum contraction. This muscle is also an abductor (moving arm out to the side) and many manufacturing and clerical postures involve slight abduction, especially with mousing.

There are three key issues in understanding damage beyond the above noted constant contraction intensity:

1) Blood supply to this muscle-tendon unit is not terrific to begin with and can be decreased radically by constant use or postures where the arm is held tightly against the body.

2) The tendon passes between the head of the humerus (upper arm bone) and acromion (an overhang of bone on the shoulder blade). This space is very limited and repeated mechanical contact with the humeral head and the acromion can cause damage to the tendon (This is an example of impingement). The higher the arm travels, the worse it gets. That is one reason why shoulder level or overhead work is not a good idea. An additional variable is deformity in the shape of the acromion part of the scapula. In many people this bone hooks down which would cause impingement at much lower angles of movement.

3) The lower muscles in the rotator cuff (such as infraspinatus and teres minor) exert a downward effect on the upper arm to prevent this impingement. However, the combination of tight anterior shoulder muscles, weak upper back and weak lower rotators acts to impair this function in many people.

The combination of these three factors can act to cause significant damage to the rotator cuff complex. This includes partial thickness and full thickness tears even in submaximal repetitive environments.

It can be identified through MRI, *competent* manual examination and sometimes by arthrogram. Surgery is often required to repair this injury if it is severe. The surgery may include acromioplasty, which involves grinding down the offending piece of bone. This surgery is arthroscopic and often very successful.

Cortisone is often used 2 or 3 times in advance of surgery in the hopes of avoiding the surgery. IT IS MY UNIFORM EXPERIENCE THAT THIS IS POOR STRATEGY THAT ONLY ACTS TO IMPAIR THE ULTIMATE SUCCESS OF SURGERY OR CONSERVATIVE REHAB.


Lumbar Stabilization - Not an Everyday Occurrence (But It Should Be)

By Lisa Hoffart
Physical Therapist, Human Effort

When Jack and Jill got married, Jack built a house for his bride. One day Jill came home with groceries to the house that Jack built, only to find that it seemed to be leaning. The house that Jack built creaked and groaned. As time passed, the house leaned more. The veranda cracked on the house that Jack built. Jack spent so much time fixing the house that he had no time to do the things he enjoyed. Finally, Jack consulted a landscape architect to examine the house that Jack built. The puzzle was solved - Jack built his house on a swamp! Jack would have to rebuild his house on a solid foundation so it could withstand the test of time. That is the story of the house that Jack built.

Lumbar Stabilization

Massage - An Ounce of Prevention

By Shelly Faber
Massage Therapist

Your working day is over. You should be going home to enjoy your evening. But you can’t. Your feet hurt, your back is sore and you neck is killing you!

Whether our work requires us to be physically active and on our feet a lot, or we spend much of our free time involved in other athletic activities, our feet always seem to take a beating. If our feet are sore, generally it doesn’t take long for the rest of our bodies to follow suit. We may overuse our right leg and hip muscles to compensate for a sore left big toe which in turn stresses the back, and puts extra strain on the muscles of the neck already tight and tired front he general workload of the day.

Because some believe that the foot is a map of the body, massaging the foot is a general tonic for the whole body. Although full body massage adds many benefits, the position and condition of the foot sends much postural information through the central nervous system. Many nerve endings on the feet match acupressure points, and when they are stimulated they release endorphins and stimulate lymphatic movement. Massaging the whole foot and ankle stimulates circulation, nerves and reflexes having a great effect on posture and gait thus prolonging endurance and promoting relaxation.

An ounce of prevention can in fact, go a long way. In the world of massage, many of us feel we get the best results when treating the person as whole. In the case of a serious athlete, a pre-event massage can prepare him/her both mentally and physically for the task at hand; by getting the body and mind psychologically and physically psyched; by getting the circulation going and readying the joint and muscles, thus helping to prevent injury and exhaustion because the athlete “feels” ready to go. At work, take the time during the day to massage your feet, walk around, shake out your legs from the hip to get the blood flowing, and stretch your arms and neck to prevent muscle tension. Make a point of drinking water throughout the course of the day to prevent dehydration, exhaustion and that sluggish feeling.

Do you need a massage? Whether you’re an athlete, that hard-working person, or (more likely) both, if you’ve never had one by all means...please do! The more you experience, the more you learn what feels good, and what works for you on your quest for good health.


The Hip Bone is Connected to the Thigh Bone . . .

By Greg Hart
Kinesiologist
President, Human Effort

The song we sang when we were kids about all the bones in the body being connected was really a very valuable lesson in human function. There are very few things that occur independently in the human body with effects that are restricted to only the structures they occur in. One of the key principles of human function is the nature of its interdependence. It is important to consider the importance of proper lower limb function to maintaining normal function throughout the entire body.

The Hip Bone...  Connected to.....


Video Gait Analysis

By Geoff Cuskelly
Physical Therapist

Running and walking have become very popular activities over the past 20 years and have improved the health and well being of millions of people. Unfortunately due to large forces, which must be absorbed during these, weight bearing activities, the body is placed under loads that can cause injury. These forces amount to as much as nine times a person's body weight on each strike of the ground in running. Over the course of a mile this amounts to approximately one tonne of force to absorb through the foot and lower limb. If these forces are applied through perfectly aligned and balanced joints and muscles the body will adapt and compensate in beneficial ways. These include improved muscle, joint and nerve flexibility and strength and improved coordination and agility.

However, for many people, the body’s joint alignment and muscle balance is far from perfect. Assessing these imperfections can help prevent injuries and keep the body functioning at full capability. This assessment includes static and dynamic postural testing, key muscle strength testing, flexibility scans and video analysis of walking and running patterns.

Corrections to the imbalances are made through equipment modification (changing footwear, custom fitting orthotics, etc.), exercise therapy to improve muscle and joint balance and technique changes to walking and running patterns.

If injuries are keeping you from doing what you enjoy you may consider getting assessed by a physiotherapist or related health professional to keep you in stride.

 

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