'The Body’ Nicky’s second instalment of her fantastic ‘Human Garage’ Trilogy is days away from release!
‘The Body’ Nicky’s second instalment of her fantastic ‘Human Garage’ Trilogy is days away from release!
To celebrate we are offering an amazing 45% off any Magnetic Resonance Treatment. If you or someone you know needs help with Osteoarthritis, Bone Problems, Sports Injuries or Spinal Disc issues.
Call us on 01889 881488
“For a longer active life”
Offer ends 30th September
Terms and Conditions apply.
The Pain Relief Clinic is pleased to announce Consultant Physiotherapist, Nicky Snazell, has won a top award and national recognition for ‘Excellence in Patient Service’ at a Gala Dinner, held by The Acupuncture Association for Chartered Physiotherapists, (AACP). The prestigious awards dinner was held on Friday 13th May at the Hilton Hotel in Coventry as part of the AACP Annual Conference. The awards were held to recognise individuals who were honoured for their achievements and the contributions they have made.
Nicky Snazell, Clinical Director of The Pain Relief Clinics was honoured at The AACP Awards evening. Nicky was selected from more than 6000 physiotherapists in both NHS and private practice from across the UK to win the first ever ‘Excellence in Patient Service’ Award. Nicky was recognised for her incredible achievements and for making a significant contribution to the practice of acupuncture having successfully treated thousands of patients throughout her career spanning nearly thirty years.
The AACP celebrated Nicky’s patient-focused approach, holistic understanding and treatment of patients and excellence in practice. Nicky was said to be an inspirational leader in her field and having made a significant contribution to the practice of acupuncture in the UK. Collecting the award Nicky said,
“Winning this award inspires me to continue my work driving holistic physiotherapy practice forward. I believe it is every health practitioner’s duty to study and share with enthusiasm the secrets of good health. We should work in the wellness industry with preventative health advice and not just the illness industry”
Nicky’s drive to learn and discover better methods to treat pain was ignited by her frustration as a child watching her mother suffer years of terrible back pain. Despite Nicky’s mother seeing numerous professionals nothing ever really helped.
A qualified biologist, physiotherapist, spinal pain specialist and author; Nicky’s career has taken to her to China, Korea, Canada and many European countries, where she has been privileged to work alongside many pioneers in their field. Nicky is one of the few people in the world to have achieved the highest level of qualification and the first practitioner in the world to be awarded a fellowship from the Institute for the Study and Treatment of Pain.
It’s this work Nicky continues at her two clinics in Stafford and Harrogate.
For the love of dance
Love to Dance…
For those of you who love to dance on a regular basis – whether for your job, for exercise or for the sheer love of it – you will already by familiar with the absolute joy that dancing can bring you, and you’ll crave that unmistakable “buzz” inside you, with the happy endorphins kicking in whilst you move your body to the beat. The genre of music and style of dance doesn’t matter – you’ll simply know the passion it brings out in you, and in others who share your love of it.
However, dancers will also be only too familiar with how tough dancing can be on the body, and often, after hours of blissful dancing, you will then find yourselves aching – in your back, you neck, shoulders, hips… and especially in your knees and feet, which can take quite a hammering with all that bending, sliding, spinning and turning!
Usually, within a day or two, the soreness wears off, and you’re craving your next dance.
But sometimes the problem can be more worrying, with severe pain developing, causing you to restrict your dancing – or even prevent you from dancing altogether for a while.
A few examples include:
• Menisus Knee Tear, from twisting the knee whilst moving;
• Lower Back strain and muscle spasms;
• Plantar Fasciitis – pain as you put weight on your foot;
• Hallux Limitus, where your big toe becomes stiff;
• Patellofemoral Pain Syndrome, from tight hamstrings and calf muscles, and weak quads, plus repetitive pressure on the knee cap;
• Ankle sprains – eg, from landing wrongly from a jump;
• Tendonopathy of the Rotator Cuff, Posterior Tibial tendon, and in the Achilles.
Fear not… Help is at hand!
Yes, we can help you if you are suffering with any of these. At the Nicky Snazell Pain Relief Clinic, we have treatments whereby we can actively intervene to get you back to doing what you love. And the sooner you do something about it, the less damage you will cause – and the sooner you can return to the dance-floor.
Happy dancing!
The key to healthly exercise
The key to healthly exercise is just that.Let’s take another look at why we should exercise so we can hold a green fitness key.Today I find that humans are far too sedentary, all too
often sitting in front of a computer by day, followed by
sitting in front of a TV at night. This lack of physical
activity causes emotional and physiological imbalances,
but we can change this by looking at how we exercise; improving your
fitness changes your chemistry, acts as a powerful antidepressant, promotes
mental clarity, and reduces the likelihood of cancer.
If you’re not happy with either how you look or feel about your weight,
then with correct guidance, you can break out of inactivity and be rewarded
by smiling at yourself whenever you see your reflection. I will guide you towards 4 green keys to health and tonight is fitness.
You can learn more about how and when you should
exercise, as getting the correct mix can extend your life.
When I am working at my clinic, I hear echoing around the walls: I am too
old to exercise, too old to work. Are you too old to exercise? Well, no one told
Jiroemon Kimura (born 1897) that he was too old. He passed away recently
at age 116, farming until he was 90 years old. Remember the Carry On films?
Well, did you know that Barbara Windsor carries on exercising in her late 70s?
You can find her in her gym wear keeping fit outside in Hyde Park.
Over 450,000 people in the USA and over 70,000 people in the UK risk total
knee replacement every year. Want to talk pain? Then talk TKR. What’s
worse is that it is unsuccessful 10% of the time, and you can even die from
having total knee replacement. Furthermore, the age for TKR is constantly
dropping. Why? Anybody want to hazard a guess? That’s right: obesity.
Now, this isn’t proven yet, but it is most likely the biggest cause.
So, what happens when you get fat? Ladies, take the ‘C’ off chips and you
know what you get! Guys, you put it on around the waist and lose sight of
your favourite toy! What you probably don’t know is that your knees are
loaded with up to four times your weight, so every extra stone (14 lbs) is
an extra four stone (56 lbs) on your knees – that’s why knees are so often
the first casualty with OA. If you want to know why the four times multiple
occurs, it’s because of leverage. Now, you are intelligent people, and you are
surely interested in health or you wouldn’t be here. So, why have you made
the decision to get arthritis? Made the decision to get lots of pain? Made
the decision to risk surgery and even death? It’s because much of the pain
associated with the pleasure of eating too much is too far away, and anyway,
going to the gym is a pain for most. We need to change the way we think
about exercise, and hopefully this chapter will go some way to doing that
for you.
Here’s some more cheery news: an in-depth study into retirement found
that men in their sixties are every bit as good at driving business than those
physically and mentally in their prime. In later life, prescriptive exercise is
more effort than swallowing a pill, but it is well worth it; in a nutshell, you get
less senility and less pain. Exercise weaves its magic, strengthening the heart,
releasing more neurotransmitters for cell communication, boosting BDNF
for improving neural connections in the brain, aiding metabolism, improving
blood flow, stimulating toxic disposal systems, and strengthening bones.
This next fact gets me out running in howling gales and rain: current research
in Sweden shows that exercise alters the way genes work in the tissue that
stores fat, and changes in adipose tissue storage sites were measurable even
with just two workouts a week. Epigenetics has always fascinated me since
studying biology, and this is the study of how chemical alterations will
change how genes work in a cell. This allows us to fine tune our body to a
changing environment.
Exercise alters this process in muscle cells and improves how sugar is
processed. Furthermore, adipose tissue (fat cells) is an organ in its own right, producing active chemicals that have profound effects on the body. In
this tissue, 18,000 markers were found on 7,663 genes! This is leading to a
greater understanding of why exercise helps fatty tissue do its job properly,
which means that as we get older, we don’t have to have such a lumpy,
bumpy body. This smooth body needs a good structural support.
The 4 keys to health
The 4 keys to health is all about investing in the healthiest happiest future you could wish for with sound scientific knowledge and big spoonfuls of commonsense and experience.Tonights blog is for nutrition week. The traffic lights approach to healthfor the 4 keys to health gives one point for every yes answer.
0 – 3: RED.
3 – 6: AMBER.
6 – 9: GREEN.
Scores: Now count up your scores – are you red, amber, or green for this key?
Initial score:
Once you’ve read the chapter and implemented any changes, take the
questionnaire again to see how much you’ve improved.This questionnaire is in 4 parts.
Diet and Blood Sugar Levels
• Is your weight good for your age and height?
• Do you have lots of energy and do you like to exercise?
• Are you free from joint pain?
• Do you rarely feel like dozing in the day and feel alert after eating?
• Do you hardly ever get stomach ache or bloating?
• Do you concentrate easily with a clear memory and few
headaches?
• Do you hardly ever need sweet food or caffeine fixes?
• Do you jump out of bed, raring to go?
• Do you rarely feel dizzy / irritable / have mood swings in
gaps between meals?
Water
• Do you rarely have thirst / dry mouth?
• Do you rarely get headaches?
• Is your urine a mild (not dark) yellow colour?
• Are your skin and lips moist, not dry?
• Do you have regular bowel movements most days?
• Do you have less than two glasses of alcohol a day?
• Do you have five helpings of fresh fruit and vegetables a day?
• Do you have several glasses of fruit water / juice / herbal
teas a day, even if resting?
• Do you avoid having too many salty snacks?
Healthy Low Homocysteine Levels (repairing DNA
and building nerves / cartilage)
• Is your weight satisfactory and stable?
• Are you a clear thinker with a good memory and rare
headaches?
• Do you eat healthily with green veggies, seeds, and nuts,
but aren’t vegan?
• You are not an alcoholic, smoker, or heavy coffee drinker?
• Do you have little joint pain?
• Do you have great stamina without weariness?
• Is your cardiovascular system and blood pressure normal?
• Do you sleep well?
• Are you rarely angry, irritable, or down?
Essential Fats
• Do you have healthy hair?
• Do you have flexible, pain-free joints?
• You are not taking painkillers?
• No arthritis, asthma, or eczema?
• No diagnosed cardiovascular problems?
• Do you spend more than thirty minutes a day outside in
sunlight?
• Do you eat healthily with oily fish, about four eggs a week,
seeds and nuts most days, and fewer than two alcoholic
drinks a day?
• Do you have a good memory, learning abilities, and
concentration?
• You don’t get down, anxious or unnecessarily angry?
Anti-Ageing, Anti-rot, Antioxidants
• Are you a quick healer?
• Are you younger than middle aged (40)?
• Do you have healthy skin?
• No diagnosis of cancer or cardiovascular disease?
• Don’t bruise easily?
• Do you live in quiet, clear air, healthy countryside, not
near major roads?
• Do you eat healthily with five lots of fruit and veg a day,
raw seeds / nuts, and at least two oily fish a week?
• Do you take antioxidant supplements?
• Do you exercise and raise your heart rate five times a
week?If you got a red key read my blogs or get a copy of my book,through www.thepainkiller.co.uk,www.painreliefclinic.co.uk, or amazon.
Exercise is vital for healthy aging
Exercise is vital for healthy ageing, so get out of that chair! When we slouch
in our chairs, we don’t breathe correctly, we have less lung capacity, less
oxygen, a poorer blood flow, a weaker heart, and less nutrient delivery.
Smooth muscles tighten up to take up the slack, and our blood pressure
readings go up. Blood flow can’t accommodate sudden movements anymore,
so dizziness follows, and with it, increased accidents. Men’s sexual potency
falls, the gut slows, and digestion fails. Sugar metabolism struggles andcc
diabetes is more likely to take hold. In an article in Psychological Medicine,
Dregan and M.C Gulliford wrote about how intense exercise helps brain
function (Dregan & Gulliford, 2013), so you can remember where you put
your gym wear! Get my drift?
Here are some more facts I sourced for you to back up reasons to exercise
– for all you academic buffs out there. Whether you are old or young,
‘it’s widely acknowledged that a healthy body equals a healthy mind. The
government recommends a minimum of 150 minutes of exercise per week,
between the ages of 19 and 64’ (Dregan, 2013). A word to the wise – if you
don’t exercise at all, start. If you are new to exercise, start small and just walk
a little further than usual. Exercise doesn’t have to mean enduring lengthy,
intense programmes or taking up a gym membership, although I think the
discipline of going and the social angle is great. If you are exercising on your
own, you still need to add in working out with weights as well as aerobic
exercise, such as walking.
Did you know that at 44 years old, without exercising, we are at the peak
depressive age? However, at 70 – if we follow a fitness programme – it is
possible to be as physically fit and happy as we were when we were 20!
Another study got a group of 60 year olds to start doing three long swims a
week, and their medical measurements and tests were those of 40 year olds.
Exercise is much like medicine – it doesn’t have to taste nice, but the outcome
is more than worth it. Being disciplined about getting your exercise is your
key to longevity, so exercise regularly and effectively. Most people will say
they don’t like it, that it’s boring or painful, that they have no time to do it,
but they’re just in denial for the need to move. Well, couch potatoes, here
are some more facts for you:
• A study looked at 50 elderly people of an average age of 87.
Given a 10 week weights workout at this age, they doubled their muscle
Tennis Elbow Part 3
Welcome back to the series of articles about physiotherapy and tennis elbow (also known as lateral epicondylitis, lateral epicondylosis and lateral epicondylalgia). So far we have covered who is affected by tennis elbow, the anatomy of the elbow and which muscles or tendons are most likely to be injured. This article will try to give an overview of a huge subject: the physiology of tendons and why they get injured, now this is a massive topic in physiotherapy and has been the subject of huge amounts of research (and in fact our knowledge on this topic is still developing) so I will only be touching the surface.
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Forearm extensor muscles
Firstly we need to look at what tendons actually are and why they might get injured in tennis elbow. Simply put a tendon is a piece of connective tissue that joins muscle to bone and is comprised of well organised mostly one directional collagen fibres (Wang et al 2003). Unlike muscles tendons can not contract themselves and are relatively inelastic (with a much lower proportion of elastin – only about 1-2% Jozsa & Kannus 1997). So basically muscles do the contraction and force generation but tendons, because they connect to the bones and are relatively inelastic, transfer that force over to the bones and move our joints. A key fact about tendons is that they generally will have a much lower blood supply than muscles and in turn have a lower metabolic rate which affects their ability to heal and makes an injury to a tendon much slower to recover and heal properly (Abate et al 2009). Furthermore the point at which muscle turns into tendon (the musculo-tendinous junction) is the point which is most often injured and is subject to large mechanical forces (Abate et al 2009).
Okay – how does this affect tennis elbow? Well, as we found out in the last article, extensor carpi radialis brevis (ECRB) is the most commonly injured muscle in tennis elbow and this muscle is most commonly injured at either the musculo-tendinous junction or at the lateral epicondyle (bony bit of the elbow) where the common extensor tendon inserts into the bone. Therefore understanding tendons and how they react and function is key to understanding tennis elbow.
Tennis Elbow
The common extensor tendon as shown above is the continuation of all the extensors of the wrist and fingers and therefore any time you extend your wrist or your fingers to pick anything up it is put under stress. So it isn’t really a surprise that if you do too much of anything like picking things up then this tendon may get irritated and sore and that your physiotherapist will be able to find fairly easily a very sore spot on the lateral epicondyle of your elbow.
Next blog post will look in more detail at the physiology of what happens when the tendon gets injured in tennis elbow and hopefully manage to summarise and simplify decades of research on tendinopathies.
References
Abate M., Gravare-Silbernagel K., Siljeholm C., Di Iorio A., De Amicis D., Salini V., Werner S., Paganelli R. (2009) Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Research and Therapy 11 (3): 235
Jozsa, L., and Kannus, P., Human Tendons: Anatomy, Physiology, and Pathology. Human Kinetics: Champaign, IL, 1997
Wang J., Jia F., Yang G., Yang S., Campbell B., Stone D., Woo S., (2003) Cyclic Mechanical Stretching of Human Tendon Fibroblasts Increases the Production of Prostaglandin E2 and Levels of Cyclooxygenase Expression: A Novel In Vitro Model Study Connective Tissue Research 44: 128 – 133
Eat, drink, but don’t be acid
I am sure you have heard about lemmings, those little animals that supposedly follow their leader and all jump off a cliff to their deaths. Now at first thought, you may be thinking dumb leader and dumb followers. But if you look at human behaviour, much of what we do is very lemming like. For example, just look at fashion. Some remote group decides what the ‘in look’ and colour is going to be for next year, then promote it like mad, and everyone buys it to be ‘in fashion’. Doesn’t matter how bad or uncomfortable some of the fashion is sometimes, we follow like lemmings.
Now some of you are probably thinking ‘I wouldn’t do that, I’ve got too much common sense’. Have you ever thought about what ‘common sense’ means. Something can only be sensible if it’s common to us. Fire is dangerous, don’t play with it, that’s common sense, right? No, not necessarily. A couple of years ago I was watching a program about polar bears and one bear came close to this Canadian village, who were burning their rubbish in a sizeable bonfire. The bear clearly had no idea what fire was and just walked up to it and stuck a paw in, only to run off yelping. That bear was probably unique after that in being the only polar bear to have the common sense to know that fire was dangerous.
So now we are approaching Christmas, it’s a time I always look forward to, just like everyone else. Advertisers are in full swing, promoting alcohol, chocolates, turkeys and so on, and like lemmings we will all go off and over indulge. And why not, everyone else does it, don’t they and I don’t see what’s wrong with it? Sit back and think about that. ‘Everyone else does it’ translates to ‘lemming behaviour’ and ‘I don’t see what’s wrong with it’ translates to ‘it doesn’t break my common sense test’.
The problem here lies in the fact that for the majority, the health risks associated with a very rich and acid diet are not known and are no more ‘common sense’ than fire was to the polar bear. But at least the bear learnt very quickly that fire was dangerous and would be very wary the next time. The implications of poor diet and for many, a far too acidic diet, are not immediately apparent. Even worse, the fact that ‘everybody else’ in an individual’s social group is doing the same thing, means that it doesn’t’ even register that a diet may be poor in the first place.
No better example of this can be given than a highly publicised TV program shown a few years ago, which monitored the health implications of junk food by getting a volunteer to live on nothing other than junk. He had to be taken off the diet because his health plummeted so rapidly. What impact has this had? Very little, if you look at the explosion of junk food outlets.
There is a very interesting video on YouTube which shows how the Japanese discovered the health benefits of ionised water back in the 1960’s and since then its use has been medically approved. An ioniser produces both alkaline water, which you drink, and acid water which you can treat skin conditions with, or if very acid, use to sterilise. The video shows how hospitals are sterilising operating theatres and medical instruments with nothing other than acid water. Surgeons are shown washing their hands before surgery in nothing other than acid water.
This ‘miracle’ is said to be possible as the water is so acid that it kills all germs. The irony is that some soft drinks that we consume are just as acidic as this water. Now you tell me, is it common sense to do this, or is this an example of lemming behaviour.
Poor diet will slowly, but surely damage your body and will eventually surface as deteriorating health and disease. You will not get the luxury of an early warning that the bear had with the fire.
Enjoy your Christmas, as I most certainly will, but if nothing else, make a decision not to go ballistic with way too much rich food and commit to start the New Year with a healthier way of living. Do that and you will live to enjoy a lot more Christmas seasons and what better Christmas present can you get than that.
If you would like to know more about ionised water then call our clinic on 01889 881488.
Tennis Elbow Part 2
Welcome back to the new series of articles about physiotherapy and common injuries and pathologies seen by physiotherapists. Last time we took a brief look at one of the most common musculo-skeletal conditions that a physiotherapist will encounter – tennis elbow (also known as lateral epicondylitis, lateral epicondylosis and lateral epicondylalgia). This article will now look at the anatomy of the elbow and the muscles connected to it in detail so that we can have a good idea of what is hurting or being injured in tennis elbow and can maybe start to have an idea of what causes it.
Elbow Anatomy:
Elbow Joint
The elbow is an amazing piece of biomechanical design and is comprised of 3 bones – the humerus which is the upper arm bone and two bones in the forearm called the radius and ulna. The radius runs from the elbow to the thumb and the ulna starts at the bony prominence on the back of your elbow (olecranon process) and runs down to the wrist. To make it easy to remember which bone is which, when I was a student I used to repeat “the ulna is underneath the radius”. Simple I know but effective nonetheless when you are a physio student desperately trying to cram in your anatomical knowledge.
Now as we are looking at tennis elbow we are not going to look or worry too much about the actual elbow joint itself except to say that it has two ways of movement – flexion and extension (basically straightening and bending) and pronation and supination (pronation is rotating the hand palm down and supination palm up). It may seem strange that in a condition called tennis elbow we will be ignoring the elbow joint itself but hopefully the reason why will become clear soon.
Tennis Elbow
The key part of the elbow in tennis elbow that we really need to examine is the lateral epicondyle – this is the point where all of the wrist extensors and finger extensors start from and is the point at which pain is felt in tennis elbow, it is also called the common extensor origin (for reasons which will become apparent soon) and is the site of attachment for the common extensor tendon. Pain here is the cardinal sign for tennis elbow that all physiotherapists look for.
Forearm extensor muscles
Running from the lateral epicondyle and the common extensor origin are all of the muscles that extend the wrist and the fingers – extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum, extensor indicis and extensor digiti minimi. Two other muscles have attachments at the lateral epicondyle – supinator and anconeus. All of these muscles merge together here to form what is known as the common extensor tendon which then attaches to the lateral epicondyle. So it is fairly obvious that this common extensor origin is an important point in wrist and finger extension and may well be a likely site of injury that physiotherapists will need to examine.
Before moving on it is worth considering the actions of a couple of these muscles in more detail extensor carpi radialis brevis and extensor carpi ulnaris have an important synergistic role in stabilising the wrist – they both act at the same time in concert with their flexor brothers (flexor carpi ulnaris and flexor carpi radialis) to prevent side to side movement at the wrist (ulnar and radial deviation). The two extensors also act together at the same time you grip an object to hold the wrist in extension a bit and prevent the finger flexors from flexing the wrist. In fact studies have shown that extensor carpi radialis brevis is the tendon most commonly injured in tennis elbow and the most common point that it is injured at is the common extensor tendon.
So hopefully from the above brief anatomy lesson we can now see that any extension or even flexion of the wrist is going to put a large amount of stress through the common extensor tendon and in turn if this tendon receives any injury we are likely to feel pain at the lateral epicondyle – which is where patients with tennis elbow will normally describe to their physiotherapist that they feel pain when they pick things up.
The next article will look at the physiology and some of the reasons why tendons get injured and why tennis elbow can often become chronic and last for a long time.
Tennis Elbow – Introduction
This will be the first blog post in an upcoming series about physiotherapy and common pathologies or injuries seen by physiotherapists. We will be examining in detail the causes and nature of various pathologies, who they affect, treatment options, self-management and how physiotherapy can help. The first pathology that I would like to deal with is an extremely common but frustrating and painful condition called tennis elbow that as a physiotherapist I encounter regularly in practice.
Tennis Elbow
Tennis elbow has several other more complicated sounding names such as lateral epicondylitis, lateral epicondylosis and lateral epicondylalgia. All of which basically try to describe the fact that the pain people feel is at the outside (lateral) bony bit of the elbow (epicondyle). The pain normally comes on when picking up heavy objects, twisting items such as screwdrivers and can be quite sharp and uncomfortable.
It is one of the most common musculo-skeletal conditions that a physiotherapist will see and affects approximately 3 – 11/1000 patients per annum (Dingenmanse et al 2012). It is thought to occur in 1.4% of the population (Shiri et al 2006), now these do not sound like huge numbers but when you consider the size of the UK population (roughly 60 million) then 1.4% of the whole population is a lot of people! It is 7 – 9 times more common than the next most common elbow injury: golfer’s elbow (medial epicondylitis) (Walz et al 2010) and causes prolonged time off work especially in chronic sufferers (Walker-Bone et al 2012). Numerous studies have shown that it is associated with handling tools and repetitive twisting and lifting actions of the forearm (Van Rijn et al 2009) basically meaning that if you are an electrician, carpenter, manual labourer or a housewife then you are at an increased risk of developing the condition.
So… what causes it? Well that is a common question for physiotherapists and seemingly a simple question. Unfortunately it is a complicated answer and will need us to look in some detail at both the anatomy of the elbow and physiology of tendons. Which will be covered in the next blog post.
Reference List:
Dingenmanse R., Randsdorp M., Koes B., Huisstede B. (2012) Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review British Journal of Sports Medicine Published Online
Shiri R., Viikari-Juntura E., Varonen H., Heliovaara M. (2006) Prevalence and determinants of lateral and medial epicondylitis: a population study. American Journal of Epidemiology 164 (11): 1065 – 1074
Van Rijn R., Huisstede B., Koes B., Burdorf A. (2009) Associations between work-related factors and specific disorders at the elbow: a systematic literature review Rheumatology 48: 528 – 536
Walker-Bone K., Palmer K., Reading I., Coggon D., Cooper C. (2012) Occupation and epicondylitis: a population-based study. Rheumatology (Oxford) 51 (2): 305 – 310
Walz D., Newman J., Konin G., Ross G. (2010) Epicondylitis: Pathogenesis,
Imaging, and Treatment Radiographics 30 (1): 167 – 185