What is Causing your Elbow Pain?

A common form of elbow pain occurs when the muscles on the inside of the elbow (Medial Epicondylitis) or outside of the elbow (Lateral Epicondylitis) become inflamed and irritated.  You may have heard of “Tennis Elbow” or “Golfer’s Elbow”, as these names typically describe elbow pain based on its location.  However, despite the names, these symptoms can be brought on by a variety of different motions or activities that involve the elbow.  Both forms of elbow pain are typically caused by overuse from a repetitive activity.

Tennis Elbow (Lateral Epicondylitis) occurs when the extensor muscles of the forearm become inflamed.  Many of the muscles on the outside of the forearm attach to the outside of the elbow on the humerus bone at a spot called the “lateral epicondyle”. Symptoms may include sharp pain, swelling, and tenderness when the spot is touched or bumped.  In addition, repetitive motions of wrist extension, which is used when performing a backhand tennis shot, can aggravate symptoms.

Golfer’s Elbow (Medial Epicondylitis), on the other hand, occurs when the flexor muscles on the inside of the forearm become irritated.  Just like in Tennis Elbow, the flexor muscles on the inside of the forearm attach to a common bony spot on the humerus called the medial epicondyle and may become irritated and painful after overuse or repetitive motion.  A common motion is the gripping of a golf club, hence the name “Golfer’s Elbow”.

So, what can you do if you have this pain? The best approach is to rest and ice the affected muscles.  Since these symptoms are caused by overuse, taking a break from the aggravating activity is important.  Along with resting, decreasing the inflammation in the elbow is very important. Icing the elbow for 10-15 minutes every 3-4 hours can be an effective way to help decrease pain levels.  In addition, some gentle stretching may help to alleviate tightness in the muscles.  Finally, as symptoms decrease, strengthening exercises are important to help prepare the muscles for returning to the stressful activities.  In addition to these treatment plans, people may find relief from wearing a brace just below the elbow to help reduce the amount of strain placed on the affected tendons.





In more severe cases, NSAIDS may be needed to help reduce pain and inflammation in the elbow.   As the symptoms decrease, it is important to begin a stretching and strengthening program to help restore full strength and range of motion in the affected elbow.  A gradual return to activities is encouraged, however any increase in pain or soreness could indicate that the elbow is not ready to return to full activity levels.

If you have are having difficulty treating the pain and soreness in your elbow on your own, physical therapy can be very helpful in guiding you with appropriate stretches and strengthening exercises for either Tennis Elbow or Golfer’s Elbow.   In addition, PT can assist you in returning to the activities you love, including golf or tennis.

Shoulder Injuries in Swimmers

Around 70% of Americans will be treated for some type of shoulder injury in their lifetime.  If we narrow the focus to competitive swimmers, the percentage skyrockets.  Why, you ask?   Well, the repetitive motion inherent in the act of swimming combined with the complicated junction of muscles and tendons surrounding the shoulder joint can be a recipe for disaster in those swimmers who don’t yet have perfect technique.

A COMPLICATED JOINT: The shoulder joint is intertwined with many other muscles groups of the torso including the abdominals, upper and lower back, and pelvic muscles.  When one of these adjacent muscles is not working in harmony with the others, the instability causes increased wear and tear on the shoulder joint.  This can contribute to unnecessary fatigue and potentially cause injuries, like “Swimmers Shoulder”.   Beginners and those who swim with poor technique are especially susceptible to such injuries.

There are three distinct components of the shoulder on which we should focus when assessing strength for injury rehabilitation or prevention:

  1. Rotator cuff
  2. Muscles that stabilize the shoulder blades (upper back)
  3. Muscles of the lower back including the pelvic muscles and abdominals


Injury prevention techniques can be a good way to ensure you can continue to have fun in the water without pain, but the best advice is to slow down and use good form to avoid future injuries.

Strengthen Rotator Cuff: A great exercise to ensure rotator cuff strength is to place the arm at 90 degrees with the elbow at your hipbone and rotate to the outside.  This builds strength and muscle stamina

Joint Stabilization Exercise: For shoulder stabilization improvement, you can do a straight arm lift. Keep your arms out to your side as long as you can hold them.  This will strengthen the muscles behind and between the shoulders.

If you are a competitive swimmer or triathlete who is experiencing shoulder pain, we welcome you to stop in for a visit, even if only to get some tips on prevention and strengthening.  As a former Division 1 collegiate swimmer, Brian Hartz specializes in treating and preventing swimming injuries. HARTZ PT offers an endless pool in its Lititz office which is ideal for stroke analysis and modification.

Frozen Shoulder

FrozenShoulder picture

Are you dealing with a pain in your shoulder during the day and at night? Are you noticing stiffness and decreased motion in your shoulder, making it difficult to perform your daily tasks? There is a chance you may have Adhesive Capsulitis, also known as Frozen Shoulder. Adhesive capsulitis commonly affects women more than men and it usually occurs between the ages of 40-70 years old. There is no known cause why people develop frozen shoulder, but studies show that those with diabetes, stroke, or Parkinson’s may be at a higher risk. It also tends to develop in those that have had an injury to the shoulder, or during periods of immobilization.

The shoulder is a ball-and-socket joint. It is made up of three bones, the humerus, scapula (shoulder), and clavicle (collar bone). The head (top) of the humerus fits into a shallow socket in the scapula. There is connective tissue that surrounds the joint known as the shoulder capsule. Within the joint is synovial fluid, which helps to lubricate the capsule and helps to ease movement. When Adhesive Capsulitis is present, the shoulder capsule thickens and becomes tight. Stiff bands of tissues called adhesions form and there is a lack of synovial fluid. This can lead to pain and decreased range of motion within the shoulder joint.

There are 3 stages of frozen shoulder; the progression can last 18-30 months:

  • Freezing: There is a slow progression of pain and gradual reduction in shoulder range of motion. Pain can be noticed during the day and at night and can even be noticed when the arm is at rest.
  • Frozen: The pain begins to slowly improve but the stiffness remains. The lack of motion can make daily tasks difficult to perform.
  • Thawing: The shoulder range of motion begins to slowly improve and the focus is on getting the shoulder back to normal or as close to normal as possible.

Treatments for adhesive capsulitis include anti-inflammatory drugs (NSAIDs) or moist hot packs to help with the pain and stiffness. An Xray or MRI may be recommended to rule out other potential causes of pain.  A manipulation or arthroscopic surgery may be suggested for patients who see no improvement after non-surgical measures are taken. During a manipulation, the patient is put under anesthesia and the shoulder is stretched to help break up scar tissue. An arthroscopic surgery could also be performed to cut through the tight portions of the joint capsule.

Physical therapy has been proven to be one of the most effective ways to help improve frozen shoulder symptoms. Studies show that there is a 90% success rate with non-surgical treatment approaches (oral NSAIDs and Physical Therapy) for patients with frozen shoulder. The focus of physical therapy is to restore the range of motion within the shoulder joint and to help manage pain. The patient will go through gentle stretching programs and manual therapy techniques to help achieve these goals. Patients will be given home exercises and stretches to perform on their own. As symptoms improve, the patient will begin a strengthening program to help restore the strength that was lost.

Adhesive capsulitis can be a very painful and limiting condition. So, don’t wait to get it checked out, for best results – the sooner you get it looked at, the better. Physical therapy has proven to be the best treatment method to help you get back to your happy lifestyle!

Rotator Cuff Tendonitis

Shoulder pain is most often caused by a condition called rotator cuff tendonitis. The rotator cuff is made up of four muscles surrounding the shoulder joint. Considering these muscles work as a collective, if one area is inflamed or injured, the whole shoulder is affected.

Rotator cuff tendonitis is caused by inflammation of the tendons of the rotator cuff muscles. The onset of pain is typically sudden and may limit you from being able to move your arm above shoulder level comfortably. This is a common ailment among athletes, such as softball and baseball players, as well as swimmers. Additionally, non-athletes may experience this pain if there is a history of heavy lifting or activities involving repetitive movements of the shoulder. Examples include the profession of a painter or carpenter.

Delayed treatment of rotator cuff tendonitis can lead to more severe pain and elongated recovery time. Treatment may include rest, anti-inflammatory medication, physical therapy and possibly steroid injections. Adequate and prompt treatment, however, can lead to complete recovery. Physical therapy will help improve flexibility and strength of the muscles surrounding the shoulder joint, allowing the patient to return to daily activities and/or work without pain.

After years of competitive swimming, I know the importance of shoulder strength and how shoulder pain can negatively affect life. If you are concerned about shoulder pain, no matter how slight or severe, don’t hesitate to contact me.

Brian Hartz, DPT, OCS, CSCS

Carpal Tunnel Syndrome

Carpal TunnelOver 11.5 million Americans suffer from carpal tunnel syndrome (CTS). The primary symptom associated with CTS is numbness of the fingers. Unfortunately, this numbness is only one of the negative effects associated with the condition. A decrease in hand function, along with decreased strength, are also symptoms of CTS.

But how does this happen?

CTS is a common overuse condition. Symptoms typically occur when the median nerve (the nerve that travels through the bony passageway in your wrist) receives pressure from swollen tissue. If left untreated, CTS can cause permanent nerve damage (and a nagging – as well as constant – pain).

Do not lose hope: you can prevent CTS.

Many times CTS can be brought on by repetitive processes that put strain on your wrists (e.g., typing at a computer for many hours, daily). Many people benefit from ergonomically designed keyboards that minimize pressure at the weakened area. You can help prevent acquiring CTS by stretching and taking breaks often. It’s also suggested that a healthy diet and regular physical activity can prevent CTS.

But what if you already suffer from CTS? Well, there’s hope here too.

Treatment may include any of the following:

–        Use of a splint to reduce discomfort

–        Heat/cold treatment for pain relief

–        Stretch and strengthening exercises

Physical Therapy should be able to help treat the most common symptoms of CTS. However, there are some severe conditions that require surgical consultation. It is important to communicate with your physical therapist about the level of discomfort you are experiencing to help determine next steps.

Questions about carpal tunnel syndrome? Contact us!