golfers elbow

1fredric carsongolfers elbow

1. injury or condition - golfers elbowa. also known as medial epicondylitis or javelin thrower's elbow. An

inflammatory condition affecting the common origin of the common flexor

tendons of the forearm which results in pain and tenderness caused by inflamed

tendons of tendonosis on the inside (ulnar side) of the elbow at the medial

epicondyle of the humerus. Most commonly the result of overactivity of the wrist

flexors, especially with increasing intensity or duration of activity or poor

technique.

b. Causes -

i. Gripping or swinging the clubs incorrectly can take a toll on your muscles

and tendons.

ii. Racket sports. Excessive topspin can hurt your elbow. Using a racket that's

too small, heavy or tightly strung also can lead to injury.

iii. Throwing sports. Improper pitching technique in baseball or softball can

be another culprit.

iv. Other activities. Painting, raking, hammering, chopping wood, typing and

other repetitive wrist, hand or arm movements can result in golfer's elbow

as well.

1. Mechanism of injury or etiology - Dave Jewett

2. wood chopper

a. went to doctor after a competition and tested positive for golfer's elbow

b. father test concluded that it was tendonosis causing the pain

3. signs and symptoms -


a. Pain and tenderness on the inner side of your elbow. Sometimes the pain extends

along the inner side of your forearm.

b. Stiffness. Your elbow may feel stiff, and it may hurt to make a fist.

c. Weakness. You may have weakness in your hands and wrists.

d. Numbness or tingling. Many people with golfer's elbow experience numbness or a

tingling sensation that radiates into one or more fingers — usually the ring and

little fingers.

e. The pain of golfer's elbow may appear suddenly or gradually.

4. The pain may get worse when you

a. Swing a golf club or racket

b. Squeeze or pitch a ball

c. Shake hands

d. Turn a doorknob

e. Pick up something with your palm down

f. Flex your wrist toward your forearm

5. Management plan -

a. Phase 1.

i. goals : ease pain and improve healing of the collagen in elbow pain

free stretches

ii. Estimated Length of time of phase: 4 days

iii. exercise rehabilitation:

1. ice therapy

2. Shock wave therapy


3. Wrist active range of motion, flexion and extension

a. Bend the wrist of your injured arm forward and back as far

as you can. Do 2 sets of 15.

4. Wrist stretch - Flexor Carpi Radialis, Palmaris Longus, Flexor

Carpi Ulnaris, Flexor Digitorum Superficialis, and Flexor

Digitorum Profundus Extensor Carpi Radialis Longus, Extensor

Carpi Radialis Brevis and Extensor Carpi Ulnaris

a. Press the back of the hand on your injured side with your

other hand to help bend your wrist. Hold for 15 to 30

seconds. Next, stretch the hand back by pressing the fingers

in a backward direction. Hold for 15 to 30 seconds. Keep

the arm on your injured side straight during this exercise.

Do 3 sets.

5. Forearm pronation and supination - pronator teres, pronator

quadratus, supinator and biceps

a. Bend the elbow of your injured arm 90 degrees, keeping

your elbow at your side. Turn your palm up and hold for 5

seconds. Then slowly turn your palm down and hold for 5

seconds. Make sure you keep your elbow at your side and

bent 90 degrees while you do the exercise. Do 2 sets of 15.

b. Phase 2

i. goals : regain strength in lower arm and walk through motions of

wood cutting to correct form


ii. Estimated Length of time of phase 4 weeks

iii. exercise rehabilitation:

1. stretching

a. same as phase one2. strengthening

a. Eccentric wrist flexion: Flexor Carpi Radialis, Palmaris

Longus, Flexor Carpi Ulnaris, Flexor Digitorum

Superficialis, and Flexor Digitorum Profundus

i. Hold a can or hammer handle in the hand of your

injured side with your palm up. Use the hand on the

side that is not injured to bend your wrist up. Then

let go of your wrist and use just your injured side to

lower the weight slowly back to the starting

position. Do 3 sets of 15. Gradually increase the

weight you are holding.

b. Eccentric wrist extension: Extensor Carpi Radialis

Longus, Extensor Carpi Radialis Brevis and Extensor Carpi

Ulnaris

i. Hold a soup can or hammer handle in the hand of

your injured side with your palm facing down. Use

the hand on the side that is not injured to bend your

wrist up. Then let go of your wrist and use just your

injured side to lower the weight slowly back to the


starting position. Do 3 sets of 15. Gradually

increase the weight you are holding.

c. Grip strengthening: Flexor Pollicis Longus, Flexor

Digitorum Superficialis, Flexor Digitorum Profundus,

Opponens Digiti Minimi, Opponens Pollicis, Flexor Digiti

Minimi Brevis, Flexor Pollicis Brevis, Adductor Pollicis,

First Dorsal Interossei and Palmar Interossei. -

i. Squeeze a soft rubber ball and hold the squeeze for

5 seconds. Do 2 sets of 15.

d. Forearm pronation and supination strengthening:

pronator teres, pronator quadratus, supinator and biceps

i. Hold a soup can or hammer handle in your hand and

bend your elbow 90 degrees. Slowly turn your hand

so your palm is up and then down. Do 2 sets of 15.

e. Resisted elbow flexion and extension: - biceps, brachialis

and brachioradialis and triceps

i. Hold a can of soup with your palm up. Slowly bend

your elbow so that your hand is coming toward your

shoulder. Then lower it slowly so your arm is

completely straight. Do 2 sets of 15. Slowly

increase the weight you are using.

3. sports related exercises


a. Standing Wood Chop - abs, rotator cuff, deltoid glutes,

hamstrings and quadriceps.

i. Stand in a split-stance position with your left foot

forward holding a medicine ball in both hands.

Keep the ball close to your body. Engage your

abdominal / core muscles to stiffen your torso and

stabilize your spine. Your torso should be upright.

ii. Stage 1 Starting Position (illustrated): Slowly bring

the medicine ball to the left, to a starting position

high and behind you. Do not rotate your head, chest

or torso. Your head, chest and hips should remain

facing forward at all times throughout this exercise

stage. Keep the medicine ball relatively close to

your body.

iii. Movement: Slowly, bring the medicine ball down

and across your body toward the right hip. Do not

rotate your head, chest, torso or hips, and keep them

facing forward. Keep the medicine ball relatively

close to your body. Hold this end position briefly

before returning to your starting position. Repeat

the movement in the opposite direction with your

opposite leg forward.


iv. Exercise Progression: Repeat the same movement,

but extend your arms at the elbow and maintain this

arm position throughout the wood chop movements.

This longer lever increases the loading on the spine,

requiring the core muscles to work harder.

v. Stage 2 Starting Position (not illustrated): Change

your foot position to a stagger-stance moving feet

wider apart. Assume the same starting position with

your arms bent, but allow your hips to rotate to the

left with your arms, increasing your degree of

rotation. Your head, chest and torso should remain

aligned over your hips. Much of your body weight

should be loaded into your left leg.

vi. Movement: Slowly, bring your arms down and

across your body toward the right, while squatting

down slightly to an end point where the medicine

ball is positioned lower than your right hip

(performing a wood chop movement). Much of your

weight should be shifted over into the right leg.

Rotate your hips, but keep your head, chest and

torso aligned over your hips. Keep the medicine ball

relatively close to your body. Hold this end position

briefly before returning to your starting position.


Repeat the movement in the opposite direction with

your opposite leg forward.

vii. Exercise Progression: Repeat the same movement,

but extend your arms at the elbow and maintain this

arm position throughout the wood chop movements.

This longer lever increases the loading on the spine,

requiring the core muscles to work harder .

viii. stage 3 Starting Position: Assume the same

starting position as in stage two, but fully extend

your elbows and allow your torso to rotate further

than your hips, rotating even further. Shift more

weight into your left foot and allow your right foot

to pivot on the floor.

ix. Movement: Slowly, rotate your arms down and

across your body to the right, while squatting down

slightly to an end point where the is positioned

below your right hip (performing a wood chop

movement), and much of your weight has shifted

into the right leg. Your torso will rotate further and

faster than your hips. Keep your elbows fully

extended throughout the movement. Hold this end

position briefly before returning to your starting


position. Repeat the movement in the opposite

direction with your opposite leg forward.

x. Engage your abdominal / core muscles throughout

this exercise to stabilize and protect your spine.

b. reverse wood chop

i. starting with feet shoulder distance apart. Holding a

Swiss or medicine ball with both hands on the side

of your right hip, squat down while keeping arms

straight. If you are new to the move, keep arms bent

until you are strong enough. Push through your legs

and stand straight while moving the ball across your

body and up. With your legs straight, your arms

should be straight towards the ceiling above your

left shoulder.

4. Phase 3

a. goals - integrate full body movement and strengthen

swing.

iv. Estimated Length of time of phase: 10 weeks

v. exercise rehabilitation:

1. Yoga-inspired Dynamic Warm-up

2. exercise


a. Spinal Twist with a Push-Pull Movement- rotator cuff

rhomboids pecs, serratus anterior

b.

i. Starting Position: Lie on your side on a mat with

both legs straight so that your hips and shoulders

are stacked and vertical with the floor. Your spine

and head should be aligned. Rest your head resting

on the mat or upon a small pillow or rolled-up towel

if necessary. Bend your top knee to create a 90-

degree bend at both the hip and knee. Rest the

inside of that knee on the mat or upon a raised

surface (e.g. rolled-up towel, block, etc.). Reach

both arms out directly in front you at chest level,

stacking your hands one on top of the other.

ii. Engage your abdominal muscles to stabilize your

spine in a neutral position and maintain this

engagement throughout the exercise. Gently exhale.

Slowly rotate your trunk and upper arm until your

belly button faces the ceiling and your upper arm

extends out to the other side, touching or slightly off

the floor.

iii. Avoid rotating your hips. If your upper thigh is

sliding backward as you rotate, the hips are rotating.


Placing a raised surface under the inside of the

upper knee will help control this hip rotation. Do

not allow the low back to arch. Keeping your

abdominal muscles engaged will help prevent this.

iv. Keep your shoulder blades pulled back and down

throughout the exercise. Hold this position briefly,

then bend the elbow of the lower arm so that the

back of the arm is on the floor / mat, and the

forearm is vertical to the floor. Reach the other arm

toward the ceiling, but keep the shoulder blade

down.

v. Gently exhale. Keeping your shoulder blades, trunk and hips stabilized, perform a series of push-pull movements with your arms:

vi. (a) Press the lower arm upwards, extending the elbow without allowing the scapula to move forward

vii. (b) Pull the upper arm downwards towards the chest, bending the elbow without allowing the scapula to move backwards.

viii. Exercise Variation: The exercise intensity can be increased by using dumbbells.

ix. To maximize the benefits of this exercise and

reduce the potential for injury, it is important to

stabilize the shoulder blades, trunk and hips and

control movement at the shoulders. Follow the

instructions provided carefully.


c. Spider Walks

i. Starting Position: Lie on your stomach on the floor with your hands directly under your shoulders, fingers pointed forward and elbows close to the sides of your body. Brace your abdominal muscles to stabilize your spine. Pull your shoulder blades back and down. Maintain these engagements throughout the exercise. Gently exhale and press your body off the floor about 6" keeping your entire body parallel with the floor. Tilt your head to look forward.

ii. While keeping your body as close to the floor as possible perform the following sequence and simultaneously: Drive your right knee forward, bending your knee and moving it out to the to the side of your body until your knee is level or near level with your hips, or touches your elbow. Place right your foot firmly on the floor. Lift your left hand off the floor and move it forward about the same distance that your right foot moved forward. While some rotation of your hips and trunk is acceptable, attempt to minimize rotation.

iii. From this position push forward driving the opposite limbs forward (e.g., left leg and right arm) in the same manner outlined above. Continue this spider walk movement over a distance of 30 feet (approximately 10 m). Attempt to stay low to the ground while keeping your trunk rigid throughout the movement.

iv. Exercise Variation: To increase the intensity of this

exercise, you can extend the distance covered or

increase the walking pace.


v. To maximize the benefits of this exercise and

reduce the potential for injury, it is important to

control your movement speed and attempt to

maintain a rigid torso.

vi. Exercise Variation: As this technique is mastered,

the exercise intensity can be progressed by: (1)

Switching the stance (supporting or balance) leg

(i.e., holding a dumbbell in the left arm and lifting

the right leg rather than the left leg). This increases

the need for balance and stabilization within the

body; (2) using heavier resistance; (3) bending over

and / or lowering the hips closer to the ground by

increasing your knee bend; and (4) standing on

unstable surfaces (e.g., Airex pad).

3. sports related exercises

a. pop flies and ground balls- keeping the bat in the torso zone

only

b. chopping wood

c. criteria to return to sport or activity

i. preform all exercises with little effort and no pain

golfers elbow

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