Elbow Bursitis- What is it and What can i do about it?

Elbow Bursitis- What is it and What can i do about it?

The elbow contains a large, curved, pointy bone at the back called the olecranon, which is covered by the olecranon bursa, a small fluid-filled sac that allows smooth movement between the bone and overlying skin. Inflammation of this bursa leads to a condition called olecranon bursitis.

The causes of elbow bursitis may include trauma or a hard blow, excessive leaning on the elbow, infection through puncture wounds or insect bites, or conditions such as gout and rheumatoid arthritis. People in certain occupations such as plumbing or air conditioning technicians which involve a lot of crawling on the elbows are highly prone to this condition.

Swelling is your first symptom of elbow bursitis. As more and more liquid fills into the bursa, the swelling increases and can cause pain. This pain is generally mild, but can increase with direct pressure or bending of the elbow. If the bursa gets infected, your skin can become warm and red, and may spread to other parts of the arm or even the blood stream if not treated immediately.

Elbow bursitis can be diagnosed by reviewing your medical history and undergoing a thorough physical examination. Your doctor may also order an X-ray and biopsy of the bursa fluid to test for infection.

If bursitis is caused due to an infection, your doctor may recommend removal of fluid from the bursa with a needle and prescribe antibiotics. Elbow bursitis not caused from infections, can be treated with an elbow pad to cushion your elbows, avoiding activities that place direct pressure on the swollen elbow, taking anti-inflammatory medications to reduce swelling, or injection of corticosteroid medication directly into the bursa to relieve pain and swelling. When these methods do not help, the bursa is surgically removed.

Protection of your elbow from excessive friction may prevent bursitis, or an elbow pad can be used when you need to lean on your elbow while working

Golfers Elbow

Golfers Elbow

Eccentric training of the wrist extensors has been shown to be effective in treating chronic medial epicondylalgia. A study conducted by Tyler and others in 2014 studied the efficacy of adding eccentric exercise to standard physiotherapy consisting of ultrasound, cross-frictional massage and self-stretching, heat and ice.

The specific isolated eccentric wrist flexor strengthening exercise performed by the patients involved twisting a rubber bar (Flexbar, Hygenic Corportation, Akron OH) with concentric wrist flexion of the non-involved arm and releasing the twist by eccentrically contracting the wrist flexors of the involved arm. This was performed 3×15 twice daily. Changes in symptoms were assessed using the DASH questionnaire. (Disability of the Arm, Shoulder and Hand).

Symptoms related to  chronic medial epicondylalgia were markedly improved with the addition of an eccentric wrist flexor exercise to standard physical therapy

This novel exercise is an easy way to utilise eccentric training in the treatment of chronic medial epicondylalgia.

What’s the Latest with Tennis Elbow Strengthening?

What’s the Latest with Tennis Elbow Strengthening?

Load Management


Load management and activity modification are vital in the rehabilitation of tennis elbow. From the elite athlete to the weekend warrior this can often feel like the end of the world. This can be achieved by reducing the aggravating activities within possible occupational and recreational limits. Through use of appropriate education and communication the athlete can be


Tendon disorders have been closely studied in Australian physiotherapy circles. Researchers have found the following exercise protocol to be the most effective avenue to successfully recover from tendon issues.


  • Muscle contraction whereby the targeted muscle does not move
  • 5 repetitions of 45 seconds, 2-3 times per day


  • Muscle contraction where the targeted muscle and limb is taken through its range of motion
  • 3-4 sets at a load of 15RM (repetitions max) – progressing to a load of 6RM, every second day
  • Initiation of high velocity (e.g plyometrics) movements in preparation for the return to sport phase.
  • Volume and intensity are progressed gradually using exercise to replicate the demands of the sport. E.g double leg boundsàsingle legs hopsà
  • This marks the return to play phase. Training drills and match simulation are undertaken to prepare the athlete for return to play. The athlete must be able to perform all competition drills in order to successfully return to play.
What Is Tennis Elbow?

What Is Tennis Elbow?

What is it?

Tennis Elbow, also known as lateral epicondylitis is an overuse injury of the forearm and the wrist extensors tendons, primarily the extensor carpi radialis brevis and common extensor tendon typically presents as progressive pain over the lateral aspect of the elbow.

It is primarily due to repetitive strain from tasks and activities that involve loaded and repeated gripping and/or wrist extension. It historically occurs in tennis players but can result from any sports that require repetitive wrist extension, radial deviation, and/or forearm supination. Relating to occupational and athletic population tennis elbow is often precipitated by poor mechanics, technique or improper equipment.


Patients will typically report:

  • Pain over the lateral elbow. It can typically occur 1-3 days after performing unaccustomed activity involving repetitive wrist movements
  • Decreased ability to perform tasks that involve gripping, forearm rotation or wrist movements due to pain
  • Pain when touching the lateral aspect of the elbow

Latest research indicates the following for optimal recovery:

  • Relative rest from aggravating activity as guided by the level of pain.
  • Ice (particularly after activity)
  • Ultrasound
  • Dry Needling
  • A graded exercise program initially focusing on isometric muscle strength
  • Bracing and/or taping

It is important to know that any tendon condition may take 12 to 24 months to completely resolve. Persistence and adherence to the recovery plan is vital for optimal rehabilitation and successful return to activity.

Rehabilitation  of Peroneal Tendinopathy

Rehabilitation of Peroneal Tendinopathy


1) Strengthening

As soon as it is comfortable to do so, you should start strengthening the Peroneal muscles. Strengthening helps the collagen fibres within the tendon to realign and also helps develop the strength needed for running.

Start with isometric exercises which are static contractions. An easy way of doing this is to sit on the ground with the legs out straight on the insides of a chair. Position the front two chair legs on the outsides of the feet. Push outwards with the feet, into the chair legs so there is no movement, but the muscles are contracting. Hold for 5 seconds, rest and repeat 5-10 times initially. This should only be performed if there is no pain. If it is painful, rest and try again in a few days.

The next step on is concentric strengthening which can be achieved using rehab (resistance) bands or ankle weights. With a band, tie it in a loop and place it around the  balls of the feet. Turn both feet outwards at the same time, against the bands resistance. Always do band exercises slowly and under control, especially on the way back to the starting point. Again this should be done without pain and with low reps to start with, which can be built up every couple of days. For examples, start with 12-15 reps, build to 25.

Concentric Peroneal strengthening can be achieved with ankle weights which should be wrapped around the forefoot. Lay on your side with the foot to be worked on top and turn the foot out so the toes point towards the ceiling (keep the ankles and heels together).

The final stage of strengthening is eccentric which is the hardest type of contraction for a muscle and really important when running to slow the pronation force on the foot. This is harder to do yourself, but with a partner is pretty straightforward. Sit on the floor with both legs out straight. The partner pronates (inverts) the foot so the sole of the foot faces inwards. As they do this, you try to slow them down. Don’t resist the movement completely, but just aim to control it. The stronger you get, the harder they can push! This is really hard on the muscles and tendons so definitely start with low rep (around 8-10 initially).

2) Stretching

It’s quite difficult to stretch the Peroneal muscles so personally I don’t worry about this. If you are having massage treatment then this is going to be just as, if not more effective than stretching for this injury.

I would however, recommend stretching the calf muscles daily. This is especially important if you overpronate as tight calf muscles can contribute to this and place more strain on the Peroneal tendons.

3) Correcting Causes

Whilst the tendon is resting, this is the ideal time to look at what might have caused you to develop the condition and what you can do about it to stop it coming back.

If you haven’t had a gait analysis I would highly recommend this for Peroneal injuries as they are so closely involved with foot biomechanics. This will make sure you are wearing suitable running shoes and determine if you maybe need additional insoles or orthotics. Or, if you have been running for a long time and not had your gait reassessed in a couple of years, then it is worth getting it checked again as things can change.

If you have old trainers it may be time to replace them as the support and cushioning will have worn out. 500 kms is the rule of thumb for when to change your running shoes.

If this is all ok, take a look at your running program. Were you dramatically increasing mileage? Had you changed your route or added in more hill runs etc? Running on a road with a slant (so that one side is lower) could cause these problems.

If you’re struggling to find a reason for the injury, then I would recommend consulting a running coach to get them to look at your training plans and running technique. An experienced eye may be able to spot something you have missed.

4) Return to Running

Only return to running when completely pain free on a daily basis and once you are confident you have identified and addressed any causative factors.

Start with a very short jog (10 mins e.g.) and then have 2 days rest. Provided there is no recurrence of symptoms, then try another 10 minutes followed by another 2 days rest. If still ok, start to progress your running time, by 5 minutes at a time, running 2-3 times a week and only increasing every other run. Continue with this until you are back to your normal times / distances.


What is a Peroneal Tendinopathy?

What is a Peroneal Tendinopathy?

You have currently been training for a full marathon. In preparation for you marathon in a few months time you have been increasing your training regime more rapidly. After your most recent 10km training session at a higher intensity you have started to experience a dull pain around the back and outside of your ankle. Upon presenting to your local physio and after reviewing your symptoms it appears that you have a Peroneal Tendinopathy.
So what exactly is a Peroneal Tendinopathy?
Typically it has been found that individuals which undertake repetitive activities such as runners, dancers and basketball players results in an overuse injury. Irritation occurs to the Peroneal tendons (Peroneus Longus and Brevis) as a result of repeated movements at the ankle joint over a prolonged period of time. Both your Peroneus Longus and Brevis muscles assist in moving your foot in an upward and downward direction, moving the foot outwards and assisting in stabilising and balancing the foot and ankle.
Other factors, which predispose an individual to Peroneal injuries, include improper training, increase in training load, foot footwear choices and poor foot biomechanics.
Common symptoms one may experience includes:
-Pain around the back/ outside of the ankle joint during activity
-Swelling and tenderness behind the ankle bone
-Pain when pushing off the ball of your foot
-Pain while stretching the foot in both an upwards and downwards direction
The majority of Peroneal Tendinopathies tend to heal without the need for surgery. Since Tendinopathies occur as a result of overuse rest is often the best form of treatment though will often need to be used in conjunction with other forms of conservative treatments.
Here are 5 home remedies for you to reduce pain and discomfort on your ankle

Here are 5 home remedies for you to reduce pain and discomfort on your ankle

  1. Icing       
    your ankle may respond better to an alternating hot-and-cold therapy. Use two gel packs. One should apply heat for 20 minutes. Follow it with a cold pack for 20 minutes.
    Alternatively, you can  prepare ice packs. Apply the ice pack on your swelling ankle to reduce the amount of swelling will reduce your discomfort. Ensure that the ice rests directly on the swollen area. If the cold is too intense, place a small rag between the skin and the ice pack.
  2. Herbal Remedies
    Home remedies such as coconut and garlic oil help reduce pain and swelling when they soak directly into the skin. Mix 3 table spoon of coconut and garlic oil into a container and heat in the microwave for ten seconds, slightly warming the mixture. Generously massage the oil directly onto your ankle for ten minutes, allowing the oils to soak into your skin. Cabbage contains minerals and vitamins that are useful when ingested, as well as when they’re applied externally. Gather the outer layers, or leaves, of the cabbage plant. Blanch the leaves by boiling them in water and then immediately placing the leaves into a container of ice-cold water. Once the leaves have been blanched, wrap your entire foot and ankle, and allow them to rest for 30 minutes before removing.
  3. Dieting
    Changing your diet to relieve ankle pain can be effective over a longer term. If you are heavy, you may experience poor circulation and heightened stress in the ankles and other weight-bearing joints. If you are overweight and suffer from frequent strains or bone degeneration, losing weight can permanently end your ankle pain. Adding a joint supplement to your diet, such as glucosamine or chondroitin, may also help some people by protecting the ankle joint and surrounding tissue.
  4. Exercises
    Exercise is an ongoing home treatment that will serve as pain relief and prevention. To prevent future ankle injuries, and to strengthen an ankle that is already injured, range-of-motion exercises and stretches provide the most benefit. Only stretch or exercise the ankle once the pain has subsided.Range-of-motion exercises will increase the flexibility of tendons and ligaments that have tightened during an injury. Trace the alphabet with your toes, moving the ankle as much as possible throughout. Repeat at least ten times per day to strengthen your ankle and improve your flexibility.
  5. Orthopaedics treatment
    Seek for medical support if your pain still persists after trying out the suggested remedies. It is advisable to seek for professional help if your ankle pain is giving you symptoms that can be interpreted into serious health issues.
What is Proprioception / Balance of the Ankle?

What is Proprioception / Balance of the Ankle?

Proprioception is also known as the Joint Position System (JPS).  JPS is a system that allows the joints to send a continuous stream of information to the brain about muscle use, joint position and movement.  This allows us to know subconsciously where our limbs are in space without looking and it’s also the sense that produces sudden reflex actions when we sense danger.

For example, close your eyes….. do you know exactly how your hands are placed? Of course you do! That’s your proprioception at work.


JPS is very important for co-ordinating all our movements and in terms of sports, where good co-ordination is crucial. Following injury to ankle joints and ligaments, the joint position receptors located within them can be damaged. This interferes with the joint position information that’s usually sent to the brain, and the messages are conveyed much slower. As a result, the joint feels unstable and odd in the sense that “you don’t completely trust it not to give way”.


Once you’ve damaged the proprioception or JPS, it can cause you to move awkwardly with decreased co-ordination in ordinary activities and in sports. Loss of JPS also affects balance and this interferes with the ability to avoid injury by quick and co-ordinated movements.

Fortunately, physiotherapists are able to re-train the JPS system with special exercises.   In some cases, injured athletes have gained a heightened JPS sense after physio treatment for an arm or leg injury and improved their performance!


Following an ankle injury the doctor may need to immobilize it in a plaster cast to ensure the bones heal in the correct alignment.  When the plaster comes off and the doctor is satisfied that the bones are healing well, the physiotherapist takes over.

If a cast hasn’t been necessary, the physiotherapy exercises should be started as soon as possible after the injury.  This is important because the early scar tissue is still soft and can be broken down by the physiotherapist.  If you don’t get physiotherapy early on, the scar tissue becomes rigid and causes permanent restriction in the flexing and rotating movements.

Proprioception exercises

Massage, heat treatment, joint manipulation and stretching are the best way to get an injured joint back to normal mobility.  Muscle exercises fortify the muscles that control the joints and special proprioception exercises, like balancing and ankle disk training restore the nerve-muscle control.

Physiotherapy reduces your vulnerability to the same injury in the future and speeds up recovery – so you can return to your daily activities and sports in good form!

Are Ankle Braces Useful?

Are Ankle Braces Useful?

There is a lot of misinformation being circulated about ankle braces and their effect on the body and athletic performance.

Why Use a Brace or Support?

A support brace helps you by:

  • Relieving your pain
  • Resting the injured tissues by taking some of the stressful loads
  • Protecting the injured structures from further injury
  • Allowing for initial tissue healing
  • Preventing future injury by support or joint stabilisation.


A hinged style ankle brace that allows full up and down ankle range of motion will not weaken the joint because the brace is allowing unrestricted natural ankle motion. Hinged style ankle braces move with the ankle joint, and not against it, to protect the ankle from twisting and turning while still allowing for full natural range of motion.

A lace-up style ankle brace restricts all ankle range of motion, even up and down movements. This up and down natural ankle range of motion is not a cause of ankle injuries so there is no need to restrict it. One could argue that by restricting normal ankle range of motion you could potentially weaken the ankle, so it’s important to compare different ankle braces and choose the one that is best for your specific situation.

Wearing an ankle braces for an extended period of time will not weaken the ankle. There are no clinical studies available that support the notion that wearing ankle braces weaken the ankle.

Lace -up style ankle supports do hurt athletic performance. A recent study by the University of South Alabama concluded that wearing a lace-up ankle brace negatively affective ankle joint motion and muscle function. In other words, wearing a lace-up ankle brace reduced ankle range of motion and muscle strength in athletes thus reducing the level at which they could effectively perform.

Aren’t You Only Supposed to Wear an Ankle Brace After an Injury?

Athletes that play sports with a high incidence of ankle injuries like volleyball and basketball should wear preventative ankle bracing since there are many situations during a game where ankle injuries cannot be prevented regardless of ankle strength or athletic ability. With these sports it’s not “if” the injury will occur but “when” it will occur – think coming down on another player’s foot after jumping for a block or a rebound.

However, in other sports with less ankle injuries it’s not absolutely necessary to wear preventative ankle bracing. In those cases, it would be important to look into ankle bracing after an injury since 70% of athletes who sprain their ankle end up re-spraining that same ankle causing further damage to ankle ligaments.



  1. When should I see a Physio?The first reason to see a physio is to be evaluated for a fracture. Signs of a fracture include the inability to bear weight following the injury or if there is tenderness over the bony protrusions of the ankle or foot. In these situations X-rays should be performed to assess for a fracture. Another reason to seek medical advice is to reduce the risk of recurrent or chronic ankle problems. The most important risk factor for ankle sprains is a previous ankle sprain. Therefore, individuals should seek medical guidance and possibly formal rehabilitation to prevent recurrent and chronic ankle issues.
  2. How long does it usually take to get back to my activity?
    Most ankle sprains require two to six weeks to recover, but the length of time required is dependent on the severity of the injury and the activities required of the individual. Treatment involves three phases. Initially controlling inflammation, next regaining full range of motion and strength and finally regaining the muscular control and endurance required for one’s activities.
  3. What is involved in controlling inflammation?
    Initially controlling inflammation will decrease pain and swelling, and involves the following:
    – Icing (usually 10- 20 min, with at least 30 minutes in between sessions to avoid frostbite)
    – Compression (using an elastic bandage)
    – Elevation
    – Relative rest.

Depending on the severity of the injury, rest may involve a short term use of crutches or walking boot. However, it is important to note that early mobilization improves time to recovery, long-term stability and decreases swelling. Therefore one should begin protected and full weight bearing activities as soon as tolerated. Completing all phases of rehabilitation allows one to confidently return to sport and lessens the likelihood of chronic ankle issues.  In particular, rehabilitation should involve exercises to improve strength, balance and functional rehab exercises to guide one back to sport and exercise.

  1. Does wearing braces help prevent sprains?
    Wearing braces, specifically an air stirrup brace or lace-up support can be used to aid in early mobilization and to protect against re-injury following return to sport. Unfortunately, braces must be worn during all high risk activities for at least one year to have this benefit. In addition, braces do not stimulate healing or retrain one’s muscles, ligaments and reflexes to react to the stresses placed on them.
  2. How do I know when I am ready to play again?
    In general, once the individual has full movement and strength, in addition to being able to perform all sports specific activities required without pain they can return to play. One rule of thumb is the “rule of 20s” where the athlete is able to run20 yards, cut 20 times, hop on the leg 20 times, and balance with eyes closed for 20 seconds on the effected ankle without problems. However, it’s important to note that the risk of re-injury persists for up to 12 months, even after full rehabilitation. External ankle support and neuromuscular training can reduce this risk and are an important aspect of returning to play safely.