Physiotherapy for Golfer’s Elbow

Medial Epicondylitis Physiotherapy Treatments

If you have golfer’s elbow, also called medial epicondylitis, your forearm muscle or its tendon attaching to the inner side of your elbow is painful or inflamed. Sometimes, you may feel pain along your forearm muscles that bend your wrist and hand. You may also have difficulty grasping or gripping objects.

Physiotherapy can help you manage your golfer’s elbow symptoms. In addition, your physiotherapist will be able to help you return to your original activities as fast as safely possible.

Physiotherapy for Golfer’s Elbow: Your First Visit

You will likely be asked about your usual activities or activity at the time you felt your symptoms. After you’ve answered your physiotherapist’s questions, he or she will perform a thorough evaluation and examination of your elbow to find the real cause of your symptoms and to find other problems that you might have from your golfer’s elbow.

Your physiotherapist will then formulate a comprehensive treatment plan specifically made for you. You will be actively participating in deciding on your plan of care.

Physiotherapy treatment interventions that you might receive may include physical agents (ice/heat packs), ultrasound therapy, physiotherapy exercises, and other electrotherapeutic modalities.

Your physiotherapist will educate you about golfer’s elbow, and may advise you to modify your activities. He or she may also recommend that you wear a splint for a limited time to allow healing of your muscle or tendon tissues.

Physiotherapy Treatment Options for Golfer’s Elbow / Medial Epicondylitis

Based on your specific problems and symptoms and your stated physiotherapy goals, your physiotherapist may provide you with a combination of any of the following physiotherapy treatments
  • Recommend modified rest
  • Cold therapy or Cryotherapy
  • Heat therapy
  • Transcutaneous electrical nerve stimulation (TENS)
  • Ultrasound (US)
  • Soft tissue mobilization
  • Joint mobilization
  • Stretching
  • Range of motion (ROM) exercises
  • Flexibility exercises
  • Strengthening exercises
  • Recommend splinting if necessary
  • Patient education
    • About golfer’s elbow
    • Precautions
    • Self-care of symptoms
    • Injury prevention
    • Activity or work modification
  • Iontophoresis / Phonophoresis
  • Work or sport-specific rehabilitation program

The physiotherapy treatments for golfer’s elbow enumerated above will not be provided to you in just one visit. Your physiotherapist will help you decide on what appropriate interventions are best for you.

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Wrist Tendonitis – What Is Wrist Tendonitis?

Wrist tendonitis occurs when any of your tendons passing through your wrist joint is irritated and inflamed. A tendon is a connective tissue attaching your muscle to your bone. Wrist tendonitis is often caused by repetitive movements of the wrist and hand. Most cases of wrist tendonitis do not lead to serious complications.

Causes

Inflammation of the wrist tendons often occurs as a result of overuse or repetitive movements of your wrist or fingers. Carpenters, painters, typists, and athletes participating in sports that require them to use their wrist and hand over and over again are at risk for developing wrist tendonitis. In some cases, a direct blow to the wrist may also injure the wrist tendons. The condition may also occur as a result of another health problem such as rheumatoid arthritis and gout.

Symptoms

The most common complaint of people who suffer from wrist tendonitis is pain. Some people may experience swelling, muscle weakness, and difficulty moving their wrist and hand.

Treatments

Treatment of tendonitis depends on the severity of your injury. If your tendonitis is caused by overuse without severe tearing of the tendon, it may be managed with rest or modification of activities; applying ice; and taking anti-inflammatory medication. Your doctor may recommend that you use a wrist splint for a while to allow healing of your tendons.

Physiotherapy for your wrist tendonitis may also be advised. Your physiotherapist will teach you how to self-manage your symptoms and teach you stretching and strengthening exercises once your symptoms have subsided. You may be provided with wrist and hand rehabilitation program to help you prepare for your return to work.

Your doctor may recommend surgery only if conservative means do not relieve your symptoms or you have severely damaged wrist tendons.

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Golfer’s Elbow – Medial Epicondylitis

Golfer’s elbow is a type of elbow injury that occurs when the tendon attaching on the inner bump of the elbow is irritated and inflamed. It is often caused by repetitive contraction of the muscles that bend your wrist and fingers. Golfer’s elbow is medically called medial epicondylitis.

Causes

Golfer’s elbow is caused by overuse of the muscles that bend your wrist and fingers. The name of the condition may imply that it is common in golfers. However, golfer’s elbow can happen to anyone whose activities or sports require repetitive movement of the wrist and hand, such as
  • Carpenters
  • Racket sport players
  • Heavy weight lifters
  • Baseball and softball players
  • Painters
  • Typists

Symptoms

The most common symptom of golfer’s elbow is pain on the inner side of the elbow. Sometimes, pain may be felt along the muscle below your elbow. Other symptoms may include
  • Swelling at the site of injury
  • Tenderness
  • Weakness
  • Stiffness
  • Difficulty gripping or grasping objects

If you experience severe pain and swelling; numbness or loss of sensation in your hands; or notice your elbow is deformed you should go to your local emergency room immediately as you may have a more serious injury.

Treatments

Minor or uncomplicated golfer’s elbow can be safely managed with proper home remedies. The first step that you should do is to stop your activity that caused your symptoms. Apply an ice pack (wrapped in towel) for 20 minutes at a time every 2 to 4 hours for the first 2 days to help relieve your pain and swelling. Elevate your limb above the level of your heart as you rest. Taking anti-inflammatory medication may also help.

Consult your doctor if your symptoms worsen or are unrelieved with home remedies. Your doctor may recommend that you use an elastic wrap. If your pain or inflammation does not go away, your doctor may recommend steroid injection.

Your doctor may also recommend that you undergo physiotherapy for your golfer’s elbow. In addition to icing, your physiotherapist may also employ other treatment options, such as ultrasound, Iontophoresis, stretching, and physiotherapy exercises.

Surgery to repair damaged muscles or tendons may be necessary. Your doctor may recommend surgery only if conservative means are ineffective in relieving your symptoms. Your doctor will discuss with you the benefits of having surgery for your elbow tendonitis.

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Elbow Tendonitis – What Is Elbow Tendonitis?

Elbow tendonitis is an inflammation of any of the tendons attaching near your elbow. A tendon is the tissue that connects your muscle to your bone. Two of the most common types of elbow tendonitis are tennis elbow and golfer’s elbow.

What is tennis elbow?

Tennis elbow, also called lateral epicondylitis, is the inflammation of the tendon attaching on the outer side of your elbow. Tennis elbow often happens because of overuse or repetitive movements of the forearm muscles. Although the condition is associated with playing tennis or other racket sports, tennis elbow can also occur in other sports and activities requiring repetitive forearm motions.

Tennis elbow can cause you to have pain and swelling on the outer side of your elbow. Treatments may involve rest, ice, pain medications, ultrasound, and physical therapy. In severe cases, surgery may be necessary.

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What is golfer’s elbow?

Golfer’s elbow occurs when the tendon attaching on the inner side of your elbow becomes irritated and inflamed. Golfer’s elbow is also called medial epicondylitis.

Although the condition can be experienced by people who play golf, it is not limited to them. People who repeatedly use their wrists and hands, such as racket players, baseball and softball players, carpenters, and typists, maybe at risk for golfer’s elbow, as well.

Golfer’s elbow can cause pain and tenderness on the inner side of your elbow. Treatment options are the same as in tennis elbow.

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Physiotherapy for Tendonitis

Physiotherapy can help you manage your tendonitis symptoms and other associated problems. Tendonitis, sometimes called tendinitis, is an irritation or inflammation of any of the tendons in your body. Your tendons are strong bands of connective tissue that attach your muscles to your bones. Tendonitis can be caused by repetitive use or overstretching of the tendon causing it to become irritated and inflamed.

Physiotherapy for Tendonitis

Physiotherapy ultimately aims to improve your quality of life. The physiotherapy rehabilitation goals for tendonitis are
  • To relieve your symptoms
  • Maintain or improve your muscle strength
  • Maintain your overall fitness
  • Promote injury prevention
  • Safely return you to your original activities or sports

The kind of physiotherapy treatment that you will receive will depend on the specific type of tendonitis that you have; your symptoms and other related problems; whether you have had surgery or not; and your overall rehabilitation goals.

Physiotherapy Treatment Options for Tendonitis

Your physiotherapist may employ a combination of any of the following
  • Immobilization if necessary (e.g. splinting, bandaging, taping)
  • Cold therapy or cryotherapy (e.g. ice pack, ice massage)
  • Heat pack
  • Electrical stimulation / Iontophoresis
  • Ultrasound / Phonophoresis
  • Massage
  • Joint mobilization techniques
  • Physiotherapy exercises
    • Gentle range of motion (ROM) exercises
    • Flexibility / Stretching exercises
    • General conditioning exercises
    • Progressive strengthening exercises
  • Suggest brace if necessary
  • Recommend walking aid if needed
  • Gait/Walking/Assistive device training (for lower limb injury)
  • Ergonomic training
  • Patient education
    • Regarding the patient’s specific condition (type of tendonitis)
    • Precautions to observe
    • Suggest activity or work modification
    • Self-care of symptoms
    • Wound self-care / post-operative care (after surgery)
    • Injury prevention
  • Suggest work or sport-specific rehabilitation program

The physiotherapy treatment options mentioned above are general treatment interventions and should not be considered as treatment guideline for tendonitis. Only your personal physiotherapist can help you determine the appropriate treatment intervention best for your specific problems and goals. Your physiotherapist will gladly discuss with you about your specific plan of care.

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Home Remedies for Tendonitis

Mild cases of tendonitis can be safely managed at home if properly done. Tendonitis is an inflammation of any of the tendons attaching your muscles to your bones. Common causes of the condition may include overuse and overstretching of the tendon causing little or large tears in the tendon fibers. Some healthcare practitioners may also call tendonitis as tendinitis.

Home Remedies for Tendonitis

Here are some home remedies that you can do for your tendonitis.
  • Rest. Immediately following your injury or occurrence of symptoms, you should stop your activity and avoid movements that worsen your symptoms. Attempting to work through your pain may lead to further injury.

    Once your symptoms subside, start using your injured limb as complete rest for a long time may lead to stiffness or delayed healing. Start making use of your injured limb in your daily home activities.

  • Ice. Apply an ice pack immediately following your injury for 20 minutes at a time. Continue to apply ice every 3 to 4 hours for the first couple of days or until your symptoms of pain and swelling subside. Remember to wrap the ice pack with towel before applying to your injury to avoid frostbite injury.

  • Compression. Apply a compression bandage to help minimize or prevent swelling. However, if you are unsure of how to properly apply a bandage, you may skip this home remedy as improperly applying a bandage can restrict blood flow to your tissues. You may want to ask your physiotherapist or doctor to teach you how to properly do compression bandaging.

  • Elevation. While resting, elevate your injured limb above the level of your heart to help minimize swelling.

If these non-medical home remedies for tendonitis do not work, you may take over the counter anti-inflammatory to help relieve your pain and swelling. Ask your healthcare provider if you are unsure of what proper medication you should use. If you have other health problems or you are taking another medication, you may want to consult your doctor first whether a pain drug does not interact with your current medications.

Get medical help

If your symptoms worsen or are unrelieved with home treatments, consult your doctor for proper diagnosis and treatment.

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Tendonitis – Where Does Tendonitis Commonly Occur?


Tendonitis means that your tendon – a strong band of connective tissue connecting your muscle to your bone – is inflamed. Tendonitis can cause pain, swelling, and difficulty moving. This condition is also called tendinitis.

There are different types of tendonitis depending on the specific type of tendon affected.

Tendons Commonly Affected with Tendonitis

There are several places in your body where tendonitis can occur. The following are some of the major tendons in the body where tendon injury can happen:
  • Rotator cuff and biceps tendons in your shoulder (See: Shoulder Tendonitis)
  • Forearm tendons near your elbow and wrist (e.g. Elbow Tendonitis, Wrist Tendonitis)
  • Tendons near or attached in your hip
  • Quadriceps tendon in front of your thigh, just above your kneecap
  • Patellar tendon, just below your kneecap
  • Hamstring tendons at the back of your thigh, near your knee joint
  • Achilles tendon, which is the largest tendon in your body, located at the back of your leg near your ankle joint (Achilles Tendonitis)

Often, tendonitis occurs as a result of overuse of the tendon or overstretching from a forceful or sudden movement.

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Tendonitis – When to Seek Medical Help for Tendonitis


Mild tendonitis can usually be managed at home even without special medical treatment. However, severe cases do not resolve on its own and usually need proper evaluation and examination and treatment. Tendonitis is also called tendinitis.

If you experience the following symptoms, don’t hesitate to consult your health care provider.
  • Fever following your injury
  • Severe pain and swelling at the site of injury
  • Symptoms worsen or are not relieved despite self-care
  • Inability to move the joint where the injured tendon passes
  • Numbness or loss of sensation below the injured area
  • Obvious deformity at the site of your injury.

Also, don’t hesitate to ask your doctor if you are unsure of the severity of your injury.

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Tendonitis – All About Tendonitis


Tendonitis occurs when any of your tendons becomes irritated and inflamed. A tendon is a strong band of tissue connecting your muscle to your bone. Tendonitis often results from overstretching or overuse/repetitive movements. Tendinitis is the other term for tendonitis.

What causes tendonitis?

Tendonitis can happen when your tendon is overstretched causing small or large tears in the tendon. In some cases, the tendon can be fully torn. The condition can be acute or chronic. Acute tendonitis can be due to a forceful movement, such as in pitching in baseball, sprinting, or sudden jumping in basketball or volleyball.

Chronic tendonitis is caused by repetitive movements putting stress on the tendon. Some sports at risk for the condition may include baseball, basketball, swimming, football, sprinting, long-jumping, heavy weight-lifters, and certain racket sports.

Repetitive activities at work can put a person at risk for developing tendonitis, as well. This may include carpenters, typists, and gardeners.

What are the symptoms of tendonitis?

The symptoms that you experience depend on what tendon is involved. However, the most common symptoms of tendonitis are pain, swelling, and difficulty moving. You may also experience bruising, a bluish discoloration of the skin overlying the injured area. Other symptoms may include tenderness, hearing a pop at the time of injury, and warmth or redness.

Treatments

What you can do

Immediately following your injury, you should
  • Rest and avoid certain movements that aggravate your symptoms
  • Apply ice on the injured area
  • Elevate your injured limb above the level of your heart
Taking anti-inflammatory medication may help relieve your pain and swelling.

If these home remedies do not work or your symptoms worsen, consult your doctor for proper diagnosis and treatment.

Other Treatments

You may need other treatments for your tendonitis including
  • Ultrasound
  • Physiotherapy
  • Use of supportive brace or strap
  • Use of assistive device
  • Steroid injection
Your doctor may recommend surgery for a severe case of tendonitis only if your condition is not relieved with conservative means.

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Physiotherapy for Prepatellar Bursitis

Physiotherapy for prepatellar bursitis vary and may depend on the symptoms that you experience, the severity of your injury, your previous work or activities, and your specific goals.

Overview of Prepatellar Bursitis

Prepatellar bursitis occurs when the prepatellar bursa – the fluid-filled sac found between the skin in front of your knee and your kneecap (patella) – is irritated or inflamed. The condition often occurs in people whose work or activity requires them to kneel. In some cases, prepatellar bursitis can be caused by a direct blow or falling on the knee during sports activities. The condition is sometimes called housemaid’s knee.
  • Learn more about Prepatellar Bursitis, its causes, symptoms, home treatment, and other treatment options.

Physiotherapy Treatment Options for Prepatellar Bursitis

Your physiotherapist may provide you with a combination of any of the following
  • Cold therapy (Ice pack or ice massage)
  • Heat pack
  • Transcutaneous electrical nerve stimulation (TENS)
  • Ultrasound (US) (Phonophoresis)
  • Soft tissue mobilization
  • Knee joint mobilization
  • Physiotherapy exercises
    • Range of motion (ROM) exercises
    • Stretching exercises
    • Strengthening exercises
  • Patient education
    • About prepatellar bursitis
    • Precautions to observe
    • Activity modification
    • Self-care of symptoms
    • Home exercise program
    • Injury prevention
  • Iontophoresis
  • Recommend orthotics if necessary
  • Postural training
  • Recommend a work or sport-specific rehab program

Remember that not all of the treatments enumerated above will be provided to you during your first visit to your physio. Your physiotherapist can help you determine the right treatment options for your specific problems and your goals.

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Prepatellar Bursitis – Housemaid’s Knee

Prepatellar bursitis occurs when the bursa in the front portion of your knee becomes irritated or inflamed. A bursa is a small fluid-filled sac found between your skin and bone or tendon. The bursa affected in prepatellar bursitis is the prepatellar bursa, which is located between just in front of your kneecap. Prepatellar bursitis is sometimes called housemaid’s knee or kneecap bursitis.

Causes

Prepatellar bursitis may be caused by
  • An overuse injury
  • Repeated kneeling or kneeling for long periods
  • Direct blow or falling on the knee during certain sports activities
  • Arthritis, like rheumatoid arthritis or gout

Symptoms

Common symptoms of prepatellar bursitis may include
  • Pain in front of the knee
  • Swelling
  • Tenderness
  • Difficulty moving the injured knee

If you experience severe pain and swelling, especially after a blow to your knee or a fall, you should consult your doctor for proper diagnosis and treatment.

Treatments

What you can do about your Prepatellar Bursitis

Mild symptoms can be managed with modified rest, applying ice, elevating your injured limb, and taking pain medication.
  • Rest. Stop your activity and take some time to rest.

  • Ice. Apply an ice pack for 20 minutes at a time, every 3 to 4 hours for the first few days or until your swelling subsides. Remember to wrap the ice pack with towel and avoid letting the pack stand for more than 20 minutes to prevent frostbite injury. Icing can help relieve your pain and swelling.

  • Elevation. Elevate your injured limb above the level of your heart to help minimize swelling.

  • Taking pain medications may also help relieve your symptoms.

Your doctor may decide to remove some fluid in your bursa if you have severe swelling. Other treatment options may include
  • Bandaging
  • Physical Therapy
  • Steroid injections
  • Surgery (severe cases)

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Physiotherapy for Tennis Elbow

Tennis elbow, also called lateral epicondylitis, is a discomfort or pain around the outside part of your elbow.

Tennis elbow is often associated with playing tennis, where it gets its name. However, the condition can happen in any activity that causes you to overuse your forearm muscles attaching to the bony lump on your outer elbow, called the lateral epicondyle. Tennis elbow often affects the dominant (most used) hand, but can affect the other one, as well.

Causes

Overusing your forearm muscles, especially those that attach to your arm bone on the outer side of your elbow, may cause tennis elbow. There are several work activities and sports that can cause the development of tennis elbow including
  • Hammering
  • Using manual screw drivers
  • Painting
  • Plumbing
  • Playing certain racket sports, such as tennis or squash

Typing or using scissors too often may also lead to the development of tennis elbow.

Symptoms

People with tennis elbow often complain of pain and tenderness on the outer side of their elbow. In some people, the pain may seem to travel down their forearm. Pain often worsens with forearm, wrist and hand movements, such as lifting, writing, or twisting the forearm. You may also have weakness of hand gripping.

Physiotherapy for Tennis Elbow Pain

During your first visit to your physiotherapist for your tennis elbow pain, you will likely be asked about your activity, your symptoms and your medical history. In addition, your physiotherapist will conduct a thorough evaluation and examination of your elbow.

Your physiotherapist will create a treatment plan specifically made for you based on the results of your initial evaluation, symptoms and stated goals. You will be actively participating in the creation of your plan of care.

Physiotherapy Treatment Options for Tennis Elbow

There are several treatment options for tennis elbow. Your physiotherapist may employ a combination of the following physiotherapy treatment interventions
  • Cold therapy or Cryotherapy
  • Heat pack application
  • Ultrasound
  • Manual muscle stretching
  • Joint mobilization
  • Range of motion exercises
    • Active range of motion (AROM) exercises
    • Active resistive range of motion (ARROM) exercises
  • Flexibility exercises
  • General conditioning exercises
  • Strengthening exercises
  • Patient education
    • About tennis elbow
    • Precautions
    • Activity modification
    • Self-care of symptoms
    • Injury prevention
  • Recommend proper equipment
  • Recommend brace if necessary
  • Work or sport-specific rehab program

Your physiotherapist may provide you with a home management and exercise program. Be sure to follow your therapist’s instructions carefully.

The type of physiotherapy treatments that you will receive depends on the severity of your injury. Only your personal physiotherapist or doctor can help you decide what appropriate interventions are best for you.

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Physiotherapy for Elbow Dislocation

Elbow dislocation happens when bones joining at your elbow become separated causing symptoms. There are three bones comprising your elbow joint. They are your upper arm bone (humerus) and two forearm bones (radius and ulna).

Causes

The most common cause of elbow dislocation is a fall on an outstretched hand (FOOSH injury). Sometimes you can dislocate your elbow when you try to reach forward with your arms straight on the car’s dashboard or sit during a car crash. Falling from a significant height may also lead to an elbow injury.

Symptoms

Symptoms of elbow dislocation may include
  • Severe pain
  • Swelling
  • Bruising
  • Deformed elbow
  • Difficulty moving your elbow
  • Weak or no pulse on the wrist (blood vessel damage)
  • Numbness or absence of sensation of hand (nerve injury)

If you have a dislocated elbow, you should have it looked by a qualified health care professional for proper diagnosis and treatment.

What you can do

Stop your activity and immediately apply an ice pack (wrapped with towel) for 20 minutes at a time and go to your nearest emergency room for prompt treatment. Untreated elbow dislocation may lead to more complications and permanent deformity.

Physiotherapy Treatments for Elbow Dislocation

There are several physiotherapy treatment options for elbow dislocation, which may include a combination of any of the following
  • Immobilization
  • Ice application
  • Heat pack application
  • Transcutaneous Electrical Nerve Stimulation (TENS)
  • Ultrasound
  • Elbow joint mobilization
  • Physical therapy exercises
    • Range of motion exercises
      • Passive range of motion (PROM) exercises
      • Active-assistive range of motion (AAROM) exercises
      • Active range of motion (AROM) exercises
      • Active resistive range of motion (ARROM) exercises
    • Stretching or Flexibility exercises
    • Strengthening exercises
  • Patient education
    • About elbow dislocation
    • Precautions to observe
    • Self-care of symptoms
    • Self-care of wound (if with surgery)
    • Injury prevention
  • Recommend work/activity/sports-specific rehabilitation program

The type of treatment plan provided for you will depend on your specific elbow problems, the stage of your recovery, and your goals. The treatment options enumerated above does not mean that your physiotherapist will provide them to you in one visit. Your physiotherapist will be able to help you determine the best plan of care for you.

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Rotator Cuff Tendonitis – A Rotator Cuff Injury

Rotator cuff tendonitis is an inflammation that occurs in any of the tendons of the rotator cuff. A tendon is a strong band of tissue connecting muscles to bones. In rotator cuff tendonitis, the tendon becomes irritated and inflamed, often, due to overuse or forceful overhead movements.

The Rotator Cuff Muscles

You have four cuff muscles in each of your shoulders. They are the supraspinatus, infraspinatus, teres minor, and subscapularis. They attach to your arm bone (humerus) via their tendons. These muscles help you perform shoulder movements such as moving your shoulder away from your trunk and rotating your shoulder. The rotator cuff is sometimes called the SITS muscles, representing the first letters of the muscles.

Causes

Rotator cuff tendonitis often occurs because of overuse of the muscles, especially in activities that require you to move your arms overhead repeatedly. Sports at risk for rotator cuff tendonitis may include baseball (pitching), racket sports like tennis and badminton, heavy weight lifting (above the shoulder), and swimming. Carpenters and painters may also be at risk if their work requires them to reach overhead.

Symptoms

The most common symptom of rotator cuff tendinitis is pain in the shoulder. Depending on the severity of your injury, you may also experience
  • Swelling
  • Bruising
  • Rotator cuff weaknees
  • Difficulty moving your injured rotator cuff

What you can do

For minor rotator cuff tendonitis, wrap an ice pack with towel and apply over your injured shoulder for 20 minutes, every 3 to 4 hours to help reduce your swelling and pain. Rest and avoid movements that cause your symptoms to worsen during the first couple of days. Taking pain medication may help relieve your symptoms. Ask your physiotherapist about exercises that you can safely perform to maintain your overall fitness and strengthen your weakened muscles.

If you have severe symptoms of pain and swelling or a deformed shoulder, you should consult your health care provider for proper diagnosis and treatment.

Treatments

Treatments for rotator cuff tendonitis may include
  • Modified rest
  • Ice application
  • Immobilization if necessary
  • Pain medication
  • Physiotherapy
Your doctor may recommend surgery to repair a severely torn tendon. After your surgery, your doctor may recommend that you undergo physiotherapy to help you improve your muscle strength and help return you to your original work or sports activity as fast and safely possible.

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UK Physiotherapy Association

The primary organisation of physiotherapists in the United Kingdom (UK) is the Chartered Society of Physiotherapy or CSP. Like all other physiotherapy associations worldwide, the CSP aims to promote high quality patient care. In addition, the Chartered Society of Physiotherapy promotes advancement in physiotherapy practice through advances in research and quality education, among others.

The CSP, according to its website, has been established in 1894 and subsequently "was awarded its Royal Charter in 1920." Today, the CSP is the leading membership organisation for physiotherapy professionals in the UK.
  • Learn more about the history of physiotherapy in UK at the CSP website.

You can contact the Chartered Society of Physiotherapy through the following:
  • The Chartered Society of Physiotherapy (Headquarters)
    14 Bedford Row
    London
    WC1R 4ED
    United Kingdom

    Phone: +44 (0)20 7306 6666
    Email: enquiries@csp.org.uk

  • CSP Northern Ireland
    41 Arthur Street
    Belfast
    BT1 4GB

    Phone: +44 (0) 2890 446 250
    Email: northernireland@csp.org.uk

  • CSP Scotland office
    49 North Castle Street
    Edinburgh
    EH2 3BG

    Phone: 0131 226 1441
    Email: scotland@csp.org.uk

  • CSP Wales Office
    1 Cathedral Road
    Cardiff
    CF11 9SD

    Phone: 029 2038 2428
    Email: wales@csp.org.uk

If you want to update your institution's information, please email us at webmaster@physiotherapynotes.com so that we may update the information in our database. Thank you very much!

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Physiotherapy Muscle Testing – Manual Muscle Testing

Muscle testing, or manual muscle testing (MMT), is a procedure done by physiotherapists and other healthcare providers to determine your muscle strength. Muscle strength testing is a part of your physiotherapy evaluation and examination.

In most cases, the physiotherapist performs manual muscle testing to asses for any muscle weakness. In addition, MMT will be done on normal muscles for comparison with the involved muscles. The results of your first manual muscle test will be used to determine possible treatments and will be used as baseline data for future physiotherapy visits or revision of your treatment plan.

Learn more about Manual Muscle Testing (MMT) Grading at the Physical Therapy Notes website. (Links open on a new window)

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Physiotherapy for Elbow Injuries

There are several types of elbow injuries. The most common, however, is tendinitis, which is the inflammation of any of the tendons attaching to your elbow area. A tendon is a strong band of tissue connecting a muscle to a bone. Two common types of tendinitis occurring at the elbow are lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow).

Other elbow injuries may include

Physiotherapy for Elbow Injuries

The physiotherapy treatment that you will receive for your elbow injury depends on the specific problem and severity. Severe cases should be seen by a qualified health care provider for prompt diagnosis and treatment. In any case, however, physiotherapy can help you manage your symptoms, strengthen your weakened muscles and help you return to your original activity or highest possible function.

Your physiotherapist will ask about your activity at the time of your injury and any other important related data. In addition, your physiotherapist will be conducting a thorough physiotherapy evaluation and examination of your injured elbow. You will be active in decision making as to what plan of treatment will be provided to you with the help of your physiotherapist.

Physiotherapy Treatment Options for Elbow Injuries

Depending on your elbow injury, signs and symptoms, your goals and whether you’ve undergone surgery or not, your physiotherapist may provide you with a combination of the following physiotherapy treatments
  • Cold therapy or Cryotherapy
  • Immobilization if necessary for a few weeks
  • Bandaging/taping
  • Heat therapy
  • Electrotherapeutic modalities (Ultrasound, TENS)
  • Soft tissue mobilization
  • Joint Mobilization
  • Gradual range of motion exercises
  • Stretching exercises
  • General conditioning exercises
  • Progressive strengthening exercises
  • Patient and family education
    • About the patient’s specific condition
    • Precautions to observe
    • Self care of symptoms
    • Wound self-care (if with operation)
    • Activity modification
    • Injury prevention
  • Home management and exercise program
  • Work/Activity/Sport-specific rehabilitation program

The treatments enumerated above will not be given to you in one visit. The type of treatment that you will receive will be based on your specific problems and goals. Your doctor or physiotherapist will be the one to help you decide which appropriate treatment or intervention is best for you.

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Physiotherapy for Shoulder Injuries


Shoulder injuries can happen to anyone, especially in those who participate in sports. Sports shoulder injuries can happen during a fall; direct blow to the shoulder; overuse injuries; or the shoulder is forcefully driven out of connection. The condition can occur in non-contact and contact sports.

Types of Shoulder Injuries

There are many types of shoulder injuries in sports depending on the specific structure/s involved at the time of injury. The following are some of the common sports shoulder injuries

Because of lack of shoulder use for a long time due to pain or injury, shoulder movements can become stiff and limited leading to frozen shoulder or adhesive capsulitis.

Physiotherapy for Shoulder Injuries

During your first visit to your physiotherapist for your shoulder injury, your therapist will likely be asking about your activity that led to your injury and any other medical history that may be related to your condition. He or she will then conduct a thorough physiotherapy evaluation and examination of your shoulder.

Your physiotherapist will then formulate a comprehensive treatment plan specifically made for you based on your specific needs and goals.

Physiotherapy Treatment Options for Shoulder Injuries

The type of physiotherapy treatments that you will receive depends on the specific condition that you have and whether you’ve undergone surgery or not. In addition, your physiotherapist will likely ask about your goals for rehabilitation.

Physiotherapy treatments for shoulder injuries may be composed of a combination of any of the following
  • Cold therapy (ice pack application/ice massage)
  • Hot pack application
  • Immobilization (splinting/bandaging)
  • Transcutaneous electrical nerve stimulation (TENS)
  • Ultrasound (US)
  • Soft tissue mobilization (massage)
  • Shoulder joint mobilization
  • Physiotherapy exercises
    • Range of motion exercises
    • Stretching or flexibility exercises
    • General conditioning exercises
    • Shoulder muscles strengthening exercises
  • Patient education
    • About the patient’s particular shoulder problem
    • Precautions and activity modification
    • Self-care of symptoms
    • Wound self-care (after surgery)
    • Home exercise program
    • Shoulder injury prevention
  • Return to work or sports rehabilitation program

Again, the type of treatment that you will receive will depend on your specific injury and not all of the treatment interventions enumerated above will be provided to you in one visit. Only your doctor or physiotherapist will be able to determine the appropriate treatment for you.

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Physiotherapy for Sports Injuries


There are many sports injuries commonly treated by physiotherapists, such as muscle strains, ligament sprains, dislocations and fracture. The type of physiotherapy treatments that you will receive for your specific sports injury will vary. You will be active in the decision making as to what intervention you will receive with the guide of your personal physiotherapist.

Your First Physiotherapy Visit

During your first visit to your physiotherapist, you will be asked about your activity that led to your injury, your past medical history and other related data. In addition, your therapist will perform a thorough physical evaluation and examination of your injured body part. Your first encounter with your physiotherapist is called the initial evaluation or examination.

Based on the results of physiotherapy evaluation and examination, your particular needs, and your goals, your physiotherapist will then formulate a comprehensive treatment plan specifically made for you. Your therapist will discuss with you about your treatment plan.

Your treatment may begin immediately following your physical therapy initial evaluation. Your physiotherapist will document your succeeding treatment visits and determine whether your treatment plan will be changed or continued.

Physical Therapy Treatments for Sports Injuries

The following are some of the general treatments that your physiotherapist may include in your rehabilitation program.
  • Ice pack application

    Ice application is often prescribed for acute sports injuries. Icing can help minimize your pain and swelling that result from your injury. Your physiotherapist will wrap an ice pack with towel and apply it to your injured part for about 20 minutes.

  • Hot pack application

    Your physiotherapist may decide to use a hot pack wrapped in towel if you do not have swelling. The pack will be applied for about 20 minutes. Hot pack application can help relieve your pain and muscle or joint stiffness. In addition, this may help hasten your healing by increasing blood flow to your injured body part.

  • TENS

    TENS, or transcutaneous electrical nerve stimulator, is a small battery-operated device that directs small amounts of current to the skin over your injury. You will feel a tingling sensation when the device is turned on. TENS can help temporarily relieve your symptom of pain.

  • Ultrasound

    An ultrasound is a machine that drives sound vibrations to your tissues. It is a deep heating apparatus or modality. This means that this physiotherapy apparatus can heat up deeper tissues or bulky body areas. An ultrasound may be used by your physiotherapist to soften your deeper tissues or to aid in your healing process.

  • Massage

    Massage, or sometimes called soft tissue mobilization, is a hands-on therapy that your physiotherapist may use. Massage may be employed to relax tight muscles, decrease swelling, reduce tissue adhesions, or pain relief.

  • Stretching

    Muscles can become tight during periods of inactivity following an injury. Stretching can help loosen these tight muscles, thus, improving your range of motion (ROM). Stretching may be done manually by your physiotherapist or he or she will teach you self-stretching exercises that your can do even at the comfort of your home.

  • Range of motion exercises

    Range of motion (ROM) exercises can help improve or maintain your joint range of motion. By performing ROM exercise whenever possible, you can prevent your joints and muscle from becoming stiff. Range of motion exercises may also be combined with strengthening exercises once you have improved strength.

  • Strengthening exercises

    Being inactive for a long time can make your muscles weak. Strengthening them is important to achieve independence in movement. Strengthening exercises can help you maintain strength of your uninjured muscles and improve strength of your weakened muscles.

  • Gait or walking training

    You may need gait or walking training using a walking device like a walker or crutches to avoid putting stress on your injured lower limb. You physiotherapist will fit you with a proper walking device and train you on how to properly use it.

  • Patient education

    Empowering you about what you can do about your specific problems is one important aspect of physiotherapy rehabilitation. Your physiotherapist will discuss with you about your specific sports injury; activity or work modification; precautions to observe; self-treatment; injury prevention, among others.

    If your physiotherapist provides you with a home management and exercise program, he or she will discuss them with you.

The physiotherapy treatments discussed here is not exclusive. There are many treatment options that your physiotherapist will employ based on your specific problems, your former activity, and your goals. Remember that physiotherapy rehabilitation is not a “packaged deal” of treatment. One treatment may be effective for one patient, but may not be equally effective for you. Only your physiotherapist or doctor can help you determine the appropriate intervention best for your particular sports injury.

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Physiotherapy for ACL Tear – Anterior Cruciate Ligament Tear


An ACL tear occurs when the anterior cruciate ligament (ACL) within your knee joint is partially or completely torn causing symptoms. ACL tears may be experienced by athletes who participate in high demand sports like soccer, basketball, football, or rugby that require them to suddenly run and stop, kick forcefully, jump, or pivot.

Signs and Symptoms

Signs and symptoms of ACL tear may include hearing a pop at the time of the tear; pain and swelling; and difficulty moving the knee or feeling of the knee becoming unstable when used.

Treatments

First aid treatments for an ACL tear include rest, ice application, wrapping a bandage, and elevating your limb. This first aid is called RICE therapy. Taking pain medication may help relieve your symptoms. You may need to use crutches to avoid putting added stress to your injured knee.

Physiotherapy can also help you manage your symptoms, strengthen your weakened muscles and safely return you to your original activity or achieve your highest possible function.

Surgery may be necessary if your symptoms are not controlled conservatively or you have severe damage to your knee structures. If your goal is to return to your original sports, you may need surgery. Talk to your doctor about appropriate interventions for your particular injury.

Physiotherapy Treatments for ACL Tears

Whether you’ve undergone knee surgery or not, your physiotherapist will be able to help you get back to your original activity or achieve full independence or your highest possible function. Your physiotherapist will likely ask about your activity at the time of your injury. He or shi will also perform a thorough evaluation and examination of your knee.

Depending on the severity of your injury, your particular needs and goals, your physiotherapist may provide you with a combination of any of the following
  • Ice or heat pack application
  • TENS
  • Ultrasound (US)
  • Functional electrical nerve stimulation
  • Soft tissue mobilization
  • Joint mobilization
  • Suggest use of walking aid (e.g. crutches, walker or cane)
  • Walking aid use training
  • Range of motion (ROM) exercises
  • Stretching/flexibility exercises
  • Strengthening exercises
  • Patient education
    • About ACL tear
    • Precautions
    • Activity modification
    • Self care of wound (if undergone surgery)
    • Self care of symptoms
    • Injury prevention
  • Return to work or sports rehabilitation program

The treatments enumerated above are general treatments. Not all of them will be provided to you during your first day of rehabilitation. Rehabilitation of ACL tear is divided into several stages. Your physiotherapist will determine what appropriate treatments are best for you.

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Physiotherapy for Hip Pointer


Hip pointer is a condition in which the top portion of your pelvic bone is injured from a blow causing symptoms. The top part of your pelvis is called the iliac crest.

Causes

The most common cause of hip pointer is a direct blow to your iliac crest, which may occur in contact sports such as football, rugby, and contact martial arts. In some cases, the condition occurs when the person slips sideways and hit their iliac crest area in a hard object like a table or stair.

Symptoms

You may experience pain and swelling. Bruising may occur if small blood vessels near or in the skin are damaged. Trunk side-bending may be limited because of pain.

Severe pain or hearing or feeling of cracking at the time of your injury may mean that a break in your bone has occurred. You should go to the emergency room for prompt diagnosis and treatment.

What you can do

Minor cases of hip pointer with mild symptoms can be effectively managed with rest and putting an ice pack over your injury for 20 minutes at a time. Continue applying the pack every 3 to 4 hours during the first 2 to 3 days or until your pain and swelling subsides. When using an ice pack, make sure to wrap the pack with towel.

You can perform gradual strengthening of your core muscles once your symptoms go away. Ask your physiotherapist about appropriate exercises that you can perform.

Physiotherapy for Hip Pointer

The physiotherapy treatments that you receive for your hip pointer will depend on the severity of your injury. You physiotherapist will perform a thorough physical examination and evaluation of your injured body part and other associated structures. He or she will then formulate a comprehensive physiotherapy treatment plan with you involved in decision making.

Physiotherapy Treatment Options for Hip Pointer

Based on your specific problems and goals, your physiotherapist may provide you with a combination of any of the following
  • Cold therapy (ice pack application)
  • Heat therapy
  • TENS (transcutaneous electrical nerve stimulation)
  • Ultrasound (US)
  • Soft tissue mobilization (massage)
  • Stretching
  • Range of motion (ROM) exercises
  • Core strengthening exercises
  • General Conditioning exercises
  • Patient education
    • About hip pointer
    • Precautions to consider
    • Home treatments for hip pointer (home management)
    • Injury prevention
  • Return to work or sport rehabilitation program

Your physiotherapist may provide you with a list of home exercises that you can safely do at your home. Make sure to carefully follow your therapist’s home instructions.

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Physiotherapy for Hip Osteoarthritis


Hip osteoarthritis can affect your daily activities and your quality of life. Physiotherapy can help you decrease your hip osteoarthritis symptoms; improve your joint range of motion and muscle strength; and improve your quality of life.

The physiotherapy treatments that you will receive depends on your specific problems and goals, which may include a combination of any of the following
  • Cold therapy
  • Heat therapy
  • Electrotherapeutic modalities (e.g. ultrasound, TENS)
  • Joint mobilization
  • Stretching
  • Physiotherapy exercises
    • Range of motion (ROM) exercises
    • Stretching exercises
    • Conditioning exercises
    • Strengthening exercises
  • Recommend use of walking device (e.g. cane or walker)
  • Gait or walking training
  • Patient education
    • About hip osteoarthritis
    • Precautions to observe
    • Injury prevention
    • Activity modification
  • Aquatic physiotherapy

Your physiotherapist may also teach you how to manage your symptoms when your get home. In addition, your physiotherapist may provide you with a list of home exercises that you can do at the comfort of your home as a part of your home management and exercise program.

Don’t hesitate to ask your physiotherapist about questions that you might have about hip osteoarthritis and what appropriate exercises that you can safely do.

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Hip Osteoarthritis – About Hip Osteoarthritis


Hip osteoarthritis occurs when the articular cartilage thins out or is damaged due to wear and tear. Your articular cartilage is a type of tissue that covers ends of bones in a joint that helps you move your joint easily. Osteoarthritis is the most common type of arthritis known today. Hip osteoarthritis is also called hip OA.

Your Hip Joint

Your hip joint is composed of a ball-like upper end of your thigh bone (femur) called the femoral head or the head of the femur and the acetabulum of your hip. The acetabulum is a depression or socket that connects with your femoral to form your hip joint. Both the head of the femur and the acetabulum are covered with a thin layer of articular cartilage.

Cause

Damage to the articular cartilage due to wear and tear often causes the symptoms of osteoarthritis. Although once thought as a disease affecting only the older population, it is now known that hip osteoarthritis can also affect younger people. Hip osteoarthritis in younger people may result from injury to the joint; malformations in the joint; or due to a genetic defect in the joint cartilage. Having a family history for the condition or being overweight may put you at risk for having hip osteoarthritis.

Symptoms

The symptoms that you experience depend on the severity of damage to your hip joint. Symptoms usually start out slowly and worsen as more of the cartilages are damaged. At first, you may experience discomfort in your hip or groin area, especially during physical work or exercise and is relieved with rest. Joint pain may worsen as your joint further degenerates. You may experience hip joint stiffness and inflammation may occur.

Once your cartilages are completely gone, your bones in your joint will rub against each other causing more significant pain. Moving your hip becomes difficult, which can affect your daily activities.

Treatments

There are several treatment options available for hip osteoarthritis. Often, conservative treatments are employed first, such as
  • Modified rest
  • Physiotherapy
  • Using an assistive device, such as a cane, walker, or crutches
  • Pain medication
  • Modification of activities
  • Decrease weight if you are obese or overweight
  • Eat a healthy diet and get plenty of rest

Your healthcare provider may recommend surgery to replace your damaged joint with a new artificial hip joint. The procedure is called hip replacement. This surgical procedure may be recommended by your doctor if you have a severely damaged joint or conservative treatments do not improve your symptoms.

References:
Handout on Health: Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Available at http://www.niams.nih.gov/Health_Info/Osteoarthritis/

Osteoarthritis of the Hip. American Academy of Orthopaedic Surgeons (AAOS). Available at http://orthoinfo.aaos.org/topic.cfm?topic=A00213


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Physiotherapy for Quadriceps Tendon Tear


Quadriceps tendon tear happens when the large tendon located just above the kneecap is partially or completely torn. A tendon is a strong cord of tissue connecting a muscle to a bone. The tendon connecting your front thigh muscles (quadriceps) is called the quadriceps tendon. This condition is also called quadriceps tendon rupture or torn quadriceps tendon.

Causes

Quadriceps tendon tear can happen in sports activities that require the athlete to jump, run or kick. Sometimes, improper weight lifting technique or lifting too much weight beyond the quadriceps tendon can take may result in tearing of the tendon. Certain conditions and medications may result in weakness of the quadriceps tendon, which may put the person at risk for getting quadriceps tendon rupture.

Symptoms

Symptoms of a ruptured quadriceps tendon can vary depending on the severity of the injury. You may experience
  • Pain at the site of tear
  • Swelling
  • Tenderness just above your kneecap
  • Bruising, a few hours following your injury
  • Sagging or drooping of your kneecap
  • Difficulty straightening your knee
  • Difficulty walking
  • Muscle weakness

Some people who experience tearing of their quadriceps tendon report that they felt a tearing or popping sensation at the time of their injury.

If you experience severe pain, your symptoms worsen, or are unsure of the severity of your injury, don’t hesitate to consult your doctor for proper diagnosis and treatment.

Treatments

The type of treatment that you receive will depend on the severity of your injury. Your doctor may recommend that you be immobilized with a knee brace to allow healing. In addition, your doctor may require you to use crutches to avoid putting added stress to your injured limb.

Your doctor may recommend that you undergo physiotherapy after your symptoms have subsided. Your physiotherapist will help you increase your knee joint range of motion (ROM), improve your muscle strength and your overall fitness.

Your doctor may recommend surgery to repair your damaged quadriceps tendon, especially if the tear is so severe.

Physiotherapy Treatment Options for Quadriceps Tendon Tear

Physiotherapy treatments that you receive depend on the specific problems that you have and your particular goals. Your physiotherapist may decide to provide you a combination of the following treatments
  • Cold or Heat therapy
  • TENS (transcutaneous electrical nerve stimulation)
  • Ultrasound
  • Soft tissue mobilization (massage)
  • Joint mobilization
  • Stretching
  • Physiotherapy exercises
    • Range of motion exercises
      • Passive range of motion (PROM) exercises
      • Active- assistive range of motion (AAROM) exercises
      • Active range of motion (AROM) exercises
    • Gradual quadriceps strengthening exercises
      • Isometric exercises (quadriceps setting)
      • Straight leg raising (SLR)
      • Weight training
  • Recommend crutches or other walking aids
  • Gait or walking training
  • Patient education
    • About quadriceps tendon tear
    • Precautions to observe
    • Injury prevention
  • Work or sport-specific rehabilitation program

Your physiotherapist will also provide you with a home management and exercise program that you can do at home. The type of treatments and physiotherapy program that you receive will depend on your stage of recovery.

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Physiotherapy for Mallet Finger


Mallet finger, also called baseball finger, is an injury to the tendon attaching near the tip of your finger. A tendon is a strong band of tissue that connects a muscle to a bone. The extensor tendon attaches at the bone on the tip of your finger that helps straighten your finger.

Causes of Mallet Finger

Mallet finger is often caused by a sudden or forceful bending of the tip of your finger resulting in tearing of your extensor tendon. It is a fairly common injury among athletes participating in ball games, such as football, basketball, volleyball, or baseball.

In some cases, a portion of the finger bone is chipped resulting in a small fracture instead of tearing of the extensor tendon. This condition is called an avulsion fracture.

Symptoms

If you have mallet finger, you may experience
  • Pain at the site of your injury
  • Swelling
  • Bruising after a few hours after the injury
  • Inability to straighten your injured finger

What you can do

Immediately apply an ice pack wrapped in towel for 20 minutes at a time and elevate your limb above the level of your heart. Seek medical attention as mallet finger does not tend to correct itself.

Physiotherapy Treatment Options for Mallet Finger

Your finger will be put in a splint to avoid movement and allow healing for a few weeks. You will be advised to wear the splint always during your recovery.

Physiotherapy treatments may include
  • Cold therapy
  • Recommend splinting of the injured finger
  • Stretching
  • Physiotherapy exercises
    • Passive and active range of motion exercises
    • Strengthening exercises
    • General conditioning exercises
  • Patient education
  • Return to activity rehabilitation program

The type of physiotherapy treatments that you will receive depends on your specific problems and rehab goals. Your physiotherapist will determine the appropriate treatments that you will receive. Your therapist may also provide you with home treatment program to self-manage your symptoms. In addition, your PT will provide you with a home exercise program that you can do at home when your splint has already been removed.

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