Tennis elbow, called lateral epicondylitis, is a condition characterized by pain of the lateral elbow that is provoked by extending the wrist or fingers.  It is the most common cause of elbow pain and is classified as an overuse injury of the forearm muscles.  Pain originates at the insertion of the forearm muscle tendon at the lateral bony prominence, the lateral epicondyle, of the elbow.  It is thought that micro-tears occur at the tendon-bone junction due to tendon breakdown and muscle weakening. Research shows very little inflammation with tennis elbow.  The injury is more mechanical in nature than inflammatory. 

 Causes of Tennis Elbow
Any activity that over stresses the involved tendon, the extensor carpi radialis brevis, can cause the disorder. Here are some causes of tennis elbow:
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1. Overuse 
The most common cause of tennis elbow is repetitive strain.  This can occur due to an acute or gradual cause.  When a person performs many wrist extension over a short period of time, such as swinging a hammer all day shingling a roof, the tendon can have an acute overuse reaction and get injured at the elbow.
Secondly, a person can gradually injure the tendon insertion by creating prolonged irritation over days of work.  This is common with jobs involving  a lot of wrist movements, gripping, holding, pulling, or using a knife when cutting meat. 

2. Trauma
The tendon can become acutely injured and painful when the lateral elbow is struck by blunt force trauma directly at the tendon insertion.  

3. Weakness in the mechanical Chain
There is an old song that says: "the wrist bone is connected to the elbow bone, and the elbow bone is connected to the shoulder bone....."  There obviously isn't an elbow bone, but the song tells us that everything is connected and everything works together.  It is very common to see weakness in the shoulder girdle causing pain into the elbow.  It is important to have stability and strength with coordinated movements involving the entire mid-back, neck, shoulder, and arm.  Research shows that if the neck and mid back is not functioning at their optimal ranges, arm movements are compromised.  

4. Neck Dysfunction
The lower nerves of the neck go down the arm to provide sensation, muscle control/strength, and reflexes.  Sometimes when a nerve is irritated in the cervical spine, the pain radiates to the lateral elbow. This cause can mimic tennis elbow pain. Another cause is the fact that decreased nerve flow to the muscle can cause weakening and therefore make you more susceptible to injury. 
Gunn and Milbrandt investigated the effects of treatment directed to the cervical spine on 50 patients with lateral epicondylitis whose symptoms did not improve after 4 weeks of elbow treatment. Cervical spine treatment included 1 or more of the following: cervical traction, mobilization, isometric cervical exercises, and ultrasonography and heat. In an average of 5.25 weeks of cervical treatment, 43 patients (86%) experienced good or satisfactory relief of the elbow symptoms. (10. Gunn CC, Milbrandt WE. Tennis elbow and the cervical spine. Can Med Assoc J. 1976;114:803-809.

Strengthening the elbow is a priority but you should be strengthening the entire arm and shoulder. Strength training should not aggravate the elbow and light resistance with high repetitions (15 to 20) is the best method. Three sets of the exercises once a day will help you to avoid over training the area. Always remember to stop doing the exercise if it is painful and consult a professional for further advice.

Some tennis elbow exercises are:
- squeeze an object such as a sponge ball
-swirl a glass half full of water in both directions
-draw the alphabet out with your pointer finger achieving large wrist movements
-place your wrist at the edge of a table with the palm down (hanging over the edge), and with a soup can in your grasp, lift your hand up fast and then lower it slowly.
-ring out a towel both ways
-strengthen biceps, triceps, and shoulder girdle musculature

Conclusion:
If you are worried that you might have tennis elbow, visit a trained healthcare provider to get a proper diagnosis and then establish a treatment plan. Most work can be done at home with simple tools and can be very effective.

Activity fact: Most cases of tennis elbow heal with conservative therapy with only 10-15% needing surgery at the elbow.

​There is a lot of confusion regarding whether to use heat or ice when you have pain.  Both therapies are inexpensive and effective when used properly.  This article will reveal when it is appropriate to use either option.

Pregnancy is a very exciting time for a woman. However, it can come with many physical changes that can cause back pain. It is estimated that 50 percent of pregnant women will experience an episode of back pain during pregnancy. 
The rapid changes in a woman's body over a relatively short amount of time during pregnancy causes changes in hormones, changes in mechanical forces on the ligaments, and changes within the body as it accommodates the fetus.  These changes, along with added weight gain,  contribute to the possibility of back pain.

Relaxin
Relaxin is a hormone that is essential throughout pregnancy. Relaxin levels are highest in the first trimester and it acts on the uterus and blood vessels to better support the pregnancy. At the end of the pregnancy, relaxin plays a role in preparing for delivery. It acts on the ligaments to loosen and increase their flexibility. ​The flexibility in a woman’s spine increases the lumbar curvature, called lordosis, to shift the center of gravity forward, keeping it over the pelvis. This prevents her from falling forward as the fetus grows. This increase in lordosis also helps minimize the force acting on the muscles and ligaments. Due to the extra mobility in the ligaments, a woman is more likely to have a hyper-mobile spine and pelvis.  This can also be more common after having multiple children and it increases the probability of back pain. 

Get Active!
Postural changes and exercise can be helpful to prevent and manage back pain. Try the following:

* Make sure that you are walking daily.
* Avoid prolonged sitting. Move around frequently
* When sitting, keep your knees below your hips, with an angle greater then 90 degrees in your hip joints.
* Sit backwards on a kitchen chair.
* When on an exercise ball, keep your knees below your hips.
* When seated, keep your back upright, not leaning backwards.
* When standing, swing your hips in a figure-of-eight motion.
* Avoid carrying another toddler on your hip.

These postural habit changes may also help support the positioning of baby to facilitate less potential for painful back labor, or necessity for birth interventions.

It is very important to maintain cardiovascular and strength conditioning activities. If you were exercising regularly prior to pregnancy, you should be able to continue moderate intensity exercise. Moderate intensity exercise is classified as being able to maintain a conversation while exercising. If you are not able to maintain a conversation,  you are working too hard. If you were running before pregnancy, you should be able to continue running while pregnant. Pregnancy is not the time to take up running. You should avoid exercises that have the risk of falling, contact sports, heavy resistance training and exercises that require lying on the back after the first trimester. (https://www.myvmc.com/pregnancy/exercises-to-do-and-avoid-during-pregnancy/). Studies of women who maintain exercise throughout pregnancy have decreased risk of gestational diabetes, decreased Cesarean section rates, and improved postpartum recovery time. If you are experiencing low back pain or pelvic girdle pain, water exercise is great alternative. 

Activity Fact: Studies show that by the third trimester, the baby moves about 30 times each hour! Babies know before they are born how important it is to move!

​(This article was written by: Dr. Melendy from the Neepawa Chiropractic Centre)

Back pain will effect 80% of the population at some time in their life and is the leading cause of disability and absenteeism from work.  The majority of back pain is due to mechanical causes including sprains, strains, instability or degeneration.  
However, there can be times when your back pain is caused from internal structures of your body rather than from joints and muscles.  

How Pain Works
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Pain is our signal to tell us that something is wrong with the body. We have many types of sensory nerves giving us information about temperature, vibration, touch, stretch, pain, smell, sound, taste, and sight. A common example of this can be found with back pain. When a joint is not properly stabilized by the surrounding muscles, the force going through the joint causes a strain of the surrounding tissues. There is an extra stretch to the  the muscles and ligaments, provoking a pain signal to the brain.  This type of pain mechanism is easy for the brain to localize in the body.
Referred pain is a different type of signal, and there are several theories of how this works. One theory is that many organs have sensory nerves that work through complex pathways, and these signals can converge at the same spot as sensory nerves from the skin, muscles and joints. The body reads sensory information from the periphery more often than the organs, and therefore assumes the pain is from this area and referred pain occurs.  A common example of this is the heart. Cardiac pain in is often felt in the chest, arm, jaw, mid-back, and neck.  A kidney infection may be felt as a mid back ache.  You may have shoulder tip pain after having laparoscopic surgery.

 The most common organs of the body to cause spinal pain are the following:
Head - brain aneurysm, tumor, or lesion
​Neck and shoulder - heart, lung, diaphragm, and thyroid gland
Mid back - stomach, pancreas, gall bladder, liver, and heart
Low back - kidney, bladder, colon, reproductive organs

How to Determine the Source of Pain

When uncertain if your pain is coming from the back, there are four general rules to consider:
1. The mechanism of the injury is the most obvious tool to tell you if pain is from muscles and joints. If you have a trauma or repetitive strain injury, the pain is most likely from the muscles and joints. 
2. If it hurts when you use the joints and muscles around the sore area, it is most likely joint or muscle pain as the cause.  Pain when activating and/or stretching a muscle is a sign pain is not coming from the organs.   (i.e.  If the pain is originating from an internal structure, such as your kidney, you should be able to move about and not provoke or make the pain worse.)  Often muscle and joint pain is characterized by being "sharp" and "pulling".  Referred pain is characterized by being a "deep and achy" pain.
3. If you are experiencing abnormal activities with one of your body systems along with back pain it might not be the back causing your problems. (i.e. If you have low back pain and are noticing that the color of your urine is more red than normal and that it hurts to urinate, you might have kidney problems, not back problems.) You should think about your own medical history, and consider whether a previous issue is recurring, or possibly progressing.
4. If your pain does not subside with rest and lasts longer than usual, you need to consider a secondary source to your back pain.  Most uncomplicated muscle and joint problems heal within 6 to 8 weeks. Persistent pain is a sign that the pain can be more than just a nagging back. 

Conclusion
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There are circumstances when your back pain may be coming from an internal structure.  Listen to your body and use the information provided to determine if your pain is originating from the back or from the internal organs.  Always consult a trained health care provider to help determine the cause of your pain. 

Activity Fact: Women are 3 times more likely then men to experience throat and jaw symptoms when having a heart attack.