Tips and Tricks for Preventing and Managing Tendonitis

You wake up on a Monday morning with some forearm and elbow soreness.

You did a lot of yard work this past weekend- raking, pruning, and using the weed wacker. And last week, at work, you had to use several hand tools that required a lot of gripping and moving your wrist around.

You think back to several years ago when you dealt with a lot of pain and other issues with that same part of your arm…something they called “tennis elbow?

Boy, you’d really like to avoid another case of that!

So what should you do?

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Tendonitis is a common experience . It is a musculoskeletal condition when a tendon, the thick fibrous cord connecting muscles to bones, becomes inflamed. Repetitive motions, overuse of muscles, or improper ergonomics can cause it. However, with proper awareness and preventive measures, minimizing the risk of tendonitis and effectively managing its symptoms is possible.

Recognizing Early Signs of Tendonitis:

Early detection of tendonitis symptoms is crucial for timely intervention. Industrial workers should be vigilant of the following signs:

· Pain or tenderness near a joint, usually where the tendon attaches to the bone

· Swelling or inflammation around the tendon

· Stiffness or difficulty in moving the joint

· Gradual onset of discomfort, especially after repetitive tasks

· Weakness in the affected muscle group

Stretches and Strengthening Exercises:

Regular stretching and strengthening exercises can help industrial workers maintain flexibility and muscle strength, reducing the risk of tendonitis. Here are some recommended stretches and strengthening exercises for the wrist and elbow.

Wrist/forearm/elbow:

o Wrist Flexor Stretch:

• Extend your arm in front of you with the palm facing down.

• Use your other hand to gently bend your wrist upward until you feel a stretch in the forearm.

• Hold the stretch for 2-4 rounds of 20-30 seconds each.

o Wrist Extensor Stretch:

• Extend your arm in front of you with the palm facing down.

• Use your other hand to gently bend your wrist downward until you feel a stretch in the forearm.

• Hold the stretch for 2-4 rounds of 20-30 seconds each.

o Forearm Strengthening Exercise:

• To focus on the muscles on the inside of your forearm, hold a light dumbbell or a resistance band with your palm facing up.

• Slowly curl your wrist upward against the resistance, then lower it back down.

• Perform 2-3 sets of 10-15 repetitions.

• Do this same technique, starting with your palm facing down to target the muscles on the outside of your forearm.

Modify your work:

Correct ergonomics and tool usage are essential for preventing tendonitis in industrial settings. Workers should adhere to the following guidelines:

1. Maintain neutral wrist positions while gripping tools whenever possible to reduce strain on tendons.

2. Take regular breaks to rest and stretch muscles during repetitive tasks.

3. Use ergonomic tools with padded handles and adjustable grips to minimize joint stress. Using anti-vibration gloves may also help decrease the demands on tendons while using power tools that create a lot of vibration.

4. Avoid excessive force or sudden movements when using tools, as this can strain muscles and tendons.

Preventing and managing tendonitis requires a proactive approach focusing on early recognition, regular exercise, and proper ergonomics.

By implementing stretching and strengthening routines and following correct ergonomics, you can reduce the risk of tendonitis and maintain optimal musculoskeletal health.

Please note that these exercises above are general recommendations. They should not take the place of advice from a medical professional.

If you would like a program developed specifically for you and your needs by one of our physical therapists, occupational therapists, or athletic trainers, contact us today!

In addition to elbow and wrist stretching, strengthening, ergonomic modifications, your plan may include things like manual therapy, trigger point dry needling, therapeutic cupping, functional exercise and so much more.

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About the author:

Megan is our Sports Medicine Coordinator and a key player on our Industrial and Tactical Medicine Teams. She has utilized this preventative exercise and ergonomic strategies to help all the athletes she works with within all realms.

References:

• https://www.ptandrea.com/blog-posts/ergonomic-principles-and-hand-care-techniques

• https://www.medicalnewstoday.com/articles/324489

• https://www.researchgate.net/figure/Recommendations-for-hand-tool-handle-design-5_fig10_234056130

• https://www.harborfreight.com/anti-vibration-mechanics-gloves-x-large-58696.html

• https://steemit.com/sledge/@lindawilson/high-quality-sledgehammers-make-a-high-impact

How to Decrease fatigue and reduce stiffness in 5 minutes.

Feeling sluggish or stiff at work?

Try these 5-minute breaktime exercises to boost circulation, reduce fatigue, and alleviate stress!

These short and simple exercises can be done during breaks to relax overworked muscles and activate those not used as often. This will improve your ability to perform your job with focus and reduce aches and pains. Dynamic stretches and postural reversals are critical to this process.

Dynamic stretches held for just 0-5 seconds increase blood flow and improve flexibility and strength.

Postural reversals, done throughout the day, counteract the effects of prolonged postures. Incorporate these exercises into your daily routine and feel the difference immediately! 

Dynamic Stretches:  

Dynamic stretches assist with restoring physical functioning & flexibility, elevating the core body temperature, increasing circulation, accelerating energy production, and improving speed & strength.

Increased blood flow to your tissues helps delay muscular fatigue. 

Perform each exercise until the muscles feel warmed up, avoiding any movements that cause pain.* Progress slowly and always move through a pain-free range. Stop when you feel a gentle pull. They are most effective if they are done a few times per day.

• Head Circles - Rotate the head to make circles. Complete in both directions.  

• Arm Circles - Lift arms away from the body. Move in a circle. Complete both directions.  

• Wrist Circles - Bend elbows. Move the wrist in a circular direction. Complete in both directions.  

• Squat-to-Fly: Stand with feet hip-width apart and push hips back as if sitting on a chair. Cross arms in front of your chest. Bend your knees to lower yourself into a squat. Stand up while uncrossing/opening your arms as wide as you can. Squeeze your shoulder blades together.  

• Toe-Touch to Side-Bend - Stand with feet hip-width apart. Try to touch your toes, and stop when you feel tension. Return to an upright position and lift one arm above your head. Reach to the opposite side. Re-center. Bend towards the toe and then reach towards the opposite side.  

• Butt Kickers - Stand with feet hip-width apart. Bend your right knee and lift your heel toward your butt. Lower your right leg and do the same on your left side.  

• Lunges: Stand with your right foot in front and your left foot in back. Move your hips forward while bending your front knee to tolerance. Repeat on the opposite side.  

• High-Knee with a Twist - Lift knee upwards towards the chest while rotating trunk. Bring opposite elbow to knee at the same time—alternate sides.   

This is an example of a program we use for our industrial clients; however, these are great for office workers too!

Postural Reversals:  

Postural Reversals involve placing your body in the opposite position or motion. They can be done throughout the day and only take a few seconds to accomplish. Postural reversals are more effective for combating muscular tension from prolonged postures than stretching alone.

• If you’re Standing, perform 5 squats every 30 minutes of continuous standing.  

• If you’re twisting your wrists a lot, draw circles with your wrist for 3-5 reps in each direction.  

• If you’re gripping a lot, Make a tight fist and then spread your fingers out as wide as possible, returning to the starting position with 3-5 reps total.   

• If you’re forward-bending a lot, Stand hip-width apart and reach up towards the sky for 5-10 seconds. Slightly bend or curve your spine backward, using your hands to support your lower back as needed.   

• If you’re Forward Reaching a lot, Stand hip width apart, arms out to the side, elbow bent at 90 degrees into a “Happy Cactus” position, perform 3-5 reps for every 15 minutes of work.  

• If you’re sitting a lot, stand and complete 25 high knees every 30 minutes of sitting. We can do this in place or march forward.  

• If you have low back discomfort while seated, arch your back and round your back for 5-10 reps as needed.  

You can perform these exercises wherever you have adequate space or surface support, as needed. 

Dynamic stretches and postural reversals boost circulation and reduce muscular fatigue. Incorporate these into your daily routine and feel the impact on your physical and mental health. 

*Disclaimer: Please note, these exercises are general recommendations. They should not take the place of advice from a medical professional. If you would like a program developed specifically for your or your workforce by one of our physical therapists, occupational therapists or athletic trainers or feel like you could benefit from manual therapy, dry needling or cupping to compliment these exercises, contact us today!

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About the author: Megan is a Physical Therapist Assistant at our Fond du Lac and Ripon Clinics. She is also heavily involved with our Industrial Team. She uses similar exercises to help workers thrive during their workday and prevent injuries for jobs requiring prolonged postures/positions and repetitive work.

National Athletic Training Month Recap.

National Athletic Training Month is held every March in order to spread awareness about the important work of athletic trainers (ATs). The care provided by these experts, whether to middle, high school, collegiate or professional athletes or the industrial athlete, can be life-altering. The athletic training ranks teem with stories of current ATs drawn to the profession through their interaction with an AT who helped them through a devastating injury when they were young. Such profound encounters contribute mightily to the next generation of ATs so vital to the health and well-being of athletes of all ages and disciplines.

As providers of front-line care, ATs offer wide-ranging skill sets that go well beyond the physical aspects of sports medicine. Their ability to connect with patients is perhaps the true hallmark of the AT. Another characteristic shared by many ATs is their slightly annoying reluctance to highlight their own skills.

As it’s National Athletic Training Month, we asked them the following question:

What unique value do you feel athletic trainers offer their patients?

And forced them to answer.

Lynsey Hansen – 11 year in athletic training, previous experience with youth, high school, and collegiate athletics. Past year and a half with Industrial and Tactical Medicine.

“AT’s have the unique opportunity to get to know their patients before they get injured in most cases, which can help improve the patient's outcome, and the AT also gets to watch them successfully return to their career, hobby they love, etc. Having that sort of relationship can help keep the small things small, but also incorporate techniques to aid the mental and emotional aspects when those injuries are more severe.”

Joe Hanel – 8 years in athletic training. All in Industrial setting.

“I think the general public is starting to understand that AT’s have a very broad range of knowledge about all kinds of injuries, human anatomy, kinesiology and more. When it comes to the front line of care, AT’s seem to be most knowledgeable in whole-body care. Most LAT’s need to be ready to treat any injury so our continuing education is not often specialized, allowing us to stay current on a wide spectrum of healthcare issues. I believe this really helps us stand out.”

Heidi Bohl – 13 years in athletic training, previous experience in youth and high school athletics. Past 4 years in Industrial and Tactical Medicine.

“Athletic trainers offer multiple skillsets that dabble in a variety of healthcare spectrums including physical care as well as emotional wellbeing. The range of training allows us to guide and address the whole body.”

Traci Tauferner - 17 years in athletic training, previous experience in youth, high school, collegiate and semi-professional athletics. Past 15 years in Industrial and Tactical Medicine. APTSM’s Director of Industrial and Tactical Medicine.

“I work mostly in the tactical setting. So for me athletic trainers bring valuable expertise to police and fire departments by offering specialized injury prevention, rehabilitation, and fitness training tailored to the physical demands of their jobs. Our knowledge of sports medicine principles can also help in managing and preventing work-related injuries, ultimately promoting the overall health and well-being of police officers and firefighters.”

Sean Gough – 12 years in athletic training, previous experience in high school and collegiate athletics. Almost 1 year with APTSM in Industrial and Tactical Medicine

“Athletic trainers excel in being the go-to, that trusted face due to the long-term relationships we build with patients—especially in the athletic setting but also now in the industrial and tactical space. Not only do we get to see our patients at a time where they are vulnerable, hurt, or uncertain about their future, but we also get to see them at their best.”

Marc Viergutz – 8 years in athletic training, previous experience in high school, collegiate, and professional athletics. Past 3 years with Lawrence University.

“AT’s offer a truly sport-specific view which is unique in the world of medicine. From the way we are educated to the way we approach things. It’s always from a view with the athlete’s sport in mind. We have the opportunity to work every day with that sport and provide tailored treatment plans.”

Megan Werner – 14 years in athletic training, previous experience in youth, high school, and collegiate athletics. Past 6 years in Industrial and Tactical Medicine and as Sports Medicine Coordinator.

“I feel athletic trainers offer a huge value to our patients because of our dynamic skill set. With our roots in athletics, we naturally learn to be flexible and are quick to adjust based on the needs of our patients and clients. We are always looking for ways to help our patients recover from injury or continue to improve their performance, no matter if their “playing field” is an actual field or court for an athlete, a manufacturing facility for an industrial worker, or a burning building for a firefighter.”

So if you see your friendly (or even somewhat laconic) athletic trainer, invite them to chat about their chosen profession as well as their national organization’s tagline for the month-long celebration: “From Head to Toe.”

Actually, once the ATs got going they couldn’t resist answering our second question (“How does ‘From Head to Toe’ encapsulate what you and Advanced PTSM do in athletic training?”), which we combined into a tidy paragraph that represented the group’s thoughts nicely:

“As athletic trainers, we are ready to address almost anything our patient might need. Our education includes emergency care, evaluating and treating orthopedic injuries, injury prevention, as well as concussion care, nutrition, and hydration. We’re also typically in environments like working with a team or company where we get the chance to develop strong relationships with our patients and get to know them as a person, not just their injury.”

Quick Access to Quality Care

The Zoom connection was spotty.

“So you said you’re from the Twin Cities? I love Minneapolis,” I stated.

“Not Minneapolis,” she said. “Leopolis!”

Wait, what?

“And now I live in Pella.”

After the reconnect, I had Sally Egan of Advanced Physical Therapy & Sports Medicine (APTSM) begin anew.

“As an onsite provider at three companies and a municipality in Northeastern Wisconsin, it’s my job to help create and maintain healthy environments for employees,” said Egan. “And the best way to do that is to provide quick access to quality care.”

Egan is a veteran of APTSM’s industrial rehabilitation team, a group of licensed athletic trainers and physical therapists dedicated to keeping employees healthy, safe, and on the job. Like many of her colleagues from the athletic training world, she began her career in the high school setting, as the athletic trainer at nearby Shawano High School (about 15 minutes away from what she refers to as the “Twin Cities”) for nearly a dozen years.

She stresses the similarities between the two environments.

“What we do as industrial athletic trainers is bring the sports medicine model of immediate, consistent care to the workplace,” said Egan. “And we do this at no cost to the employee.”

Which is so important to her clients, everyday people who are just trying to make a living and put food on the table.

Egan understands that concept well.

“I grew up in this area on a very small dairy farm. I know what it's like for a family to live paycheck to paycheck and not able to get healthcare when you really should, because you just can't afford it,” said Egan. “So being able to provide that service—literally in my hometown—is just an amazing opportunity for me.”

Interesting that she and her chiropractor brother (“two tiny farm kids”) both pursued careers in health care. It makes complete sense, though, as she describes it as a simple transition from fixing tractors or boards on a wall to fixing people.

The similarities don’t end there, as Egan quickly points out.

“You have to be adaptable and inventive because you don't usually have the resources. That's what onsite rehab is. You don't have a lot of equipment, so you have to work with what you have,” she said.

The companies and organizations she works with rely on Egan to deliver services known as “rapid response,” where direct access to care means employees will be seen in 24-48 hours for an evaluation. That kind of quick care creates the opportunity for an improved healing timeframe, as the onsite provider can swiftly address and manage issues that, if left untreated, could become a recordable injury.

“We can prevent that from occurring,” said Egan. “So you’re keeping the employee healthy and keeping them at their job, and you’re saving the employer money by reducing direct and indirect costs that result from such an injury.”

Again, she leans on her sports medicine background.

“One domain of athletic training is about reactive and emergency care, which in industry is rapid response and OSHA first aid. So we're there for that assessment, and occasionally wound care and emergency care,” said Egan. “For injuries, we’re able to assess and make appropriate decisions if this is something that you can rehab or treat, or make that decision for a proper referral and guide them to where they should go for the best quality and line of care.”

Developing a relationship and a rapport with her employees is crucial.

“Well, it’s on me to get out on the floor and make connections,” said Egan. “You need to show them that you're there to know them as a person, not just a patient.

Forming such bonds requires a level of trust, something Egan says comes naturally when employees get treated right away and feel better. Whether it’s Egan making the rounds on a factory floor or working with a patient who scheduled an appointment in a (usually) small treatment room, the brief interactions are the sources of the best kind of marketing there is word of mouth.

“One employee will say, ‘Sally has done great things for my shoulder. Go see if she can help you.’ And that keeps my days full,” said Egan.

Egan highlights additional services she can provide if companies so choose. One company, for instance, wanted to offer their office personnel some strategies to improve general wellness. So, every week at the scheduled time, staff members stop what they are doing, grab a chair, and join Egan at the center of the office, where she leads them in fifteen minutes of stretching and body mechanics.

“It’s just a special need that the company felt strongly about, and we can do those types of things,” said Egan. “We individualize services based on the company. I meet with HR every single week at my companies just to keep the lines of communication open. We’re there to prevent health issues as much as possible, so that kind of collaboration ensures their needs are being met.”

The stability of the Wi-Fi connection notwithstanding, someone needed to get going. Technically her “day off,” Egan was headed to a side gig, teaching chair yoga to retired adults. But she wanted me to know she hadn’t looked at list of questions I had sent her prior to the interview.

“I wasn’t going to prep for this. Because what works in this field is that we're ourselves. We're not scripted. You get the real me,” said Egan.

The small-town country girl paused, and before signing off acknowledged one final similarity between her job as an industrial rehabilitation specialist and her work with high school athletes in a previous life.

“We’re in healthcare for a reason, and that’s to help people. I get to make those personal connections with industry clients just like I did in sports medicine. And the best part is when I get somebody that comes in and says, ‘Thank you so much for helping me. I feel so much better, and I didn't know if I was ever going to feel better.’

“That’s the best part of my job.”

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Click Here to learn more about our Industrial and Tactical Medicine and Wellness programs.

The impact of Athletic Trainers in Industrial Medicine

Heidi demonstrates a simulated pull during a post-offer test to assess the employees ability to perform their job duties.

Advanced PT’s Heidi Bohl had the opportunity recently to share her experiences as an industrial athletic trainer to college students on the AT track in South Carolina. The college seniors who comprised her audience have been the beneficiaries of a number of presenters who highlighted a variety of topics related to pursuing a career in athletic training, but this was their first exposure to industrial athletic training.

While there are many paths open to those earning an athletic training degree, the majority make their debut in organized athletics (secondary schools, colleges, etc.). Already employed at the YMCA when she joined Advanced Physical Therapy & Sports Medicine, Bohl was initially hired for on-call work, covering for full-time athletic trainers to provide care to high school and middle school athletes as well as to club team participants.

Bohl enjoyed the work but made clear to her audience the importance of considering options and thinking about what is most important to each individual as they continue their education and pursue their career goals

“The schedule of a high school athletic trainer isn’t necessarily conducive to raising a family,” Bohl said. “My husband and I knew we wanted kids, and I wanted to be home for them.”

Bohl continued with part-time efforts at both jobs until her position at the YMCA was eliminated due to COVID; to replace those missing hours, she looked to the bourgeoning field of industrial rehabilitation, where companies hire providers to deliver healthcare services onsite to their employees.

It just so happened her current employer was a leader in the delivery of industrial onsite services. And because of the growth in that area, Advanced was looking for additional providers.

“Rob Worth (President of Advanced PT) knew me through the PRN work I had done, and we discussed the kinds of services Advanced was performing at companies,” Bohl said. “We both thought it would be a great fit for me.”

Advanced PT works with over 60 industrial companies, who employ physical therapists, physical therapy assistants, occupational therapists, occupational therapy assistants, and, of course, athletic trainers from Advanced to deliver the services necessary to keep employees at their best. The idea driving the model is simple yet profound: reduce the time and money lost to a company by reducing employee injury.

“We look at the employees at our companies as industrial athletes,” said Bohl. “Our presence onsite allows them to work safely at their job and enjoy life outside of work.”

Bohl’s skill set is vast, and good thing, as there are a multitude of areas on which to focus, including early intervention services, job testing, injury prevention, ergonomics, and wellness initiatives, to name a few. Programs are customized by the employer; they choose what best fits their needs and objectives.

After three years in industry, Bohl now dedicates all her hours to a single employer. She’s available onsite, naturally, but she’s also available by phone, text and email when not onsite to discuss injuries and determine plans of care.

“We promise opportunities for access to care within 24 hours if we aren’t onsite, which includes access to orthopedic providers we partner with,” said Bohl. “That kind of rapid response is a win-win scenario for employees and the employer.” Typically, companies utilizing the onsite model will see a reduction in OSHA recordable injuries by at least 50%, along with significant reductions in healthcare costs from both work-related and non-work related injuries. Bohl covered a lot of information in her thirty-minute presentation, but she saved a few minutes at the end for questions.

“Can you discuss the importance of developing rapport with the employees and understanding the company culture?”

“It’s vital,” said Bohl. “You have to know your employees and know how to interact with them. I provide services at a concrete and construction company. My dad was a general contractor. My uncle does concrete for a living. This is just a natural fit for me.”

If students didn’t understand the concept of variety in the world of industrial athletic training at the beginning, they sure were on board at the end.

“You’ll be on the floor, moving from area to area, employee to employee, encouraging people to come talk to you if they have questions, then you’ll head back to meet with the employees who made appointments to see you. Afterwards, you’ll be at a safety meeting sharing data and ROI; following that, it’s time to perform a jobsite analysis and then an ergonomic evaluation,” said Bohl.

After a busy day that included many of the aforementioned tasks plus the Zoom presentation to prospective industrial athletic trainers located a thousand miles away, Bohl was back at her full-time job, the primary focus of which revolves around getting her children to and from a plethora of practices, games and competitions.

She has a vast mom skill set too.

“Police Support Staff Person of the Year.”

Traci Tauferner supplying rehab services at Wausau PD.

On January 7, 2023, the Wausau Police Department recognized Traci Tauferner as “Police Support Staff Person of the Year.” Tauferner, the Director of Industrial & Tactical Medicine at Advanced Physical Therapy & Sports Medicine, provides onsite preventative and reactive care for members of the Department and has been doing so since 2020.

Those who know Traci understand how squirmy this blog will make her, as she is the consummate team player who shuns any form of self-aggrandizement; however, the award is in her name, so we’re going to roll the dice and hope she’s too busy to notice we posted this.

And to put us in an even more precarious situation—because Traci flips really big tractor tires just for the fun of it—we’re going to use her own words to explain what she does and why:

“My passion to do my job to serve and protect others can be directly linked to the events of 9/11. The moment I saw TV news footage of departing soldiers leaving their families at airports across the country, I knew I was also going to help. I joined the Army soon after, and my 17 year old self went from "What have I gotten myself into?" to "I am capable of so much more than I have ever thought.

“I spent nine years in the National Guard, including a six-month deployment in Iraq providing security and surveillance support for tactical units. This training led me to where I am today. Helping others do what their job requires is what fuels and excites me, and a good deal of my energy now goes into developing programs and strategies that ensure essential job requirements can be performed safely.

“The day-to-day work with my tactical teams puts me in the unique position of understanding the physical and mental stressors they face; more importantly, it affords me the opportunity to do something about these circumstances. By providing the most advanced conditioning and rehabilitation resources available to the professionals tasked with keeping their communities safe, we can keep them performing at the highest levels while dramatically reducing the financial burdens placed on their departments.”

Congratulations, Traci!

Advanced Physical Therapy & Sports Medicine provides onsite therapy for Wisconsin companies, organizations and municipalities ranging from 50 to over 5,000 employees. To learn more about how we can customize an injury prevention and management program for your workforce, contact Traci Tauferner at 920-979-5597.