Relief for Painful (Tennis) Elbow

Lateral Epicondylitis Explained
By Mike Brezak, DPT, Hampton Physical Therapy


Were you like many along the Seacoast this past Fall raking up the leaves? Did it never seem to end with bag after bag of filled to the brim? And have you noticed lately a pain developing on the outside of your elbow? You’ll likely experience the same when shoveling snow. Well that my friend, is mostly likely lateral epicondylitis or tennis elbow.

Well then what is this lateral epicondylitis exactly? Lateral epicondylitis is an inflammation of the connective tissue of the wrist extensors in the forearm. It is an ailment that is accounted for in 1-3% of the population with primary occurrence noted between 30-50 years, of age. Repeated overuse and strain on the muscles in our forearm pull on the connection at the elbow causing tearing of the tissue and increased inflammation.

Typically the initial injury is caused by a repeated use of the forearm extensor muscles that largely has been developing for some time. Usually signs and symptoms that you may have this diagnosis is:

  • ~ reproducible pain with grasping and gripping activities including driving or drinking from a glass
    ~ pain on palpation of the elbow joint
    ~ taught muscle bands of the forearm
    ~ possible numbness/tingling into the fingers (may have a neck component)elbow-pain

Like many, symptoms don’t often become noticeable until weeks or even months after the damage has been done to the tissue and can persist upwards of 2 years if left untreated!

So what can you do about it? If you first start to notice an increase in pain in the elbow stop or limit the activity that is causing an increase in your pain. Give your arm time to heal and use ice to control the pain/discomfort. You can also wear an elbow brace that wraps around your forearm sold at many local pharmacies to also help manage your symptoms by decreasing the strain on the tendons of the joint. In terms of ice vs heat, you want to avoid sources of warmth as these will increase your symptoms whereas ice will help diminish the pain.

arm-stretch-hptA simple forearm extensor stretch can help manage your early symptoms holding for 30 seconds performing 2-3 times per day, but it is best to seek treatment as early as possible.


Graston Technique™ beneficial for tennis elbow pain at Hampton Physical Therapy

And what if your symptoms are too severe? Well, all of the Physical Therapists at Hampton Physical Therapy have extensive knowledge in the identification and treatment of lateral epicondylitis. Each therapist have been trained using the latest techniques including Trigger Point Dry Needling, Graston Technique™, and neural mobilizations to get you back and ready for the coming snow this Winter.

We have both offices in Seabrook and Hampton and look forward to working with you! If you need further information or questions we can gladly assist you at

  1. Bisset, Leanne et. al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomized trial. British Medical Journal, 333(7575): 939. 2006 Nov 4.

Spinal Thrust Manipulations: Not Just for Chiropractors

By Lauren Richards, PT, DPT
Providing Spinal Thrust Manipulation to patient at Hampton Physical Therapy – Seabrook NH. 

Have you ever woken up with a stiff neck or back that makes it painful and difficult to move and go about your everyday routine? Your first thought may be to call the chiropractor, but did you know physical therapists are licensed and trained to perform spinal manipulations as well?

What does thrust manipulation mean?

Physical therapists have been performing thrust manipulations in the United States since the 1920’s and have been evolving with technique and application through years of clinical research and evidence based practice. Manipulation/mobilization as described by the Guide to PT practice is “A manual therapy technique comprised of a continuum of skilled passive movements to joints and/or related soft tissues that are applied at varying speeds and amplitudes, including small amplitude/high velocity therapeutic movement.” Thrust manipulation is defined as a high velocity, low amplitude therapeutic movement within or at end range of motion. It is within PT scope of practice and is taught in professional physical therapist education as well as continuing education courses which all of our therapists have participated.

Is thrust manipulative therapy right for you?

Thrust manipulation is just one of the many services and interventions physical therapists administer during patient care. Manipulations provide many benefits for patients in pain including immediate decrease in pain, increase in range of motion, increase circulation, relaxation of tight muscles, and improved muscle function to perform daily activities. The risks associated with spinal manipulation are very low and all of our therapists have been trained to perform the techniques in a safe, effective manner for those deemed appropriate. Spinal manipulative therapy is used to treat a variety of ailments including neck pain, headaches, low back pain, sacroiliac pain, rib pain, shoulder pain, and thoracic pain. Therapists are trained to recognize indications and contraindications for thrust manipulations and are able to make educated clinical decisions based on their evaluation findings. However, there are those that are not appropriate for spinal manipulations including those with advanced osteoporosis, CAD, aortic aneurysm, TB infection, tumor, fracture, upper cervical instability, cauda equina, cervical myelopathy, and extreme or excessive pain.

Should you choose to see a physical therapist instead of a chiropractor?

Application and technique of spinal manipulations are similar across both professions however the treatment models between physical therapists and chiropractors differ. Most chiropractors practice under the theory of the “spinal subluxation complex”, meaning a subluxation of a vertebrae in the spinal column can alter neurological function and if left untreated can lead to disorders and disease of all systems. Physical therapists on the other hand utilize manipulative therapy of the spine and extremeties along with other manual techniques and exercise to treat and prevent neuro-musculo-skeletal pain and dysfunction and restore mobility within these systems.

Lauren Richard - stm2What’s the next step? Do I need to see my doctor first?

New Hampshire is a direct access state meaning depending on your insurance you can come to physical therapy without a doctor referral. All of our Doctors of Physical Therapy are trained to determine if you are appropriate for manipulative therapy and will develop a plan of care to help you rid of your pain and reach your goals! So if you or someone you know think could benefit from manipulative therapy or any of the other services we provide please contact me or any of our other licensed and trained physical therapists at Hampton Physical Therapy to schedule an evaluation today!



Guide to PT practice
SMT-1 High Velocity Low Amplitude Thrust Manipulation of the Cervical, Thoracic, Lumbar, and SI Joints course book. Dr. James Dunning DPT, PT, MSc Manip ther, OCS, MTC, MSPT, MCSP, MAACP (UK), FAAOMPT, MMACP (UK) 2014
Spinal Manipulation- Not an “Adjustment” – Orthopedic and Spine Therapy.

Non-Invasive Pain Relief ~ Graston Technique™

by Lisa Wheldon, DPT


Ouch my aching elbow! Most of us are familiar with issues related to overuse injuries of our muscles and joints. Whether you are a weekend warrior that really tries to push it when they get in the gym and pulled in their calf, or you’re at work performing the same task over and over again and now your elbow just seems to throb. We are all familiar with injuries that just nag on and on, and think it will get better on its own. Well 6 months later you are still hobbling along because that calf hasn’t healed and you are constantly rubbing your elbow to make it feel better. There is no reason to live in pain. There are many non-invasive treatments at Hampton Physical Therapy. One of the options to treat musculoskeletal injuries is the Graston Technique™. This technique involves using an instrument to perform soft tissue mobilization, and it allows the therapist to not only detect scar tissue but treat it as well.

The therapist works the specialized tool along the affected area to assess for restrictions in the tissue. As this is taking place there are several physiological effects occurring at a cellular level. As pressure is applied tissue remodeling and fibroblast recruitment is taking place1,2. A fibroblast is a fiber producing cell that when it is stimulated can produce new tissue to an area to aid in healing. An inflammatory response takes place which allows for blood flow to a localized area. Mechanotransduction takes place, cells sense and respond to the force applied. The tissue responds by remodeling the tendon, muscle, cartilage or bone3. A piezoelectric phenomenon causes the soft tissue to generate an electrical signal when subjected to mechanical stresses. This occurs due to the shearing of collagen fibers past one another. Then there is the concept that soft tissue models around demand imposed on it.

The problem with thinking that your injury is just going to heal on its own is that you aren’t completely wrong. Yes it will heal but it won’t heal properly causing scar tissue to build up. If there is scar tissue in the muscle the muscle is now in a shortened position and can’t function properly. The muscle fibers are no longer sliding and gliding smoothly underneath the fascia, and can cause other issues in the chain. The muscle can now have limited range of motion causing the patient pain. So if you have been walking around with a calf strain for 6 months now and all of the sudden your knee or foot starts to hurt it could be caused by altering your gait due to the initial calf injury. Now your injuries are multiplying because you never addressed the root of your issue.

grastonThe Graston Technique™ could have ended all of this discomfort from the start. If you contact Hampton Physical Therapy from the time of initial injury or even now that you have several areas of discomfort you are still a great candidate for this treatment. Upon evaluation with the Graston tools the therapist can assess for any restrictions in the muscles and then treat those areas using the same tools. Following the Graston treatment the patient is then instructed in effective ways to properly stretch the affected areas to promote the blood flow that was just attained with the tools and aid in proper healing of the tissues. The patient will then perform strengthening exercises, and possibly ice and electrical stimulation if deemed appropriate for the patient. Frequently patients will ask how long it will take for positive effects to be noticed. The standard plan of care is twice a week for 4-5 weeks. The patient should notice improvements within 3 to 4 treatments. Typically patients are able to complete all of their daily activities following treatment. The Graston technique has positive outcomes in 75–90 percent of all conditions treated. It is equally effective in restoring function to acute and chronic injuries, and pre- and postsurgical patients.

Now that tight calf that was stopping you from getting back to running or that elbow that is stopping you from raking your yard can be treated. You could be back to your activity in just a couple weeks. With such a high likelihood for improvement why not give physical therapy a chance. Call me at Hampton Physical Therapy at: 603-474-2259 for more information on how this therapy could help you! Or visit us online at

1. Gehlsen GM, Helfst R. Fibroblast response to variation in soft tissue mobilization pressure. Medicine and Science in Sports and Exercise, 31(4): 531-535.
2. Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. JOSPT 39(7): 506-514
3. Khan KM, A Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sp Med, 43(4): 247-251.