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If you suspect that you are suffering from golfers elbow, early
action is advisable as this responds to physiotherapy treatment
more quickly and satisfactory than does tennis elbow. Lack of adequate
rest in the early stages too often makes for a chronic (long term)
This is as real a condition as "tennis elbow" and like
this, is obviously named after the sport which commonly causes the
problem. The two are different - tennis elbow affects the muscles
on the outer side of the elbow and golfers elbow affects the muscle
group at the inner (medial) side of the elbow - the function of
these latter muscles being to bend the wrist and fingers. This is
usually an overuse injury and may be caused by faulty technique,
inappropriately sized grips on the golf clubs or because too much
of the striking impact is transmitted via the shaft to the forearm
and elbow. A case in point is the pain of the right elbow of a right
handed golfer when hitting (usually inadvertently!) a divot!
When seeking treatment from your chartered physiotherapist, a full
history and assessment is necessary. This enables your physio to
rule out the possibility of the symptoms mimicking conditions affecting
the cervical spine (neck) which must be excluded in persistent cases.
Previous injury to the arm, including falls particularly on the
wrist could also cause some knock-on problems at the elbow. Of course
tight muscles on the opposite side cause interference as well.
Physiotherapy treatment in the first instance involves manual techniques,
electrotherapy, support and/or taping techniques. Advice on stretches
and self help should also be given. A good chartered physiotherapist
should be able to teach a number of effective stretches and a tailored
self help program to keep you on the golf course. If possible, a
short abstinence from the offending action (!) helps as does advice
on modification of grip technique and further training.
It must be stated again that early treatment and good advice avoids
an on-going repetitive problem, thereby cutting out the necessity
for some of the more aggressive treatments often recommended by
doctors. You will no doubt have heard of steroid injections and
release surgery. Injections we are discovering give increasing risks
to the surrounding healthy tissue, not to mention the problems of
poor injection techniques. Over the last twenty four years, I have
found that poor injection techniques have caused more problems than
the original injury! If surgery is necessary due to inflamed, scarred
and tethered tendon attachments, these can be slightly lengthened
but recovery is disappointing and may take several months.
As always, early treatment means an earlier recovery with fewer
First the technical bit!! The knee is a relatively unstable hinge
joint between the femur and the tibia. It is secured internally
by two cruciate ligaments and a capsule and externally by ligaments,
tendons and muscles. Internally, it is also cushioned by two semicircular
shaped cartilages. The third bone of the knee is the knee cap
(patella) that sits in the thick tendon of the quadriceps muscles
as it attaches into the top of the tibia.
Obvious injury to one of the structures of the knee due to a sport
or other form of accident is readily identified and therefore treatment
is sought and as always, early accurate treatment gives the best
General treatment following the RICE principal is advised:
I - Ice
C- Compression - as firm as possible without obstructing the circulation
E- Exercise appropriate to the problem.
Unfortunately, a great deal of knee pain is suffered that has no
obvious trauma to identify it and therefore most individuals "put
up with" a large amount of unnecessary discomfort that ultimately
leads to not enjoying your sport or indeed general activity. Pain
is a warning. Sadly, many will suffer needlessly due to inappropriate
action the first time they had a problem or consultation as many
injuries are incorrectly diagnosed by the original treating doctor.
Two basic and common causes of on-going non-specific knee pain
are often missed:
1. foot posture problems
2. weak thigh (quadriceps) muscles.
An early appointment with a Chartered Physiotherapist who is an
expert in joint assessment and its further management will throw
a great deal of light on the problem and simple remedies can often
A Chartered Physiotherapist with bio-mechanical knowledge will
be able to assess you and hopefully with the supply of an orthotic
(moulded) insole, you will be able to walk away with an easy and
long term solution. Footwear advice in general will also be given.
Some local electrotherapy may be required to settle the irritation
at the knee and a specialised quadriceps exercise routine will be
started. Weakness in these quadriceps muscles makes for inadequate
support of the knee and can cause on-going problems
Some clues. In health, there is minimal swelling in the knee. Swelling
indicates inflammation and needs treating - immediately. This swelling
may not be painful but will stress the surrounding structures of
the joint. If the swelling is painful and the knee is hot, this
needs identifying in order to find a suitable solution. Unless this
is cleared, on-going problems will persist. A careful history will
provide many clues and liaising with your medical practitioner may
Understandably then, cortisone injections into the knee or long
courses of medication often in the form of anti-inflammatory tablets
will not solve these problems.
Importantly (!), you should not be told to give up your golf, rather
how to solve the problem and keep active therefore preventing more
serious health risks such as heart problems!
As you can see, simple pain free remedies can often be found for
a painful knee so help yourself to early advice and save yourself
unwanted pain or discomfort.
Remember, pain of any sort is not a necessity!
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The most common cause of a whiplash injury is as a result of a
car accident however, falls can often produce similar symptoms.
Unfortunately, much micro trauma of soft tissue and nerve tissue
occurs and this is not detectable by normal investigation procedures.
X-rays at the time are often reported as normal as the bones are
unlikely to be damaged - examinations of the nerve supply are again
often seen as normal. Pain is the major problem and interestingly,
may not present itself until sometime after the incident - anything
from a day later to many weeks or even months later! This results
in a very anxious patient being told that there are no abnormal
findings when often, the pain is severe enough to cause difficulty
in moving the head, neck and upper body. Associated pins and needles
may occur in hands and face (most common) but may also affect the
feet however, these usually subside within a few days. Muscle spasm
and difficulty or inability in moving occurs as well.
Whiplash is an emotional injury and sufferers often feel over anxious
and tearful - these are normal emotions following trauma to nerve
tissue. Also a feeling of disassociation (not quite being a part
of this world) and in severe cases, this can lead to panic attacks
that need specialised help. Most sufferers complain of difficulty
with concentration and an inability to do anything for long. The
head or arms feel too heavy and getting comfortable seems almost
an impossibility therefore interrupting sleep. The knock on effects
of all of this of course is reduced effective healing.
Despite the above, the sufferer should try and maintain as "normal"
a life as possible as evidence shows that over resting and this
may include a collar after 24/ 48 hours, causes more problems than
it solves. Immediate treatment of an ice pack and pain relief coupled
with support at the back of the neck is advised.
Physiotherapy should commence as soon as possible to allow a swift
return to normal function. This would consist of mobilisation of
small joints and soft tissues of the neck, and electrotherapy. This
would then progress to gentle stretches and home exercises to maintain
function as well as pillow, posture and management advice. To support
the neck, try a rolled towel in the pillow case and following injury,
a few more pillows than normal may be required.
Unfortunately, this sort of injury can take time to settle completely
and if left untreated, can lead to more problems when normal or
excessive activity is carried out. Sadly, as the investigations
that are carried out are often reported as "normal", this
prevents people from seeking further advice from an expert in joint
rehabilitation and muscle re-education such as a Chartered Physiotherapist.
A Chartered Physiotherapist will also be able to provide specific
therapies for inflamed or damaged joints or soft tissue.
Help yourself to early advice and save yourself unwanted pain or
Remember, pain is not a necessity!
|With more moving parts than any machine,
it's not surprising your body occasionally cries out in pain or refuses
to do what you tell it to. Physiotherapy is an effective way to treat
many of the problems you can experience!
A small sample of the many testimonials
that Estelle regularly receives
Thank you for your excellent
Mrs Sheila Frank
"Thanks for getting me fit to
run in the Marathon."
Nick Le Cocq
"I would like to thank
you for all your kind help in making me feel better ... I hope we can
keep in touch"
"When others had basically given
up hope, you got me both mobile AND pain free. How can I ever thank
"I would like to thank you for
all your help in getting me to those start lines this season"
Andy Kemp - Triathlete
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