Case Presentation: Patient presents with bilateral epicondylitis after performing crawling during an exercise class.
The right side was worse when we were looking at the bilateral epicondylitis. There was pain onset following a high volume crawling exercise class. Pain present for six weeks prior to the session and was unresponsive to other treatments. The pain occurred straight on arm loading which radiated to a small degree into the… And also was radiated with bicep curls. The findings were, there was pain on finger extension and wrist extension, as well as straight arm, long head biceps loading. There was slight dissymmetry to the left, and as well as into the shoulder.
Dr. Emily Splichal quickly presents her thoughts on this case presentation.
So again being a podiatrist, it might seem a little bit out of my scope, because we’re dealing with a epicondylitis of the upper extremity elbow. However, I do have patients who do present with this, and they just happen to have foot pathology at the same time. Knowing that the body is completely interconnected and integrated, there’s actually some really good research that supports how foot-to-core stabilization actually happens before shoulder stabilizers activate. And in this specific client or patient, if their shoulder stabilizers are not stabilizing fast enough, then that can transmit down into bicep tendons, the flexors of the hand and wrist, etcetera.
On that right side with the teres minor being weak, the way that I would start approaching that from the ground up podiatrist, is looking at the way that they’re sequencing through the ground, their interaction with the ground. I would go into the deep core pelvic floor stabilizers and see how those are firing, and if we could get that sequencing to happen a little bit more. One of the issues with the groundwork that I see, such as these crawling classes, animal flow, etcetera, is everybody is used to interacting with the ground in impact forces relative to the feet. However, when you start going down onto the hands and using that as being the contact point between the body and ground in impact and stabilization sequencing, then you actually start to see this delay and this dysfunction, and then pathology results.
So a huge part in their rehab that I would want to integrate, is make sure that their foot-to-core sequencing is being trained, but also their hand-to-shoulder sequencing or even hand/shoulder/core sequencing is being trained as well. The way that I address these foot-to-core, hand-to-shoulder stabilization is through fascial tensioning, which is through the foot. It would be called short foot. For the hand, I don’t know, call it short hand.
Essentially, you’re doing the same thing, you’re rooting the digits and activating the long flexors of the foot when you’re doing it with the foot. And when you’re doing it with the hand, you’re activating the long flexors into the digits. And starting and kind of prepping the body that way, is a great way for patients or clients who do crawling body weight exercises/gymnastics movements to kind of wake up and activate the sequencing of ground/hand/shoulder/core, or foot/hip/core, whatever way it may be.
So even though, again I don’t particularly treat or diagnose within the upper extremity, I do see this foot-to-core, foot-to-shoulder interconnection. And again, a lot of it follows the fascial lines and the fascial sequencing, so I would always bring them back to how their body is interacting with the ground.
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Dr. Emily Splichal DPM, MS, NASM, NSCA-CPT
Dr Emily Splichal, Podiatrist and Human Movement Specialist, is the Founder of the Evidence Based Fitness Academy and Creator of the Barefoot Training Specialist®, BarefootRx® and BARE® Workout Certifications for health and wellness professionals. With over 15 years in the fitness industry, Dr Splichal has dedicated her medical career towards studying postural alignment and human movement as it relates to foot function and barefoot training.