Do you, or have you ever had elbow pain with gripping or wrist movements? Has a simple task like opening a jar triggered pain around your elbow? If so, this article will be a game changer!

What you are experiencing is called lateral epicondylalgia A.K.A tennis elbow. Now I know what you must be thinking: “but I don’t even play tennis! So what does tennis elbow have to do with me?” While tennis elbow is common in tennis players, with one in two players experiencing it at some stage in their career (2), it is also common in repetitive upper extremity activities. For this reason, it is commonly seen in people with repetitive one-sides movements in their jobs such as electricians, carpenters, gardeners and desk bound jobs (3).

Tennis elbow is an overuse injury that can linger if left untreated and it can cause a harmful loop where the more you use your arm the more it starts to hurt. This can make day to day activities a nightmare, especially considering that the majority of cases are in the dominant arm. Some patients also experience interrupted sleep, with things like pulling up the covers triggering pain.

Research suggests that exercise and hands-on physiotherapy is the most effective course of action, above the use of injection and medications (1). Physiotherapy will work towards identifying the problem and target it using tailored treatment. This can rectify imbalances and de-load overstressed structures, ultimately breaking the overuse cycle and allowing healing to occur.

Tennis elbow pain can be caused by many things and it is a physiotherapists role to identify the primary contributors. This could include:

• Tendonopathy, the tendon (the muscle bone attachment tissue) is unhealthy.
• The neck is a background driver to the problem.
• The nerve system ‘changes gear’ and works differently in response to movement and use.
• One of the elbow joints is inflamed, stiff or potentially not stable.

There may be a combination of all of these factors.

Depending on the cause, physiotherapy will likely involve the following:
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Muscle and tendon training: This an include making the muscle contract without moving, tightening as it is being stretched or we tech you to slide the radial nerve as it passes the elbow to sooth and add load resilience.
 
Structure de-loading: Therapeutic tape can be used to offload the soft tissues to allow them to recover and prevent the nerve system over-reacting, by giving it some downtime from being over stimulated. Don’t forget that the soft tissue re-positioning may also improve muscle function, a good reason to see tape as more than a crutch.
 
Optimal loading: Changing how you do certain provocative things will change how much load is being put through certain structures. This could involve changing your grip, wrist position to lift carry and push as well as pacing activities to do as much but do it differently.
 
So what are you waiting for?! If you want to end all the tennis elbow racquet and give your elbow the love it deserves, serve up some of these tips and check out our video above by clicking on the image, to help you net some results!

Have you ever felt a twinge or maybe more in your hamstring? It might have been from something as simple as running across the street to make the lights? Or maybe you were feeling good and pushing for a new personal best in the gym or out for a run? 

However it happened, you definitely aren’t alone, the incidence of hamstring strains can be as high as 5 players per season per team in some cases (1) with a reoccurrence rate of 34%. So welcome, kick your feet up (unless that hurts) and let’s do a deep dive into the best and worst ways to recover from a hamstring injury.
 
The number one mistake people will make is to not respect the injury. Depending on the degree of muscle damage that has occurred you are looking at 3 to 6 months of recovery. During this time the body will undergo processes of “cleaning up” the dead/damaged cells and generating new blood vessels and tissue. These are complex tasks that cannot be sped up, but can most certainly be slowed down! If you start to get confident with your injury and want to “test it out” or “see how it goes” you risk damaging healing tissues and setting yourself back, which is the equivalent of picking at a scab while a cut is healing.

The second mistake people will make is too much too soon. While it’s fantastic to be working with highly motivated people, the recovery for a hamstring tear is similar to that of walking a tightrope, the muscle needs to me moved and loaded enough to promote healing and recovery but not so much that we end up doing more harm than good.

The third mistake people make is forget maintenance of strength. It’s very easy to get tunnel vision when it comes to injury and focus on the injured muscle and getting it back to strength but the trap people can fall into is that they will have a fantastic hamstring but the rest of their leg (and whole other leg) has been deconditioned from doing nothing for the past few months. When this happens, it can not only delay the return to sport but it can also lead to injuries in other muscles and joints.
 
So now that we have what not to do out of the way, before we talk about what to do it is important to mention that while this is based on the best current evidence it is still a “one size fits all” type of advice so it may not be best for your exact presentation.
 
Loading the hamstring early is the first tip, (this is where the tightrope analogy comes back into play) Hickey et al. (1) showed that inclusion of early eccentric hamstring exercises led to greater hamstring strength and length down the track (2). Timeframes for recovery were similar but by choosing tailored exercise and load to put through the hamstring allowed for better results.
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It wouldn’t be a hamstring rehabilitation program if we didn’t talk about the infamous Nordic hamstring exercise… The Nordic has come under fire recently for not being a functional exercise but you could argue that what it DOES do, is does VERY well. The Nordic has good evidence as an injury prevention tool (3) and as a means of increasing muscle length and strength. For these reasons, Nordics will still remain a staple for rehabilitation but it is important to combine them with sport/task specific training.

Have you heard the common line that weights training during puberty/adolescents will damage growth plates and stunt growth? In reality there is ZERO evidence to support this statement.

Despite there being numerous studies that have disproven impaired skeletal maturation from weights training in both long and short term [1][2][3][4], the belief still appears to be heavily rooted in today’s training and rehabilitation.

What people frequently fail to realise is that resistance training can play a vital role in young athlete training as well as injury prevention. Relying on things like cardiovascular endurance and bodyweight exercises are simply not enough to develop the dynamic stability and strength to protect joints and a growing athlete.

Resistance training is most appropriate to a young athlete when body weight does not provide enough resistance, or when bodyweight simply cant substitute a weight. An example of this could be adding weighted leg press for a young AFL player to help with their vertical jump or adding rotator cuff strengthening to a young gymnast.

If these types of resistance training are not put into place not only could you hinder a young athletes sporting potential but you also put them at risk of injury/reinjury which in some instances can lead to a vicious cycle of reinjury.

So keeping a child or young athlete performing at their potential and remaining injury free is no longer dictated by doing tackle or agility drills, it needs to incorporate a level of resistance training to build up stabilising muscles and strengthen soft tissue.
Resistance training is widely used in adult sport so why isn’t it used in young athletes? Research conducted on the topic suggests that when performed appropriately and with good technique that resistance training provides benefits for youth athletes including:

• Stronger bones
• Reduction in injury rates
• Increased strength, speed and power

Its completely understandable for parents to have reservations about resistance training with their children, especially when its been hammered in for so long that “resistance training stunts growth”. If we think about in logically though, the forces a child’s body goes through on and off the pitch such as hard tackles, jumping out of trees and falling from play equipment far exceed the forces that weights put through the skeletal system.

So what’s the youngest age a child can start resistance training then? The Australian Strength and Conditioning Association [ASaCA] suggest the youngest a child COULD start resistance training is 6 years old!!! This isn’t to say that all 6 year old should sign up for a gym membership though, the ASaCA highlights the need for young athletes that are involved in a resistance training program to “have the maturity to follow clear instructions and an appreciation of the dangers present when training”[5].

So to summarise, there is no evidence to support that resistance training will damage growth plates and stunt growth in the short or long term but there is evidence to suggest resistance training leads to stronger bones, reduction in injury rates and increased strength, speed and power.