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Golfers Elbow

There are a number of conditions that affect the elbow area. The three most common conditions are "lateral epicondylitis" (tennis elbow), "medial epicondylitis" (golfers elbow), and medial collateral ligament sprain (throwers elbow).

The first two conditions are very similar, however the first affects the outside of the elbow (lateral), and the second affects the inside of the elbow (medial). For the purpose of this newsletter we'll stick with the treatment of medial epicondylitis, or as it is more commonly known, golfers elbow.

Anatomy of the Elbow Before we can understand just what golfers elbow is, it's important to have a general understanding of the structure of the elbow joint, and how the muscles, tendons,

ligaments and bones help the elbow joint to function.

As you can see from the diagram to the right, there are many muscles and tendons that make up the elbow joint and forearm. The diagram shows the anterior (or front) view of the forearm. The left picture shows the muscles and tendons closest to the surface of the skin, while the picture on the right shows some of the muscles and tendons deeper within the forearm. There are also three bones which make up the elbow

joint. They are the "Humerus," the "Ulna" and the "Radius."

Now that we can see how the elbow functions, lets look at what exactly golfers elbow is.

What is Golfers Elbow? Golfers elbow occurs when there is damage to the muscles, tendons and ligaments around the elbow joint and forearm. Small tears, called micro tears, form in the tendons and muscles which control the movement of the forearm. They cause a restriction of movement, inflammation and pain. These micro tears eventually lead to the formation of scar tissue and calcium deposits. If untreated, this scar tissue and calcium deposits can put so much pressure on the muscles and nerves that they can cut off the blood flow and pinch the nerves responsible for controlling the muscles in the forearm.

What Causes Golfers Elbow? By far the most common cause of golfers elbow is overuse. Any action which places a repetitive and prolonged strain on the forearm muscles, coupled with inadequate rest, will tend to strain and overwork those muscles.

There are also many other causes, like a direct injury, such as a bump or fall onto the elbow. Poor technique will contribute to the condition, such as using ill-fitted equipment, like golf clubs, tennis racquets, work tools, etc. While poor levels of general fitness and conditioning will also contribute.

Signs and Symptoms Pain is the most common and obvious symptom associated with golfers elbow. Pain is most often experienced on the inside of the upper forearm, but can also be experienced anywhere from the elbow joint to the wrist.

Weakness, stiffness and a general restriction of movement are also quite common in sufferers of golfers elbow. Even tingling and numbness can be experienced.

Stretching Exercises

Wrist Flexor Stretch

Stretching is an important part of the rehabilitation process and should begin as soon as pain allows .Stretching should be continued throughout rehabilitation and beyond. The muscles specifically involved in the rehabilitation of Golfers / Throwers

elbow can be stretched by placing the arm in the position shown in the photograph above.

Stand facing a wall with your arms outstretched and palms facing up. Place your fingers on the wall pointing downwards. Slowly try to place your whole hand flat on the wall by extending the wrist

Hold the position for 30 seconds and repeat 5 times. Aim to stretch at least 3 times a day.

Neural stretch

The Ulnar nerve runs very close to the medial epicondyle (bony bit on the inside of the elbow). This may become trapped by scar tissue. A neural stretch as shown above may be beneficial in treating this.

Adopt the position as shown. The stretch can be increased by placing something under the elbow to raise it up, which

increases the amount the upper arm is lifted relative to the shoulder (abducted), or pressing the hand further back.

Hold the stretch for only 5 seconds, repeat 5 times and aim to stretch at least 3 times a day.

Strengthening Exercises

Static Exercises It is important these exercises are done without any pain. If you feel pain, stop and wait until such time as they can be performed without pain. Repeat the exercises daily. Assess any effect on the elbow after as well as the next day. Rest the forearm on a flat surface such as a table or bench.

Start with the wrist in a flexed position as shown. Use the other hand to resist as you attempt to extend the wrist. There shouldn't be any movement at the wrist. Start at around 30% of your maximum force. Hold this contraction for 5-10 seconds and then rest. Repeat 5-10 times.

Gradually increase the duration of the static contraction until you can manage 10 contractions of 10 seconds without pain.

Move the wrist into an extended position as shown. Again use the other hand to resist as you attempt to further extend your wrist. Hold for 5-10 seconds and repeat 5-10 times. Gradually increase as above.

Dynamic exercises When the above exercises can be completed comfortably without pain then you can move on to dynamic exercises. When this happens may be from 4 days onwards. Do not rush. If the injury becomes painful take a step back. Dynamic exercises can be performed using a light weight (about 1 kg). Perform wrist extension exercises first to ensure these are pain-free. After this, you can try wrist flexion which specifically works the muscles involved in golfers elbow. Rest the arm on a flat surface, with the forearm and palm facing downwards.

Start in a fully flexed position (hand pointing down). Extend the wrist as shown. Start with 3 sets of 10 repetitions daily and build up gradually up to 3 sets of 30 reps.

Turn the arm over so the palm is facing upwards. Start in a fully extended position (hand pointing down). Flex the wrist as shown.Start with 3 sets of 10 repetitions daily and build up gradually up to 3 sets of 30.