Hitting the Gym with Tennis Elbow

Resuming your upper body workout after being diagnosed with tennis elbow can be a difficult decision. For most people, it’s reasonable to return when you are pain-free at rest and with light daily activities. Here are some tips to keep in mind when coping with this condition while still getting to the gym a couple of times a week.

1. Wear an elbow strap while working out your upper body. When a muscle contracts, there is strain on the tendon. The strap allows the stress to be distributed over your muscle belly instead of your healing tendon. Keep in mind that counterforce straps are only meant to be worn during activity. They are not designed for wear while sleeping or during sedentary activities, like watching a movie.

2. Stretch your forearm muscles before and after working out. Start with your right arm in front of you, with the shoulder at a 90 degree angle and your palm facing down. Place your left hand on top of your right hand and gently stretch your right wrist down towards the floor. If you don’t feel a stretch in your forearm, try making a light fist. If you still don’t feel a stretch, rotate your arm so that the palm is away from you and bring your arm down across your body (towards your left knee). Do two to three repetitions, holding for 20-30 seconds. Repeat on the left arm. Try two to three repetitions, holding for 20-30 seconds. This stretch is just one of the many exercises and tips that can be found in Treat Yourself Therapy’s Tennis Elbow program!

3. Lighten your grip whenever it is safe to do so. Many people don’t realize that what you do with your wrist and hand greatly affects tennis elbow. This means you may need to modify all of your upper body exercises. Here’s how:

• Wear gloves with a textured palm to improve your grip.
• Use weights that have a thicker diameter on the grip. You can also add pipe insulation or tape to bars, dumbbells, or machine handles to enlarge the grip.
• Utilize wrist wraps to take some of the weight out of your hands to alleviate strain to the tendon at the elbow.
• For those doing light weight, using ankle weights attached at your wrists instead of holding dumbbells is another option.
• Using resistive bands, where the handle can be placed across the palm (like for bicep curls) or on the wrist (like for some shoulder exercises) can also help.

4. Try keeping your wrist straight when doing machines, rather than extending or flexing the wrist.

5. Have good form and keep the elbow in a midrange when doing military presses or shoulder presses. Initially, avoid the extremes of flexion and extension during bicep and tricep exercises. Do lighter weight so you can have more control on the negative.

6. Keep the elbow bent when possible. Shoulder exercises performed with the elbow straight and a weight in your hand put a lot of strain on the elbow. Lateral or forward raises or flies should be performed with the elbow bent to reduce the strain.

7. Start back slowly. This is very important! Decrease the weight and do fewer reps initially. See how you feel over the next three days. If the pain returns, you know it was too much, too soon. If you have no pain, gradually progress to your previous level utilizing the tips above to decrease the risk of recurrence. Good Luck!


Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

What To Do When Weightlifting Gives You Tennis Elbow

Working out with weights is a great way to tone and strengthen your muscles. But for some, these activities can bring on the dreaded diagnosis of tennis elbow, or lateral epicondylitis. Whether you are a novice or a diehard, here are a few suggestions that can help prevent the condition from getting worse so you get back to your routine sooner.

1. Recognize the Signs of Tennis Elbow:  Tennis elbow is an injury to the tendon that attaches your wrist muscles to the elbow. Pain occurs on the outside of the elbow, with point tenderness over the small bony protrusion, called the lateral epicondyle. Often, pain radiates down into the forearm muscles. Numbness and tingling do not occur with tennis elbow.
2. Respect the Pain: Because tennis elbow is an overuse injury, you should NOT work through the pain. The condition is caused by small tears in the tendon. Ignoring the pain and continuing your routine can make the condition worse, resulting in longer healing times. It's best to rest your elbow for a few days. You can still head to the gym, just focus on cardio and your lower body.
3. Use Cold Packs: If you notice the signs of tennis elbow during or after your workout, place a gel cold pack in a pillowcase and put it on your elbow for about
   10 minutes. Repeat this several times a day over the next three days and then intermittently as needed to decrease pain.
4. Stretch the Forearm Muscles: Gentle stretching is important in any exercise routine but many people don't think of stretching their forearm muscles. These muscles are active whenever you use your hand, so make sure to incorporate the following stretch into your daily life. Start with your right arm in front of you, with the shoulder at a 90 degree angle and your palm facing down. Place your left hand on top of your right hand and gently stretch your right wrist down towards the floor. If you don't feel a stretch in your forearm, try making a light fist. If you still don't feel a stretch, rotate your arm so that the palm is away from you and bring your arm down across your body (towards your left knee). Do two to three repetitions, holding for 20-30 seconds. Repeat on the left arm. To learn more specific exercises to treat tennis elbow, check out Treat Yourself Therapy for a four-phased program at www.TreatYourselfTherapy.com/tennis-elbow.

If you try these steps as soon as the symptoms start, you should be able to slowly return to your workout within a couple of weeks. You'll know you're ready if you are pain-free at rest and with light activity. Stay tuned for Hitting the Gym with Tennis Elbow, which provides specific tips to decrease the strain on your elbow during your gym workout.

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

What types of arthritis affect the hands?

You may think that “arthritis is arthritis,” and that it all affects the joints in the same way.  The truth is, there are several types of arthritis and how they present themselves in the hand is very different. 

The most common type of arthritis is osteoarthritis.  It results from wearing of the cartilage on the joint surfaces.  It is usually slow in its progression, with the first signs being soreness at the joint.  As it progresses, it can become more painful.  Over time, the cartilage can wear down, eventually leading to a joint with bone rubbing on bone.  The joints in the hand most prone to osteoarthritis are the base of the thumb and the small joints in the fingers.  Nodules at these small joints, called Heberden’s nodes, are the result of osteoarthritis. Treat Yourself Therapy’s video for Thumb Arthritis is a treatment program designed for osteoarthritis of the thumb. It contains specific exercises and education to decrease pain and improve flexibility while saving you time and money.

Rheumatoid arthritis (RA) is another type of arthritis that affects the hands. RA is a systemic condition involving many organs in the body.  It usually affects both hands symmetrically, and the joints most involved are the large knuckles.  An overproduction of the lubricating fluid around the joints, called synovial fluid, is the mechanism that affects the joints.  When the condition is in its active state, the joints feel warm and become swollen, stiff, and painful. 

Gouty arthritis can also affect the hands, although it is more commonly seen in the feet.  Gout is caused by too much uric acid in the blood, which can develop into hard crystals in the joints.  It usually has a sudden onset, resulting in burning pain, swelling, and stiffness.

Ten to thirty percent of people with psoriasis, a skin condition, develop psoriatic arthritis.  It can affect many joints of the body and is characterized by pain, swelling, and morning stiffness. In the hand, the joints most frequently involved are the small end joints of the fingers.

There are treatments and medications for all types of arthritis that help make the condition more comfortable.  Consult your physician if you suffer from arthritis to ensure that you are properly diagnosed and receive the care appropriate for your specific condition.

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

What Tests Help with Diagnosing Carpal Tunnel Syndrome?

If you have pain, pins and needles, numbness, or muscle weakness in your arm, your doctor may refer you to a neurologist. Think of a neurologist as a nerve specialist. These physicians are trained to perform and interpret tests that look at individual nerves for signs of damage. Why are these tests important? With nerve injuries, the location of the symptoms may not be the location of the damage. For instance, the nerves in your arms emerge from your spinal cord at the level of your neck, called the cervical region. So if you experience symptoms in your hand or forearm, the damage could be in your hand or forearm but it also could be coming from your neck. These tests are invaluable in determining where the damage is occurring to make sure you receive the correct diagnosis. This is especially important if surgery is being considered.

Dr. S.M. Zimmerman, a private practice neurologist in the state of Utah, suggests thinking of nerves like electrical wires. The wire is the axon and the outer covering, is the myelin sheath. If only the outer covering is damaged, it can be expected to heal easily. But if the axon itself is damaged, healing can be slower and less certain.
A nerve conduction study helps to determine the pattern of a nerve injury. "The severity of the symptoms a person is experiencing usually correlates with the severity of damage shown on a nerve conduction study and EMG, but not always. Occasionally a person has classic symptoms but normal nerve conduction studies."

A nerve conduction study looks at both the nerves that make your muscles work and the nerves that provide sensation. The test measures how fast the nerve sends a signal from one point to another, called the conduction velocity. This determines if there's damage in the myelin sheath, or outer covering of the nerve. It also measures how big the response is, which tests the axon of the nerve. If the axon is damaged, it can still heal but it won't do as well as if only the sheath was damaged, explains Dr. Zimmerman.

Dr. Zimmerman explains that  during an electromyogram, or EMG, an acupuncture-like needle is placed in a muscle to act like an amplifier. The neurologist is trained to recognize subtle differences in the sound, as well as in the amplitude of the muscle response to determine if the damage is still occurring. If the damage is no longer occurring, the test indicates how recently it had occurred. The muscles are tested at rest and during an active contraction to look at recruitment. This information tells how much damage is going on in the specific muscle that is tested.

If you have numbness and tingling in your hand or forearm, be sure to see your doctor. Early detection of syndromes like carpal tunnel and cubital tunnel is important to prevent progression of symptoms. If your nerve conduction study and EMG suggest moderate to severe damage, you can expect a referral to a surgeon to further discuss your options. If, on the other hand, the injury is mild to moderate, conservative treatments like occupational therapy, splinting, or anti-inflammatory medications may be recommended. Treat Yourself Therapy has a self-treatment video on carpal tunnel syndrome that includes helpful hints to manage symptoms, how to find the right brace or splint, and appropriate exercises to manage the condition. To learn more, visit www.TreatYourselfTherapy.com/carpal-tunnel.

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

Seeing the Doctor for Tennis Elbow

Written by Kathleen Papi-Baker, OTR, CHT and Jessica Karge, OTR, CHT

First of all, you may wonder what kind of doctor you should see? Since tennis elbow is a fairly common condition, your family practice physician should be able to make the diagnosis. They will do a little poking and prodding to rule out a joint or nerve problem, and rule in tennis elbow. They will do some provocative testing, such as asking you to hold your wrist straight, while the doctor tries to flex your wrist. This typically produces pain at the outside of the elbow when you have tennis elbow.
Once the diagnosis is made, a variety of options may be presented to you. The following list is a options your doctor may suggest.
*Physical or hand therapy may be suggested if your symptoms are not chronic. You will learn about tennis elbow, and be taught specific stretches, and exercises. Of course Treat Yourself Therapy's Tennis Elbow video is an option here!
*Cortisone injection around the affected tendon. Cortisone is an anti-inflammatory hormone that relieves pain in the short run, typically yielding relief up to 4 – 6 weeks.
*Dry needling, or percutaneous needle tenotomy, which involves poking the tendon/bone unit with a needle to create an irritation, which creates an environment for healing to occur. This can be done in combination with a cortisone injection.
*Prolotherapy is similar to dry needling, however, in addition an irritant is injected into the tendon to create an inflammatory reaction, with the goal of stimulating a healing response.
The next two options are called biologics. These procedures, as explained by Dr. Joseph Albano, a musculoskeletal specialist in Salt Lake City, involve using the body's own tissues to aid in the healing process, and are appropriate for more chronic conditions. Dr. Albano first uses diagnostic musculoskeletal ultrasound to identify the extent of the damaged tissue. This ultrasound shows more detail in lateral epicondylitis than an MRI, being able to detect the thickening of the tendon, and they are less expensive. It is a dynamic diagnostic tool in that it can show the tendons and muscles while they are moving.
*Platelet Rich Plasma, referred to as PRP, is a procedure that involves spinning the patient's own drawn blood to obtain a higher concentration of platelets. These platelets contain tendon healing growth factors. Using ultrasound as a guide, the platelets are injected into the damaged area to facilitate healing.
*Augologous blood injections involve the patient's drawn blood being injected back into the damaged area without platelet separation.
*Focus aspiration of scar tissue, or FAST, is a procedure that uses ultrasonic energy to break up and remove damaged tissue after the tissue is first identified with diagnostic musculoskeletal ultrasound.
Surgery for lateral epicondylitis may be an option for some who do not respond to conservative treatment, and/or may show a tendon tear after diagnostic testing. In this surgery, the damaged part of the tendon is removed.
There are a lot of options available today for people with tennis elbow. Be an informed consumer, and be familiar with what is available before you make any decision regarding your care. Be sure to see a physician experienced in the procedures you are considering.

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

Pregnancy and Carpal Tunnel Syndrome

For many women, sporting a baby bump comes with an unexpected surprise—symptoms of carpal tunnel syndrome! A recent article has estimated that up to 60% of pregnant women get carpal tunnel syndrome, which is compression of a nerve where it lies in a small tunnel, at the level of the wrist. It's usually diagnosed in the third trimester.

So the first question is, "Why is this happening?" Well with pregnancy, hormonal changes may be a contributor but more likely it's due to an overall increase in fluid volume. Since the carpal tunnel is normally a tight space, the extra fluid constricts the contents of the tunnel even more, placing pressure on the median nerve. Gestational diabetes can also play a role by slowing the speed at which the nerve transmits signals. The symptoms that result are pain in the wrist or hand and pins and needles sensations, particularly in the thumb and first three fingers.

So the second question is "What can be done about it?" Dr. S.M. Zimmerman, a private practice neurologist in Salt Lake City, Utah, says that most cases resolve between the fourth and sixth weeks after delivery, when most of the residual swelling has dissipated. In the meantime, she recommends splinting to her patients, especially while sleeping. The proper splint for carpal tunnel syndrome should keep the wrist in a straight position while allowing you to move your fingers and thumb. The splint or brace should extend approximately two-thirds up the length of your forearm. Using a flexible gel cold pack can also help to decrease the pain associated with carpal tunnel syndrome. Place the cold pack in a pillowcase to protect your skin. Wrap it around your wrist and hand for 8-10 minutes. This can be done several times a day.

"If it persists longer than one or two months after the baby is born," Dr. Zimmerman says "it may be because it has become a        mechanical problem." The hands and arms of new moms get quite a workout, from lifting the newborn to diaper and clothing changes. When combined with the pressure placed on the nerve from the increased swelling during pregnancy, the new heavier workload and awkward wrist positions when holding the baby can keep the cycle going. She suggests discussing your options with your doctor at this point. A nerve conduction study, which is highly sensitive in detecting carpal tunnel syndrome, and an electromyography test is the likely next step in evaluating the problem. Further treatment decisions can be made based on the results of these two tests. Since many cases of pregnancy related carpal tunnel syndrome respond to conservative treatment, Treat Yourself Therapy's video provides the education and exercises necessary to decrease symptoms and manage pain. It also includes suggestions to prevent progression of the condition. To learn more visit, www.TreatYourselfTherapy.com/carpal-tunnel.

Pregnancy photo courtesy of Delatte Photography.

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com/carpal-tunnel.

Healthy Gardening

Here is some special information for our customers who feel the call of the great outdoors when spring arrives!  No matter how green your thumb, gardening is a physically demanding activity that can take its toll on you if you're not prepared.  Think of it as a sport, you need to prepare and condition yourself.

First, some general tips.... Don't be a weekend warrior!  Pace yourself, and start  back slow.  You wouldn't start out running a 10 K if you haven't run all winter.  The same is true with gardening.  Vary the activities; raking, weeding, planting, and do them for short periods of time.  Take frequent rest breaks, and listen to your body.
Use good body mechanics when shoveling and raking. These activities are hard on the back because of their rotational characteristics.  Engage the core muscles,  by tightening your stomach, and keep a small bend in the knee.  Make a plan and only do a small area at a time.  If you have a lot of hand weeding, sit on a small stool.  It makes it easier to get up and down.  Weed after a rain storm, or watering.  The soil is softer, and the weeds will come out easier.
Wear gloves, they improve your grip, and prevent blisters.  Use the right tool for the job.  Clipper blades should be sharp, making each squeeze efficient.  If your gardening tools are old, think about investing in some new ones that have padded handles and are more ergonomically designed.

For our Tennis and Golfer's Elbow customers:
Keep your grip light when you're using hand tools.  Remember to keep your elbows bent when using hand tools to lessen the strain to your elbow.  When shoveling, use good body mechanics, distributing the weight into both hands.  Keep your elbows close to your body and generate more power from your legs than arms.  Avoid using hand clippers, their use causes too much resistive, repetitive hand motion, which can aggravate tennis elbow.

Do the Forearm Extensor Stretch and the Forearm Flexor Stretch from Phase 1  of the video before and after gardening.  Use a cold pack on your elbow after gardening if you are feeling any soreness in your elbow.

For our Carpal Tunnel Syndrome customers:
A very aggravating activity for carpal tunnel sufferers is cutting the lawn.  The gripping required coupled with vibration can be irritating for this condition.  The best option is to have someone else do it!  If that's not possible, break the task up into small sections, and take breaks.  Wear biking gloves with padded palms to decrease the vibration.  Use pipe insulation on the lawnmower handle to enlarge the grip and decrease the vibration even more. Keep your grip light on the lawnmower to decrease the force through the carpal tunnel.  If you have a wrist brace, wear it.  It's a good reminder to keep your wrist straight.

For our Thumb Arthritis customers:
I can give you personal, as well as professional advice since I have CMC arthritis in my left thumb.  I love to garden, and this is what I have found helpful.  If you have a soft neoprene brace, wear it when you garden.  I like the Comfort Cool CMC Restriction Splint.  It helps take some of the stress from the base of the thumb by providing light support.

Weeding can be very painful since it requires a strong pinch force.  Try to weed when the ground is soft, after a rain.  Use a hand weeder or shovel to loosen the weeds first, requiring less pinch strength to pull the weed out.  Pace yourself, and only weed for short periods of time, then take a break.

As I mentioned earlier, there are several gardening hand tools on the market that are ergonomically designed to reduce the force on the hand.   The larger, padded handle options feel better on my thumb.   If you're not in the market for new tools, you can pad your own with foam pipe insulation, available at hardware stores.

Happy Gardening!

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

Golfer's Elbow--Or Is It?

A baseball pitcher throws a fastball. After the game, he notices his elbow is sore. He grabs an ice pack, placing it on the inside of his elbow and heads out the door.
A phone salesman wins an award for the most sales in his department. He gets in his car to drive to his favorite restaurant to celebrate, shrugging off the pins and needles sensations in his ring and small fingers and the sharp pain at his inner elbow.
When a golfer makes contact with the ball, he winces from pain in his elbow, causing him to drop the club. He grabs his arm, wondering what could be wrong.
What do all of these situations have in common? They all have pain at their inner elbow. So they all have the same diagnosis, right?
Wrong! Like the rest of your arm, the anatomy in this region is complex and intricate, so many structures can cause pain at the inner elbow. Bend your elbows to a 90 degree angle and place them next to your body. The part touching your sides is the inner, or medial elbow. This article discusses three of the most common causes of elbow pain at this location.
The baseball pitcher is suffering from a medial collateral ligament (MCL) strain, a result of repetitive torque and stress to the elbow during pitching. Small tears and overstretching of the ligament occurs, leading to laxity and instability at the elbow over time. See a physician if you suspect you have this condition. Early treatment should include a throwing analysis by an experienced occupational or physical therapist. They can pinpoint biomechanical problems and offer suggestions to correct technique. If ignored, MCL strains can progress to the point that surgery may be required.

Cubital tunnel syndrome is the likely culprit causing the salesman's symptoms. It occurs when pressure is placed on the ulnar nerve, which is located behind the bony knob on the inner elbow. Remember the last time you hit your funny bone? Well, that pain was the result of you hitting your ulnar nerve, which feels anything but funny! In the early stages, you will feel soreness at the inner elbow and may notice pins and needles in you ring and small fingers. This condition can also progress if ignored, so it's important to make an appointment with your doctor if you have these symptoms. Treatment includes splinting and stretching but focuses on modifying the activities that are aggravating the nerve. Again, ignoring these symptoms for long periods can require a surgery to remove pressure from the nerve.

The golfer does indeed have the characteristic "golfer's elbow," which is caused by inflammation of a tendon at the medial elbow. This tendon attaches the muscles that bend your wrist and fingers to the bony knob at the inner elbow. Seeking treatment in the early stages of this condition is also best because healing times are slower when any tendonitis becomes chronic. Identifying the aggravating activities and learning how to modify them can help to decrease your pain and stop the symptoms from becoming worse. Treat Yourself Therapy has a comprehensive exercise video that includes the education you need to get through your day with less strain on your elbow. It also contains hints on returning to tennis and golf! Learn more at www.TreatYourselfTherapy.com/golfers-elbow. Surgery is rare for this condition, even in chronic stages, but can be a last resort option.
The above examples have shown you that inner elbow pain can be the result of damage to a ligament, a nerve, or a tendon. The take home message is to seek advice from your doctor in the early stages to prevent the condition from becoming worse!

Shoveling Snow with Tennis Elbow

Shoveling snow is a reality of winter for many Americans. Although we haven't had much snow this year in Utah, I'm sure mother nature has a few surprises in store for us before the daffodils appear in spring! There's a lot of information on the web on proper body mechanics to avoid back injuries while shoveling snow. What I haven't seen is helpful hints for anyone who happens to be recovering from tennis elbow, and there are some things to know before grabbing your shovel and heading outside. So, if you are recovering from tennis elbow, and have no other options for getting your sidewalk or driveway cleared, read on!

First of all, shoveling snow is a strenuous activity, so be sure your back, heart and arms are up to the task before even considering shoveling your sidewalk. Warm up your muscles before getting started. Specifically with tennis elbow, it's important to do forearm stretches. Holding your arm out in front of you, with your palm down, place your other hand on the back of your hand, and apply gentle pressure, bending the wrist towards the floor, stretching the forearm extensor muscles. Hold this position up to 30 seconds, and repeat 3 times. Now rotate the extended arm so the palm is up, and apply pressure through the palm with your other hand, again bending the wrist towards the floor, and hold 30 seconds. Repeat 3 times. These stretches are good to do when you've finished shoveling as well.

Now, let's take a look at shovels. The lighter the shovel, the less stress on your arm and back. Curved handles help to keep your back straighter, enabling you to generate power through the legs and core. There are also shovels that have a "U" shaped handle, allowing you to push the show, using both arms equally, thus distributing the force between both arms. With tennis elbow, it's important to keep your elbows bent and as close to the body as possible. This lessens the stress to the elbows compared to pushing the shovel with the elbows straight. Also, keep your grip light. The lighter the grip, the less strain at the elbow.

Take small scoops when shoveling, especially if the snow is wet and heavy. Break the job up into small sections, and take frequent breaks, doing a few forearm stretches. If you have a forearm strap, or band, wear it when shoveling. Remember to keep your core strong, engaging shoulder, and shoulder blade muscles, which are larger and stronger than forearm muscles.

One thing you NEVER want to do is chip away ice. This is extremely aggravating to the elbow. The forceful gripping, lifting, and jarring actions are a deadly combination if you have tennis elbow.

When you're finished shoveling, if you have any elbow soreness, apply a cold pack, or put some snow in a baggie, wrapped in a pillowcase, to your elbow for 8 to 10 minutes. This helps decrease inflammation.

For more tips, and a 4 phase exercise program for treating yourself for tennis elbow, check out TreatYourselfTherapy.com/tennis-elbow.

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

Treatment Options for Thumb CMC Arthritis

Thumb CMC arthritis is a common condition that affects millions of people worldwide. The "opposable thumb" that has allowed us to develop fine motor coordination is made possible by the CMC joint, located at the base of the thumb. Also known as the basal joint, it's the most important joint in your hand, allowing you to pinch, manipulate objects, and to grasp items of various sizes. When this joint is painful, tasks that seem so simple, such as writing, turning keys, or buttoning, can become burdensome.

The thumb CMC joint gets most of its stability from ligaments, rather than the bony structure of the joint.
These ligaments can stretch after years of use, eventually leading to instability, causing the cartilage of these bones to wear.    A form of osteoarthritis, it's a progressive condition caused by wear and tear that can progress to bone on bone pain in the later stages.

In daily life, this joint takes an enormous amount of strain since it is used whenever we hold anything in our hand.  It often begins to show signs of wear when a person is in their late 40s to early 50s. Both women and men are affected by thumb CMC arthritis, but it's more common in women since they are more likely to have ligament laxity.

There are several options to treat the pain that occurs with thumb CMC arthritis:

1.     Splinting: The purpose of wearing a splint is to provide support to the thumb CMC joint, taking some of the strain off of the joint.  A good splint will position the thumb so you can easily touch the tip of your thumb to your index finger. Custom splints can be molded directly to your hand by a local hand or occupational therapist. Premade splints come in a variety of options. Generally, splints can be worn during activities that involve thumb use, and can also be worn at night to keep the thumb in a good resting position.

2.     Therapy: A local hand or occupational therapist can teach you ways to decrease your pain, techniques to protect your joints, and exercises to prevent stiffness. If you are unable to attend therapy, Treat Yourself Therapy has a 30 minute video on Thumb CMC Arthritis that covers everything listed above and more! Visit our website for more information www.TreatYourselfTherapy.com/thumb-arthritis.

3.     Cortisone Injections: Your orthopedic surgeon may recommend a cortisone injection to decrease your pain. It's a steroid that is injected directly into the joint to decrease inflammation.  Pain relief can vary from person to person. Some report total relief of symptoms while others don't. Talk to your doctor to learn more.

4.     Surgery:   People decide to have a joint replacement surgery when pain has progressed to the point that it limits function in daily activities. With this procedure, a bone in your wrist (or at least a portion of it) is removed. A strip of muscle or tendon is taken from your forearm and placed in the open space. There are several different versions of this surgery so if you have questions, talk to your doctor.

Despite which option you choose, pay attention when you experience thumb pain. Try to limit or avoid activities that require pinching whenever possible. Many adaptive devices have been developed to decrease the pinch force used for activities. Using a pencil grip on your pen or a key adapter on your keys can make your life easier and less painful. Remember that the earlier you seek treatment, the more proactive you can be to prevent it from progressing!

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

Skiing with Tennis Elbow

Written by: Kathleen Papi-Baker, OTR, CHT and Jessica M. Karge, OTR, CHT

"I have tennis elbow, can I still ski?"
As the outside temperature starts to drop, and the snow begins to blow, you're probably turning your thoughts to winter activities. With reports of new snow in the forecast, as you're waxing your skis, you may wonder if you should ski when you've been diagnosed with tennis elbow.

There's not a simple answer to the question, as it depends on the severity of your condition. It's helpful to talk in terms of pain levels when figuring out the acuteness of your symptoms. From zero to ten, 0 is no pain, and 10 is a pain level so high you need to go to the emergency room.

If your pain at rest is 3 or 4 but goes even higher with activity, it's best for you to rest and rehab your arm. Skiing would most likely aggravate your condition. You should consider hand therapy to get you on the road to recovery. If therapy isn't an option, check out Treat Yourself Therapy for Tennis Elbow. It's an 80 minute education and exercise video that we've developed that allows you to treat yourself. You can find it on our website, www.TreatYourselfTherapy.com/tennis-elbow.

If you have 0 pain at rest, and most of the day, but your pain goes up to a 2 with arm use, you can consider skiing if you take some of the following advice.

First, let's talk about your ski poles. Use both of them! It may seem like a good idea to ski with only one pole on your uninjured side, but this is generally not recommended. It can throw your balance off and cause injury from overuse to your uninjured side. So use both poles and keep the following suggestions in mind.

Ski poles need to be the right length for your height. You should be able to grip your poles with your elbows bent to 90 degrees. If your poles are too short, or too long, it puts more strain on your elbow. Make sure you use your ski pole strap, it allows you to generate power from your arms with less force through your grip, which decreases strain on your elbow. Also, the lighter the pole the better.
When you're skiing, keep your grip light on your poles.

Although you can't control ski conditions, it's definitely more jarring on your arms to be skiing in hard packed, icy conditions than soft snow. Ski smart and try to minimize poling as much as you can. Try to ski as close to the chair lift as possible. When you need to pole, try making shorter arm strokes, keeping your elbows close to your body, as opposed to long arm strokes with the arms fully extended in front of you. Skate with your legs when you can, it's great for core strength, and minimizes arm use.

Before and after skiing, do some forearm stretches. Try the Wrist Extensor Stretch from Treat Yourself Therapy for Tennis Elbow. It's one of several stretches in the video. If you're using a forearm strap, wear it when skiing. If your pain level increases at the end of your ski day, use a cold pack for about 8 minutes several times throughout the evening.

In early season, plan on taking several breaks during the day. Consider skiing for a half day, and see how your arm feels. Remember to dress for the conditions, and keep warm, especially your hands and arms when you have tennis elbow.
Listen to your body, and have fun!

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.

A Resolution to "Treat Yourself"

Written By: Kathleen Papi-Baker, OTR, CHT and Jessica Karge, OTR, CHT

Ring in 2012 with a resolution to take care of yourself! Perhaps you have nagging aches and pains that you ignored during the busy holiday season or hoped they would go away on their own. Well, it's a new year, and time to make taking care of yourself your top priority!
Many aches and pains can be caused by tendonitis, nerve compression syndromes, or osteoarthritis. These conditions are progressive and become more difficult to treat if they are neglected for long periods of time. Take action today!

See your physician to get a diagnosis. Your doctor will discuss your options for treatment. One suggestion may be hand, occupational, or physical therapy. Typically, therapy involves attending sessions with a therapist one to three times per week. Remember, for your therapy to be beneficial, you must follow through with the program your therapist sets up for you.

Treat Yourself Therapy's resolution for 2012 is to "treat yourself...and get better!" We have do-it-yourself videos for Tennis Elbow, Golfer's Elbow, Carpal Tunnel Syndrome, and Thumb Arthritis. Our videos are a great solution if traditional therapy isn't an option for you. They include information on diagnosis, anatomy, and what can cause the condition. Each video is loaded with helpful hints and recommendations to help decrease symptoms, as well as a comprehensive exercise program. People with hectic schedules particularly find our videos helpful, they enable you to do your exercises anywhere, anytime. No excuses....get started on your resolution today!

No problems, you say? Feeling healthy and strong? Good for you, we hope you stay that way! Overuse injuries and syndromes can sneak up on you, as opposed to an injury with a known cause and sudden onset of symptoms, like pain or swelling. With overuse injuries you may notice a slow, gradual ache or pain that can progress if not attended to. Take a moment to review the course of action if you notice a new ache or pain.

1. Make an appointment to see your physician. Remember early diagnosis and treatment leads to faster recovery. Be prepared for your visit with your doctor. Write down questions you have and be sure to discuss your options!

2. In the meantime try using a gel cold pack wrapped in a pillowcase over the painful or swollen area for 10 minutes, a few times each day. This is especially important for the first three to five days after your symptoms start.

To make your own cold pack get two one gallon Ziploc bags and place one inside the other. Fill it with a 16 ounce bottle of rubbing alcohol and 32 ounces of water. Seal it tightly and freeze until slushy.

3. Respect pain. Throw the phrase "no pain, no gain" out the window. Pain is your body's way of telling you that an activity is stressful. If you can safely stop in the middle of an activity that's increasing your pain, do so.

4. Rest the painful area as much as possible. Plan ahead to avoid or delegate
activities you know will be painful.

With each year that passes, our lives and schedules seem to get busier with less and less time for ourselves. Whatever 2012 has in store for you, taking time out to "treat yourself" may be just the answer.

Happy New Year from Treat Yourself Therapy!

Treat Yourself Therapy, LLC provides innovative and inexpensive do-it-yourself videos for people unable to attend hand therapy. These videos were developed by Jessica Karge, OTR, CHT and Kathleen Papi-Baker, OTR,CHT, both certified hand therapists who have over 40 years of combined clinical experience. To learn more, visit www.TreatYourselfTherapy.com.