3 Simple Self Care Techniques for Tennis Elbow

3 Simple Self Care Techniques for Tennis Elbow

Tennis elbow is the common name for pain on the outside of the elbow caused by damage to the forearm muscles attaching there. Although it is traditionally associated with tennis backhands, swinging a racket is not the only cause of tennis elbow. Weightlifting, cooking, rock climbing, gardening and working with hand tools are also common culprits. The technical name for tennis elbow is lateral epicondylitis.  It is very similar to medial epicondylitis, commonly known as golfer’s elbow, which is the same injury on the inside of the elbow.

If you are experiencing significant pain at the elbow which prevents you from using your arm normally, it is best to see a medical professional who can provide a thorough evaluation and management strategy. If the discomfort is relatively mild and you are still able to use your arm normally the following exercises will help with your recovery. Wait 3 days after symptom onset or a significant flare up before beginning the exercises. In the meantime rest the arm, avoid activities that involve strong grasping or lifting and ice the elbow for 20 minutes 3 times a day.

Wrist Extensor Lacrosse Ball Release

Wrist Extensor LAx

The muscles involved in tennis elbow are actually muscles that control the wrist, collectively known as the wrist extensors. They join together at the common extensor tendon where overload occurs causing damage to the tendon and the adjacent bone. Releasing tension in these muscles decreases the load on the common extensor tendon, allowing it to heal.

To perform the exercise place, a Lacrosse ball on a table and roll it along the back of your arm taking time to pause on any tender points allowing the muscle to .  You should be able to work through the muscles in less than a minute.

Wrist Extensor Stretch
Wrist Extensor Stretch

Straighten your arm out in front of your body. While keeping your elbow straight flex your wrist, bringing your palm towards your body. Provide slight over pressure with your opposite hand to add intensity to the stretch. Hold for 30 seconds.


Eccentric Wrist Curls

Eccentric Wrist Curls (1-3)This exercise takes advantage of eccentric loading principles to help strengthen the common extensor tendon.

To perform the exercise, rest your forearm on a table with the
wrist hanging over the edge. Grasp a 1 to 3 pound weight (you can use a soup can) with your palm facing the floor. Use your opposite hand to help raise the wrist towards the ceiling then allow your wrist to lower back towards the floor for a count of 4.  Aim for 3 sets of 10-15 reps.

The eccentric wrist curls should be performed 4 days a week. The wrist extensor lacrosse ball release and stretch should be performed daily. Recent studies have shown a clear relationship between lateral epicondylitis and dysfunctional shoulder mechanics1. Assessing and rehabilitating a dysfunctional shoulder is best left up to the professionals so if your symptoms persist, look to your local sports medicine professional for help.


  1. Middle and lower trapezius strengthening for the management of lateral epicondylalgia: a case report.Bhatt JB, Glaser R, Chavez A, Yung E.J Orthop Sports Phys Ther. 2013 Nov


Photo Credit: Carine06





Dance Injury Prevention: 5 Pillars of a Healthy Dancer

Dance Injury Prevention: 5 Pillars of a Healthy Dancer

11958195486_3748fa556a_oDance is a challenging activity, one that requires a physical and mental mastery equal to or
exceeding that of most sports.  Dance bridges the worlds of art and athletics and because of this, it has seldom been the focus of traditional injury prevention or strength and conditioning programs.  This is beginning to change as a growing body of research and practical experience show the benefits of injury prevention for dancers.

9139951644_e303ee21d9_oAs with any athletic activity, dance carries with it the risk of injury. Somewhere between 84-95% of dancers will suffer from an injury at some time during their career.2,5,9   In a professional setting, rate of injury can rise.  A study of a professional New York ballet company revealed an average injury rate of almost 7 injuries per dancer during a one year period.1  While these numbers may come as a shock, it is important to note that dance is still very safe and does not carry higher risks than most sports.   What the research does show is our ability to make dance safer by incorporating a few key concepts from the realm of sports medicine and strength & conditioning.  Below I have included my 5 pillars for staying healthy as a dancer.

1. Healthy Classes

This may seem obvious, but the best place to start avoiding dance injuries is in your dance class.  Take 5-10 minutes to warm up before each class.  Don’t perform any challenging dance movements before you are fully warmed up.  Focus on your form, the majority of dance injuries are overuse injuries caused by improper form.  “Sickling”, “winging”, and “rolling in” the feet, valgus collapse at the knee, excessive flexion at the hips and poor spinal posture are all common variations of poor form that can lead to injury.  Ask your instructor to evaluate your form and focus on making the corrections they suggest.

2. Appropriate Conditioning

Physical activity outside of dance has been shown to decrease your chance of getting injured on the dance floor.  A regular aerobic and strength training routine will not only help to keep you injury free, but also improve your dance.  You don’t need to become a body builder to reap the benefits of strength training.  A 2004 study which had professional ballerinas start on a strength training program showed a significant increase in strength without a measurable increase in muscle mass.4  A strength and conditioning coach or personal trainer is a great resource to get you started.

3. Safe Environment

Where you dance and what type of clothing and footwear you use plays an important part in keeping you injury free.  Make sure you are wearing properly fitting footwear that is appropriate for your style of dance.  Avoid dancing on hard concrete floors or in an environment where the floor surface is not uniform.  Ensure you are comfortable with any props or costumes before you get on stage.

4. Healthy Eating

A healthy diet is the fuel that keeps your body running at its best.  Without adequate nutrition your body is unable to fuel your performance or keep your body tissues in good repair.  Inadequate caloric intake or a diet missing key nutrients is associated with an increased risk of injury.  A sports nutritionist can help you understand your dietary needs and ensure that you are eating a well-rounded diet.

5. Adequate Rest and Recovery

Sleep is one of the most important factors in your body’s ability to recover from physical challenges.  Getting less than 8 hours of sleep causes a physical and cognitive decline which has been shown to almost double the risk of injury in adolescent athletes.6  Stress is another factor that has been correlated with dance injury.3,7  Taking time each day to relax or meditate, will help you get better sleep and reduce your stress levels.

7662021648_2c9fc9b459_oBy building your dance practice on these five pillars you will be able to minimize your risk of injury and keep dancing for many years to come.  Feel free to contact our clinic if you would like more information on incorporating a personalized injury prevention program or for help managing a current injury.


Photo Credits: Felipe Cardoso Moreira de OliveriaU.S. Consulate Vladivostok, Steven Ley, BurnAway 

 Source List

  1. Allen N, Nevill A, Brooks J, Koutedakis Y, Wyon M. Ballet injuries: injury incidence and severity over 1 year. JOSPT. 2012 (42):781-90
  2. Bowling A. Injuries to dancers: prevalence, treatment, and perceptions of causes. BMJ. 1989;298(6675):731–734.
  3. Hamilton LH, Hamilton WG, Meltzer JD, Marshall P, Molnar M. Personality, stress, and injuries in professional ballet dancers. Am J Sports Med. 1989;17(2):263–267.
  4. Koutedakis Y, Sharp NC. Thigh-muscles strength training, dance exercise, dynamometry, and anthropometry in professional ballerinas. J Strength Cond Res. 2004;18(4):714–718.
  5. Luke AC, Kinney SA, D’Hemecourt PA, Baum J, Owen M, Micheli LJ. Determinants of injuries in young dancers. Med Probl Perform Art. 2002;17(3):105–112.
  6. Milewski MD, Skaggs DL, Bishop GA, Pace JL, Ibrahim DA, Wren TA, Barzdukas A. Chronic Lack of Sleep is Associated With Increased Sports Injuries in Adolescent Athletes. J Pediatr Orthop. 2014 Mar;34(2):129-33.
  7. Patterson EL, Smith RE, Everett JJ, Ptacek JT. Psychosocial factors as predictors of ballet injuries: interactive effects of life stress and social support. J Sport Behav. 1998;21(1):101–112.
  8. Russell J. Preventing Dance Injuries: current perspectives. Open Access Journal of Sports Medicine. 2013 Sept 30; 4:199-210
  9. Thomas H, Tarr J. Dancers’ perceptions of pain and injury: positive and negative effects. J Dance Med Sci. 2009;13(2):51–59.
Training for Athleticism and Injury Avoidance

Training for Athleticism and Injury Avoidance

12682665544_800da37ab1_oI recently provided sideline medical coverage for the Mercer Island Summer Celebration Basketball tournament.  It was a great event and I was really impressed with the level of play.  The U7 and U10 teams displayed an impressive level of sophistication, running designed plays and managing the clock in a way that I would never expect from elementary school children.  These girls and boys play a lot of basketball and it shows.  Unfortunately I was also struck by the incongruity of their basic athleticism.  I spent most of my day patching up grazed knees, elbows and palms caused by players tripping over each other or themselves.

I’m not alone in noticing this trend.  The sports medicine literature is full of articles and opinion papers warning of the dangers of early sport specialization and diminishing athleticism.  The discussion of how and why we should change this trend is one that I’ll leave for another day.  For now let’s talk about some of the real world implications of an insufficient athletic base and some strategies for helping to rebuild what is missing.

I regularly see adult basketball players suffering from chronic ankle sprains and resultant instability.  Although we are generally able to keep these athletes on the court it is an uphill battle that is never completely won.  How often have you heard someone lament their “bad knees” or “bad ankles” which force them to wear a brace, pop prophylactic NSAIDS or limit their playing time?  In many instances the reason for these “bad knees” or “bad ankles” are repetitive injury cycles caused by bad mechanics and a poor athletic base.  The best way to identify and correct deficits in your athletic base is to work one on one with a healthcare provider or performance specialist skilled in qualitative movement assessment and corrective exercise.  If that is not an option there are injury prevention programs that have been shown to improve balance, and functional performance while reducing injury rates.  The FIFA 11+ and Sports Metrics programs for two of the best.

Photo Credits: Ralph ArvesenArturo Donate

Sitting Kills, But Can a Standing Desk Really Save You?

Sitting Kills, But Can a Standing Desk Really Save You?

Sitting has taken a lot of flak in recent years with some health researchers going so far as to dub it ‘the new smoking.’  While sitting isn’t likely to ravage your lungs as severely as a pack of smokes, it does carry significant health risks.  Extended periods of sitting have been linked to increased rates of colon cancer, endometrial cancer, lung cancer, diabetes, heart disease, and a slew of musculoskeletal issues (Diabetes Res. Clin. Pract., Sept. 2012; Am J Epidemiol., Mar. 2013;  JNCI, Jun. 2014) Sitting for extended periods has also been shown to lower life expectancy regardless of cause of death (JAMA, Mar. 2012).

Initially, the thought was that these risks were due to low overall physical activity levels in people who spend a large portion of their day sitting.  However, recent research has shown that sitting carries the same risks even if you exercise regularly.  The problem is not a lack of physical activity, but rather the time spent sitting itself.  Clearly we need to address our sedentary lifestyles head on.  An increasing number of people are doing this by moving to a standing desk.  But is this the right move for you?

Nurses and assembly line workers can attest that standing all day comes with its own set of issues, especially if your body is conditioned for 8+ hours a day of sitting.  Moving to a standing desk adds load to the feet, legs, and core which many seasoned desk jockeys are just not ready for.  Multiple studies have also linked prolonged periods of standing with its own set of health risks (WORK, Jan. 2002).   But don’t give up hope just yet.  There is an answer and a surprisingly simple one.  Mix it up.  That’s right, don’t limit yourself to one working posture; sit some, stand some, walk some, heck if you can figure out how to be productive lying down go ahead and add that in too.  The key here is avoiding extended periods in one posture.

Some employers have fully embraced this concept with modular work environments where employees have the ability to switch from sitting, to standing, to walking at a treadmill desk.  But even if you are stuck in a traditional office or cube there are many ways to get up and stay healthy.  The simplest solution is to take regular breaks throughout the day.  I recommend using a timer on your phone or desktop to remind you to take a short 30 second break every 20 minutes.  Each break should include getting up out of your chair and performing a few quick stretches like the ones below from Bob Anderson’s book Stretching in the Office:

A quick round of stretches like this takes less than a minute and can have a major positive impact on your health.

A quick stretch break takes less than a minute and can have a major positive impact on your health.

It is also good to work in a few longer breaks where you can take a walk around the office.  Break up your day with trips to the water cooler, coffee machine or a coworker’s desk.  Forgoing an email to deliver a message personally will get you out of the chair while fostering good relationships with your coworkers.

If you do decide to go the standing desk route, make sure that you also have the option to alternate between both sitting and standing.  An adjustable monitor and/or keyboard stand, a stool with a foot rest or a stack of books can all be used to make a function workstation for either standing or sitting.  When standing, try going barefoot on a cushioned mat to ease the strain on your feet.  Prop one foot up on a box or foot rest to vary your posture and relieve strain caused by locking out your knees.

The key thing to keep in mind with whatever workstation you use is to move as much as possible and avoid staying in any one posture for over 20 minutes without a break.  If you are having discomfort when attempting the switch to a standing desk don’t give up.  Start with short periods of standing and return to sitting when you become fatigued.  Low back pain while standing is a sign of a common muscular imbalance that develops from years of excessive sitting.  Talk to a health professional who can help you develop an individualized strategy for correcting the muscle imbalance.  It’s never too late to make a healthy change in your work environment so why not start today.

Try the following links for help getting started with a standing desk:








Shoulder Pain: How to manage it and 3 easy ways to avoid it

Shoulder Pain: How to manage it and 3 easy ways to avoid it

Shoulder pain is one of the most common musculoskeletal complaints and something we see frequently at Velo Sports Rehab.  The pain is most often associated with repetitive shoulder motions, such as painting, throwing or playing golf, but we also see pain coming from a specific traumatic event such as a shoulder dislocation or a car accident.  The shoulder is a structurally complex region with a close functional relationship to adjacent regions.  Because of this, it takes longer for patients to receive a correct shoulder injury diagnosis than with most other musculoskeletal injuries.  This trend underscores the importance of early consultation with an orthopedic or sports medicine specialist such as the one of the great doctors at Velo Sports Rehab.

SH disection

Despite commonly being discussed as if it were a single joint, the shoulder is actually a group of three anatomical joints and a fourth physiological joint.  The coordinated movement between all of these articulations give the shoulder its unparalleled range of motion.  But this complexity comes with a price.  In order for the shoulder to function properly all of these joints need to move together in a carefully choreographed sequence.  Problems arise when this does not happen, as is the case following an injury to one of the rotator cuff muscles or an acquired muscular imbalance say from years of hunching over a computer.  (Cue: sit up straight and roll your shoulders back).  When one of the shoulder structures fails to perform its part correctly, movement becomes less fluid with other structures being forced to cover for the failing structure.  The body has a phenomenal ability to compensate and can often keep an acceptable level of function in spite of focal deficiencies.  Over time however, if the issue being compensated for is not addressed, the compensatory mechanisms lead to inappropriate loading and eventually tissue damage.

This pattern can take a variety of forms and once things start to break down, it is best to talk to a qualified medical professional who can help identify the issue and develop a corrective strategy.  Luckily, most shoulder cases respond well to conservative treatment and do not require surgery.  Nevertheless, it’s important to remember that every case is unique.  Any symptoms lasting longer than 2 weeks, causing severe pain or loss of function warrant a consultation with a qualified medical provider.  That said, the easiest way to manage shoulder pain is to avoid getting it in the first place.  Below I have included my top 3 tips for keeping shoulder pain at bay.

Tips for Avoiding Shoulder Pain

1. Avoid Repetitive Overhead Activities.

Repetitive overhead activities such as baseball pitching, painting, and overhead lifting are strongly correlated with shoulder pain.  The simplest advice here is to avoid doing them at all.  However the realistic answer for most people is to minimize the negative impact from repetitive overhead activities.  First make sure that you are using good form, a coach or trainer with experience in your sport will be able to help you with this.  Be sure that you are taking adequate rest days; you are more vulnerable to injury when fatigued.  Working through shoulder pain is rarely a good idea and should only be done under the direction of a qualified medical provider.

2. Keep Your Body in Balance

Most people tend to overwork the muscles involved in pushing and rounding the shoulders forward.  Don’t forget to work pulling motions as well.  Adding rows and reverse flys into your workout routine will help to strengthen the often neglected muscles that extend and externally rotate the shoulder. Start out with light resistance and focus on perfect form.  There are plenty of other exercises that you can use to target the same muscles, the key here is to make sure that your workout routine is balanced.  If you are uncertain about your routine a personal trainer is a great resource.

3. Work on Core Stability

Earlier in this article I referenced the close functional relationship that the shoulder has with adjacent areas of the body.  The neck, thoracic spine and lumbar spine are all attached directly to your shoulder.  These connections are made via muscles which use the spine as a stable base from which to move the shoulder.  A deficit in core stability means that the base is not stable which in turn forces the shoulder to compensate.  This compensation alters shoulder mechanics, leading to inappropriate tissue loading and eventually resulting in damage.  Here is a link to a great blog post from Bret Contreras on using a foam roller to help develop core stability.

The shoulder is a complex structure that we rely on daily for everything from tying our shoes and putting on a shirt, to pitching a baseball or swinging a tennis racket.  When things go wrong you’ll need the help of a skilled medical practitioner to get you moving well again.  But as with most things, an ounce of prevention is worth a pound of cure and following the tips above will help keep your shoulders working smoothly for years to come.

Photo Credits: Shazam, University of Liverpool Faculty of Health & Life Sciences