Tag Archives: Overuse Injury

De Quervains Disease, Hand Pain, Hand Pain Treatment, Physiotherapy, Wrist pain

DeQuervain’s: How to Manage Thumb and Wrist Pain

If you’ve ever felt a sharp, catching pain at the base of your thumb or along the side of your wrist when gripping your water bottle, holding a newborn, or lifting weights, you might be dealing with De Quervain’s Tenosynovitis, or some call it DQ for short.

This wrist condition is exceptionally common among athletes, manual laborers, new parents, and anyone who uses their hands repetitively. Let’s look at what’s happening inside your wrist, how to test for it, and how physical therapy can help you get back to normal.

What is DeQuervain’s?

Diagram showing DQ, highlighting the inflammation fo the tendon and tendon sheath

A quick anatomy lesson first. De Quervain’s is the inflammation of the tendons and the sheath they run through across the back of your thumb. Repetitive movements or even a consequence of an acute injury can cause the thickening and narrowing of the tunnel. Then, the tendons that normally slide back and forth in there have a higher chance of getting stuck, further worsening the inflammation.

The 2 muscles specifically that get stuck are called abductor pollicis longus (APL), and extensor pollicis brevis (EPB). Importantly, these 2 muscles give you the ability to move your straighten and move your thumb away from the palm and other fingers.

How do I know if I have DeQuervain’s?

Common signs and symptoms include:

  • Dull or sharp pain at the back of the thumb, close to the wrist
  • Pain worsens during gripping, lifting, twisting, pinching etc.
  • Pain may radiate up the forearm
  • Catching or snapping sensation when moving the thumb
  • Swelling over the thumb area

Seeing a professional is the best way to diagnose wrist and thumb pain. There are several other causes of wrist and thumb pain and an expert Physiotherapist will be able to differentiate them. They will also determine whether imaging or medical intervention is necessary. For most cases of DQ, conservative treatment with physiotherapy has good outcomes.

How is this condition treated with Physiotherapy?

Physiotherapy is the first line of defense for DQ. Complete rest is never the answer, it will take a combined program of careful strengthening and activity modification to build an environment the tendon can recover in. Here are a couple of the topics and treatments that are likely to be part of your program.

  1. Splinting/bracing: Depending on which hand is affected, it can be very hard to avoid overusing it. A specialized brace called a thumb spica splint is very helpful to combat overuse. It immobilizes the thumb while leaving the other fingers free, giving the tendon a chance to rest. Depending on your individual factors, your PT may have you using it periodically during the day, only while sleeping, or a combo of both.
  2. Exercises: While small muscles, strengthening is a crucial part of any recovery program. Tendons do best when they are loaded, they need that stimulation to get stronger and more resilient. Your PT will you determine the right stage of exercises to begin with depending on your severity. They may also teach you tendon gliding exercises to prevent adhesions and scar tissue formation, improving the mobility of the tendons.
  3. Activity modifications: Your PT will help you determine aggravating activities in your daily life. Whether it’s changing your mouse and keyboard setup, a different grip in the gym, or a new way to hold your infant, there are strategies to minimize the strain of overuse.
  4. Manual therapy: Massage, soft tissue, and joint techniques may all be used to help pain relief, relieve scar tissue restrictions, and bring blood flow into the affected area. The specific techniques will be chosen based on the individual impairments seen in your assessment.

Can DeQuervain’s be avoided?

Consider doing stretches like above if you have a repetitive job every 30 minutes to give yourself a break.

There are many tips and advice that can be followed to minimize the risk of developing an overuse injury like this.

  1. Lift with good form. The wrists should always be in neutral, not bent to the side or back. If you have a hard time with this, consider lightening the load or using wrist wraps to help.
  2. Take frequent breaks. If you have a repetitive job or a hobby, the tension builds up over time. Even if it’s as simple as keyboard and mouse work, frequent breaks every 30 minutes for 30s-1min can make a big difference.
  3. Use other muscles. Our hand and wrist muscles are relatively small compared to other areas. If possible, use different techniques that minimize gripping or pinching with your thumbs and fingers. For example, as physios we frequently use other body parts like our elbows or knuckles to apply pressure to save the strain on our hands.
  4. Identify early signs. If you already feel a nagging pain or ache, waiting and hoping for it to go away is not a winning strategy. The earlier you catch and take care of it, the easier it is to recover. Going to Physio early on can make the difference between a few weeks of recovery and minimal disability, or a few months of recovery and having to modify a lot of things in your life.

Looking for help with wrist or thumb pain?

Look for PhysioNow! We have expert Physiotherapist help across 10 West GTA locations. Come find us in Burlington, Oakville, Mississauga or Etobicoke! Don’t let your pain stop you from participating in your life, get started with recovery today. Book with PhysioNow for your first assessment and treatment.

Hip Bursitis, Hip Pain, Physiotherapy, Sports Injuries, Sports Physiotherapy

Hip Pain: How to Resolve Your Gluteal Tendinopathy

Have you been experiencing pain on the outside of your hip recently? Or maybe you notice a sharp twinge every time you climb the stairs, step out of the car, or try to lie on your side at night?

If this sounds familiar, you aren’t alone. Outer hip pain is incredibly common, and very often, the main culprit is a condition called gluteal tendinopathy. Oftentimes, this can be accompanied by a bursitis and is generally classified as Greater Trochanteric Pain Syndrome (GTPS). Either way, the condition and pain is very treatable with Physiotherapy and we’ll go over how today.

What is a tendinopathy?

First, tendons are the tough, fibrous cords that connect your muscles to your bones. Then, tendinopathy is an umbrella term for a condition tendon that has become stressed and irritated, usually due to overuse

For a long time, people called this “tendinitis,” assuming it was just temporary inflammation. Today, research shows that tendinopathy is less about active inflammation and more about tendon overload. When a tendon experiences more stress or load than it is adapted for, its collagen fibers become disorganized, leading to localized stiffness, weakness, and pain.

How does gluteal tendinopathy happen?

Your gluteal tendons (specifically gluteus medius and gluteus minimus) attach to the bony bump on the side of your hip, known as the greater trochanter. These muscles work hard every day to keep your pelvis level when you walk, run, or stand on one leg. In other words, they are huge stabilizers of the hip and essential for daily function and sports.

Gluteal tendinopathy usually happens due to a combination of:

  • Increase in activity: For example, starting a new workout routine or increasing your daily walking/jogging mileage too quickly
  • Compressive positions: Positions that pull the tendon tight over the hip bone can irritate an already sensitive tendon. This includes things like sitting with your legs crossed or standing while resting all your weight shifted onto one hip hanging on your hip
  • Compensation for other weak areas: If the surrounding hip or core muscles aren’t taking their share of the work, the gluteal tendons take on extra strain.

What are the common signs and symptoms?

Gluteal tendinopathy presents with a fairly distinct pattern. Patients usually report:

  • Pain on the outside of the hip: A localized ache or tenderness directly over the bony bump on the side of your hip, which sometimes radiates down the outer thigh toward the knee. Most people can point directly towards the source of their pain
  • Nighttime pain: Difficulty sleeping on the affected side due to pressure, or pain when sleeping on the opposite side because the top leg falls across the body, stretching the tendon
  • Pain during single leg activities: Discomfort when walking, going up or down stairs, standing on one leg ex. getting dressed or running
  • Worse after prolonged rest: A stiff or sensitive hip when stepping out of bed in the morning or standing up after sitting for a long period

How does physiotherapy treat this condition?

Mindsets around healing have changed a lot in the past decades, no longer is resting considered a good thing. Obviously, there needs to be a modification to activity to avoid overuse, but doing absolutely nothing will only make the tendon issue worse. The most important thing to know about tendinopathy is that tendons need load to heal. Complete rest might make the pain quiet down temporarily, but as soon as you return to your normal activities, the unstrengthened tendon will likely flare up again in a relentless cycle.

Physiotherapy focuses on progressively rebuilding your tendon’s capacity so you can get back to living pain-free.

1. Activity management and modifications

First, we help you identify and temporarily adjust activities that compress or overload the tendon:

  • Place a thick pillow between your knees when sleeping on your side
  • Avoid crossing your legs when sitting
  • Stand evenly on both feet rather than resting your weight on one hip
  • Participate in activities only up to a 3-4/10 of pain, then take a rest

2. Targeted exercises

Exercise is the gold standard treatment for tendinopathy, and research now shoes that we need to push the tendon quite heavily to create the adaptations that are needed for healing. Recovery typically moves through phases, depending on the individual tolerance level and initial severity of the condition.

  • Isometrics: Holding muscle contractions without moving the joint. These are used for pain relief and to start with early muscle activation
  • Strength training: Controlled strengthening exercises like sidelying leg lifts, bridges, and step-ups that gradually build tendon strength without excessive compression.
  • Functional and heavy Loading: Restoring full strength and power through functional movements like squats, lunges, Bulgarian’s and more. Heavy slow resistance is considered the gold standard for tendon loading and should be strived for in all rehab programs.

3. Manual techniques

In the early stages, manual techniques can help to calm the pain down. Tight hip muscles can increase the compression force over the tendons or bursa, worsening the condition. Restrictions in joint mobility may be contributing to overuse at the hip. Your physiotherapist will perform a full assessment to determine the techniques that are appropriate for you.

Need help with hip pain or a gluteal tendinopathy?

Look for PhysioNow! We have expert clinicians at 10 locations across the West GTA, including Burlington, Oakville, Mississauga, and Etobicoke. Don’t let your hip pain stop you from enjoying the rest of your summer. Book with PhysioNow today for your first assessment and treatment!