REPETITIVE STRAIN INJURIES
As your workload at the office increases, so do repetitive actions, such as typing, using your computer mouse and talking on the phone. These routine tasks seem simple, but they can add a level of physical stress to the emotional and mental stress of getting the job done. In fact, repetitive strain injuries have skyrocketed in the last 20 years due to the increasing reliance on workplace technology.
Try these tips to reduce the strain:
Computer Monitor
Position your computer screen directly in front of you. Allow the muscles in your eyes to relax by following the 20/20/20 rule: Take a 20-second break every 20 minutes and focus on an object that is at least 20 feet away from you.
Telephone
Use your hand to support the telephone against your ear and alternate sides regularly. Do not cradle the phone between your ear and your shoulder. Consider using a headset or speaker.
Chair
Sit upright and all the way to the back. Place a support cushion or roll against the arch of your low back for lumbar spine support. Here are some tips to help you adjust your chair:
- Stand in front of the chair and adjust the height so that the highest point of the seat is just below your knee.
- Sit on the chair and make sure that your knees are bent at approximately a 90-degree angle when your feet are flat on the floor.
- Adjust the backrest forwards and backwards as well as up and down until it fits the hollow in your lower back.
- Sit upright with your arms hanging by your sides. Bend your elbows at about a right angle and adjust the armrest height until they barely touch the undersides of the elbows. Remove the armrest from the chair if the right level cannot be achieved.
Lastly, don’t forget to take a quick stretch break or change position every 30 to 45 minutes. Your back, neck and shoulders will thank you for it!
Provided by Dr. Luciano Di Loreto, HBSc., D.C. & Associates
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HOW TO PREVENT THREE COMMON MUSCLE INJURIES
Playing sports, sitting at a desk all day, or even running outside are all simple actions performed in our day-to-day lives. But, did you know that most of these actions require repetitive movement that can often cause muscle strain. The motions of everyday activities can sometimes contribute to common injuries, such as tennis elbow, shoulder tendonitis and shin splints.
Here are three types of preventative exercises you can do at home to help alleviate and prevent those everyday injuries from slowing you down:
- Tennis Elbow, a common overuse injury that happens in the summer months due to increased sports activity with racquet sports, cycling, or golf.
Preventative exercise: Eccentric strengthening. Use weights to strengthen the area and muscles used in your favourite activities.
- Shoulder Tendonitis, a common injury often due to faulty shoulder mechanics that can be a result of sitting disease.
Preventative exercise: Chest stretches. Chest stretches helps get the shoulders back into the right position. Shoulder blade exercises are also a great way to help mobilize the muscles around your shoulder blades and strengthen the muscles of the mid-back.
- Shin Splints, a common injury as people increase their mileage outdoors. It is caused by running on concrete or other hard surfaces for longer periods of time.
Preventative exercise: Leg stretches. Use a foam roller to warm up your calf muscles and lower leg muscles prior to running.
Being mobile and staying active is a great way to keep fit and healthy. Remembering these simple preventative exercises will help you stay on an injury-free path.
Provided by Dr. Luciano Di Loreto, HBSc., D.C. & Associates
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What is Olecranon Bursitis?
A 35 year old carpenter came to our clinic complaining that the back of his elbow was swollen and very tender/painful after banging it on a kitchen cabinet during installation. After conducting a health history and detailed physical examination, we determined that this was a case of olecranon bursitis.
What causes Olecranon Bursitis?
A fall, hit, bang or blow to the back of the elbow, repeated weight bearing, improper exercise technique or dragging of the elbow to the ground may cause swelling, inflammation, pain and pooling of edema in the elbow bursa thus causing olecranon bursiitis.
Think of it this way…subdivision and cities often have areas where water collects and distributes during flooding, heavy rainfall or snow melt. When heavy rain covers our streets it collects in a city catch basin. The bursa is the elbow’s catch basin for when inflammation, edema or swelling occurs. It, the bursa, fills up and allows our body to slowly take it away through the lymphatic system and out of our bodies through urine/excretion (similar to a sewage system which ends up distributing the water into larger areas of water outside of the city/subdivision).
What are Signs and Symptoms of Olecranon Bursitis?
Olecranon bursitis is the size of a goose egg. The olecranon is the surface of bone at the end of the ulna bone (elbow). It is very difficult to miss since it looks abnormal and may present with redness and feel tender to the touch. It must be differentiated from gout and/or kidney failure which present similarly in the elbow and other joints. Infection is another condition to rule out – however, it typically occurs near an open wound.
How do I treat olecranon bursitis?
At our clinic we treat olecranon bursitis with support tape, along with ice therapy, ultrasound therapy, laser therapy and advice about what activities to avoid. If the bursa is infected, we refer out for aspiration or antibiotic therapy. Our chiropractic and physiotherapy team, reviews the area and assesses the range of motion of the elbow before determining which treatment could be most effective.
Dr. Luciano Di Loreto, HBSc., D.C. & Associates
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Chiropractic health care
The word “chiropractic” comes from ancient Greek and means “done by hand.”
Adjustment of the joints of the body has been used in the healing arts for many centuries and is at the heart of modern chiropractic care.
Chiropractors are specialists in manual adjustment of the vertebrae of the spine and other joints of the body. Adjustment helps relieve pain and restore normal functioning to the joints and supporting muscles and ligaments – so you can enjoy your everyday activities again as quickly as possible.
Your chiropractor will recommend a course of treatment specific to you that may also include mobilization of the joints, ultrasound, muscle release techniques, muscle stimulation and therapeutic exercises. Chiropractors are also trained to provide nutritional counselling, and recommend rehabilitation and injury prevention strategies.
Back health is important
The body’s information highway – your nervous system – is protected by the spine. The nervous system travels out between the vertebrae or joints of the spine to carry messages from the brain to every corner of your body. Stress and strain on the vertebrae can put pressure on the nerves in the affected area. That is why a problem with your spine can have far-reaching effects causing symptoms such as arm or leg pain.
When to consider chiropractic care
If aching joints and muscle pain are affecting your ability to get through the day and keeping you away from your favourite activities, consider chiropractic care. Work, accidents, sports injuries, household chores, even the stress of daily living can cause painful joint and back problems. Even if you do not have painful symptoms, chiropractic care can help you maintain healthy spine and joint function.
Here are some of the most common reasons why more than 4 million Canadians visit a chiropractor each year:
- Back pain
- Neck pain
- Headache
- Whiplash
- Strains and sprains from daily activities
- Repetitive strain injuries
- Work and sports-related injuries
- Arthritis
- Restricted movement in the back, shoulders, neck or limbs
Benefits of chiropractic care
Chiropractic treatment is skilled, hands-on health care that relieves pain and helps your body be its best. Here are some of the ways it can help you.
- Improved movement in your neck, shoulders, back and torso
- Better posture
- Relief from headaches, neck and back pain
- Prevention of work-related muscle and joint injuries
- Enhanced athletic performance
- Improved flexibility
- Relief of pregnancy-related back ache
- Correction of gait and foot problems
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Let’s first start with a few Case Studies:
1) 45 Year Old Female
Pain on the outside of the elbow due to twisting/closing jam jars over the weekend. Pain is localized to the outside of the elbow. Patient is complaining of progressive pain.
2) 50 Year Old Male
Pain on the inside of the elbow after playing a bocce (lawn bowling). Patient explains that extending the wrist is painful. Patient finds it difficult to use his wrist due to the progressive pain found along the inside of his elbow.
Answers found below.
Many patients have been presenting and asking me about these two conditions (tennis elbow and golfers elbow) and how they differ. Okay, so let us break them down into very simple terms.
1) Both conditions occur at the elbow.
2) Tennis Elbow occurs on the outside of the elbow.
3) Golfers Elbow occurs on the inside of the elbow.
Now that we have these simple concepts in place, let us explore the anatomy of the elbow joint and structures surrounding the joint.
Anatomy of the Elbow
The human elbow consists of 3 bones and 3 articulations. The three bones are the humerus (arm bone), ulna and radius (forearm bones – remember the radius is on the thumb side and the ulna is on the 5th finger side WHEN the hand is in a position where the palm is facing upwards). The humerus attaches to the ulna – the humeroulnar articulation and the humeroradial articulation (the articulation between the humerus and the radius). The third is a pivot-type joint with articulation between the head of the radius and the radial notch of the ulna (the two forearm bones). Surrounding these joints are a number of muscles, ligaments, fascia and arteries/nerves. The muscles of the forearm are responsible for turning the arm as if you are using a screw driver as well as flexing/extending the wrist.
Elbow Joint
What is Tennis Elbow?
Tennis elbow also known as lateral epicondylitis is a condition that affects the muscle on the outside of the elbow.
Tennis elbow is a painful condition of the elbow caused by overuse or repetitive strain (partial tearing of muscle fibers in the elbow) . Playing tennis or other racquet sports can cause this condition. However, it is also important to note that other sports like golf, or activities that involve moving your wrists/elbow joint can aggravate the elbow (Golfers, baseball players, bowlers, gardeners or landscapers, house or office cleaners (because of vacuuming, sweeping, and scrubbing), carpenters, mechanics, and assembly line workers).
Symptoms of tennis elbow include:
- Pain slowly increasing around the outside of the elbow.
- Pain is worse when shaking hands or squeezing objects (flexion of the wrist).
- Pain is made worse by stabilizing or moving the wrist with force.
- Examples which aggravate pain include lifting, using tools, opening jars, or even handling simple utensils such as a knife, fork or toothbrush.
Tennis elbow affects 1% to 3% of the population. Interestingly, less than 5% of all tennis elbow diagnoses are related to actually playing tennis!!! Tennis elbow affects men more than women. It most often affects people between the ages of 30 and 50.
What is Golfer’s Elbow?
Golfer’s elbow also known as medial epicondylitis causes pain and inflammation in the tendons that connect the forearm to the elbow. The pain is on the inside aspect of the elbow (area the rests beside the torso when your arms are down).
Golfer’s elbow is caused by overusing or straining the muscles in the forearm that allow you to do the following motions – grip, rotate your arm, and flex your wrist. Continuous or repetitive flexing, gripping, or swinging can cause pulls or tiny tears in the tendons.
This condition doesn’t just affect golfers. Those who do activities with repetitive hand, wrist, or forearm motions can lead to golfer’s elbow. Furthermore, sports include tennis, bowling, and baseball can cause the same symptoms.
Tennis and Golfer’s Elbow are not that different!
Yes, Tennis and Golfer’s elbow are not that different. In other words, they are very similar types of strains or tendon aggravation (tendonosis) conditions. One occurs on the inside of the elbow (golfer’s elbow) and the other on the outside of the elbow (tennis elbow).
SO now that I understand the difference, how to I treat these conditions? 
At our clinic, we provide patients with a variety of both active and passive treatments. Passively, chiropractic care, acupuncture, soft tissue therapy, mobilizations, electrotherapy, ultrasound and laser therapy are effective. Actively, eccentric elbow exercises work well. An exercise is eccentric when a muscle contraction lengthens the muscle, rather than shortens it. The opposite is called concentric exercises.
Furthermore, some individuals do well with golf and tennis elbow supports. These are fairly inexpensive and assist with controlling some of the discomfort experienced at the elbow (see image to the right).
Back to the Case Studies
1) 45 Year Old Female
Pain on the outside area of the elbow. Patient was closing a number of jam jars over the weekend. Pain is becoming progressively worse. No shooting pain down the arm, only localized pain in the elbow. What can it be?
Yes, this is a case of TENNIS ELBOW!
-Pain localized to the outside area of the elbow and mechanism of injury is closing jam jars (twisting wrist and using the extensor muscles in the forearm).
2) 50 Year Old Male
Pain on the inside of the elbow after playing a bocce (lawn bowling). Patient explains that extending the wrist is painful. Patient finds it difficult to use his wrist due to the progressive pain found along the inside of his elbow.
-Pain localized to the inside area of the elbow and mechanism of injury is using the flexors of
YES, this is a case of GOLFERS ELBOW! 
MEDICAL DISCLAIMER: The following information is my personal notes about this subject matter. It is intended for informational purposes only. Consult a health practitioner to help you diagnose and treat injuries of any kind.
Dr. Luciano Di Loreto, HBSc., DC
Chiropractor in Woodbridge, Ontario
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