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

Conquering Carpal Tunnel: A Guide to Conservative Treatments

Carpal tunnel syndrome (CTS) is like an uninvited guest in your hand, but it doesn't have to stay forever. Several simple treatments can help manage CTS and make your hands feel better. Here’s how you can take control of your recovery.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome arises when the median nerve, responsible for sensation and movement in your thumb, index, middle, and half of your ring finger, gets compressed within the carpal tunnel in your wrist. This compression can lead to tingling, numbness, weakness, and pain in the hand and wrist.

What causes the compression?

It could be a combination of things: inflammation, awkward or sustained working positions, repetitive movements, operating heavy machinery, muscular strength, and mobility imbalances throughout the forearm, upper arm, and even the neck.

Combating CTS: A Multi-Pronged Approach

Conservative treatments aim to reduce pressure on the median nerve and alleviate CTS symptoms. Here's a look at some effective options:

1. Splinting: Wearing a wrist splint, particularly at night, immobilizes your wrist in a neutral position. This helps rest the median nerve and reduce pressure within the carpal tunnel.

2. Activity Modification: Mindfulness in daily activities can significantly improve CTS symptoms. Identify tasks that aggravate your symptoms and make adjustments. This may involve taking frequent breaks, using proper posture, and incorporating ergonomic tools into your workspace, keeping your wrist in neutral while you work, or changing your workspace to set yourself up for success.

3. Manual Therapy: Mobilization and manual therapy to the transverse carpal ligament and surrounding structures, trigger point dry needling to the flexor or extensor mass, depending on where the restrictions or limitations can be found, and nerve mobilizations/ gliding for the median nerve.

4. Therapeutic Exercises: Gentle hand and wrist exercises prescribed by a physical or occupational therapist can improve flexibility, nerve mobility, and overall hand function.

Wrist flexion stretching, wrist extension stretching, median nerve glides, grip strengthening, and upper extremity strengthening exercises may be appropriate depending on the severity (how intense they symptoms are and how they impact you), irritability (how much activity is required to provoke the symptoms) and nature (what other factors besides activity impact your experience) of your symptoms.

*Disclaimer: Exercises are for education only and should not be used in place of a PT or OT evaluation or free injury screen by one of our skilled PTs or OTs.

5. Functional Exercise: Using the fundamental strength and mobility built with therapeutic exercise to perform combined movements that mimic your job tasks, life outside of work, or hobbies that you may have.

The Takeaway: Early diagnosis and intervention are crucial for successful CTS management. By implementing conservative treatments at the first signs of CTS, you can prevent further nerve irritation and regain control of your hand function.

Consulting a physical or occupational therapist is vital for proper diagnosis and crafting a personalized treatment plan to conquer carpal tunnel and reclaim pain-free hand use.

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About the author: Ron Lawrence is a physical therapist and strength and conditioning specialist at our Shawano Clinic on Green Bay St. and with our Industrial Medicine Team. He holds advanced certifications in Dry Needling and Nutrition. He is an excellent resource for any work-related or non-work-related aches you may have!

Better going into surgery, better coming out.

Briana Wasielewski, PTA, CCCE, BS

Having the best rehab after surgery is one of the top priorities of all surgical candidates. Many spend a lot of time getting the best surgeon in place, getting their place to rest in order, and thinking about who can help them with daily life and getting to and from appointments once the surgery is done. While these are all things one should think about prior to surgery, many do not think about what they can do to ultimately increase their chances of having a better surgical outcome: exercise prior to surgery. 

Exercise comes in many forms and is something everyone can do before surgery. If done appropriately, exercise before surgery will likely improve recovery. Who better to help figure out your unique pre-op exercise plan than a physical therapist? 

First, a physical therapist will discuss and evaluate your reason for surgery. Many times the reason a patient is thinking about having surgery is that they have pain or their movement is affected. Exercise is usually not something surgical candidates think they can or should do before considering surgery. Prehab exercise is specifically designed by physical therapists to improve the outcome of patients’ post-surgical rehab. The idea here is “the better going into the surgery, the better coming out”. Whether that means breathing exercises, simple strengthening, flexibility work, or practicing how to use crutches, seeing a physical therapist before surgery can help the healing process in the long run.  

A physical therapist prehab visit also gives the opportunity for surgical candidates to ask questions specifically about the most dreaded part of having surgery: the recovery. Physical therapists are experts in rehabilitation and can tell you exactly what to expect in recovery, and how to prepare yourself with pain management tools.  

If you are thinking about having surgery or know someone who is, make sure you prepare yourself and your body by seeing one of our physical/occupational therapists.

Head to our location page to find a clinic near you!

Osteoarthritis of the Thumb CMC Joint

Written by: Tammy Vanevenhoven PT, DPT, CHT

As the season of fall hovers over us and the leaves begin to fall, the temperatures outside continue to fall as well. For those who suffer from arthritic hands stiffness and pain, it can quickly be felt by the changes in the temperature. Osteoarthritis is the most common of all joint diseases. It often affects the larger weight-bearing joints of the hips and knees, but it also commonly affects the smaller joints of the hands; especially the base of the thumb called the CMC joint (carpometacarpal joint). The CMC joint of the thumb is considered a saddle joint that allows the thumb its vast ability to grasp objects of various shapes and sizes, to open doors, jars, and packages, etc. It also allows pinching-- a more precision type movement for writing, buttoning, using scissors, picking up small objects or turning a key. We need our thumbs as they contribute to 60% of our hand function.

Signs and Symptoms of CMC joint arthritis are:

*pain at the base of the thumb after activity

*pain with active movement of the thumb especially with pinch

*morning stiffness

*joint tenderness to palpation

*crepitus (crunching noise in the joint) with thumb movement

*joint deformity with bony nodules felt at base of thumb

*weakness of hand grip (opening a jar, sealed packages, etc.) or with pinch (writing, buttoning, turning a key, etc.)

How is CMC joint arthritis diagnosed?

Usually a standard radiographic x-ray will show joint space narrowing, bony changes such as spur formation, and joint erosion. Based on the x-ray, the arthritic changes are usually classified as mild, moderate, or severe joint destruction.

What can be done non- surgically to help the painful arthritic thumb?

A certified hand therapist (CHT) or an occupational therapist can be of great help in alleviating pain in the arthritic thumb by fabricating a thumb spica splint that stabilizes the base of the thumb while still allowing use of the thumb tip for light pinch and grip activities. Stiffness can be reduced by using a paraffin bath that is composed of paraffin wax and mineral oil which is then melted to a therapeutic warm temperature which molds around the bony prominences of the hand to help soothe pain and improve movement of the joint. Your hand therapist will also educate you on joint protection by recommending built up handles on objects that are difficult to grip such as tools, scissors, writing and eating utensils. Key adapters can also be placed on your keys to allow ease with key pinch. An electric can opener can also be used to avoid stressing the arthritic thumb with a manual can opener. Protecting the hands from the cold weather is very important. Wearing mittens and using warming packs if you like to be outdoors will help keep your hands from getting stiff and painful while you cross country ski, ice fish or while taking a winter hike.

What does the surgery for CMC joint replacement entail?

CMC joint arthroplasty is the most common joint replacement of the arthritic hand. The beak ligament reconstruction, or the LRTI, is the most common surgical procedure performed. The hand has, thankfully, many muscles that perform the same function. They are called “spare parts.” The eroded CMC joint is removed and one of these extra tendons of the hand/wrist is sacrificed and bundled up to fill in the joint space at the base of the thumb. Patients are placed in a cast and often external pins are inserted for extra immobilization.  At four weeks the cast and pins are removed, and the patients are placed in a forearm-based thumb spica splint and sent to therapy to see a certified hand therapist or an occupational therapist that specializes in treatment of the hand. Therapy includes gentle progressive range of motion to restore normal movement of the thumb, fingers and concurrent wrist; which becomes stiff from being in the cast. Swelling control and pain management are treated by working on scar mobility to avoid tendon adherence. Hypersensitivity often occurs from the surgeons having to retract the superficial radial nerve to perform the operation. Therapists can ease this sensitivity by performing desensitization exercises to calm the nerve pain. Restoring functional hand strength while appreciating joint protection and education of patients for life-long care for the arthritic thumb are just some of the various ways your hand therapist can help.

If you would like more information in treating your arthritic hands you can call Advanced Physical Therapy and ask to speak to a certified hand therapist or occupational therapist that can assist you in answering your questions. APTSM New London phone: (920)982-0100.

October is National Physical Therapy Month!

Adam Wirtz, DPT, PT, OCS

In celebration of National Physical Therapy Month, I thought it would be beneficial to share some facts about our profession:

Physical therapists (PT’s) are movement experts who optimize quality of life through prescribed exercise, hands-on care, and patient education.  PT’s and the licensed physical therapist assistants (PTA’s) they may team with provide care across the lifespan to anyone of any ability.

There are many benefits to physical therapy. Some of which include the following:

Ø It can maximize your movement. PT’s can identify, diagnose, and treat movement problems.  Pain-free movement is essential for good quality of life, your ability to earn a living, and your ability to remain independent.

Ø Personalized care that meets your specific needs.  PT’s design individualized treatment plans to address each patients’ needs, challenges, and goals.  PT’s and PTA’s improve patient mobility, manage/decrease pain and other chronic conditions, recovery from injury/surgery, and aim to prevent future injury and chronic disease.

Ø Accessibility.  PT’s and PTA’s provide care in a variety of settings including hospitals, private practices, outpatient clinics, homes, schools, sports and fitness facilities, work settings, and nursing homes.

Ø Active participation in care.  PT’s and PTA’s empower and motivate people to be active participants in their care.  They also work in collaboration with other medical professionals to make sure patients receive high quality, comprehensive care.

Ø Reduces use of opioids.  In certain situations, when dosed appropriately, prescription opioid medications can be an appropriate part of medical care.  However, current CDC guidelines are urging medical providers to consider safer alternatives to opioids, like physical therapy, for most long-term pain management.  Opioids have several risks including depression, overdose, and addiction; plus withdrawal symptoms when stopping use.

Ø Avoid surgery.  Before undergoing expensive or invasive surgery, consider physical therapy first.  There is mounting evidence that physical therapy can be as effective, or in some cases, even better than surgery for conditions such as meniscal tears and knee osteoarthritis, rotator cuff tears, spinal stenosis, and degenerative disk disease.

Now that you are aware of some of the benefits of PT, let’s address the topic of direct access.

Did you know that you have the freedom to choose your own physical therapist?

Ø  Currently, you may be evaluated by a PT without a physician’s referral in all 50 states and the District of Columbia.  In addition, all 50 states and the District of Columbia allow some level of treatment by a PT without a physician’s referral.  This is referred to as “direct access” to physical therapy services.

Ø  Some insurance policies may require you to see a primary care provider or physician prior to seeing a physical therapist.  Also, some insurers may limit your access to preferred providers only.  Contact your insurance company to make sure you are aware of any of these policies.

Ø  If you have Medicare as your primary insurance, you are able to see a PT for an evaluation without a physician’s referral.  The PT would then send the plan of care to the patient’s physician for signature.  Once this is signed, treatment can be continued.

Ø  Your physician may refer you for physical therapy that is provided in the physician’s office, or to a facility in which the physician has a financial interest.  However, you are not obligated to attend PT in any specific facility or location.  You can choose where you would prefer to attend physical therapy and which licensed physical therapist you would like to see- if you have a preference.

Now that you know all about the benefits of PT and your ability to choose your physical therapist, the next time you have an aching knee, a bum shoulder, or an injured lower back, consider finding a physical therapist to help you get back to moving well!

You can find a physical therapist in your area at www.moveforwardpt.com