Golfer's Elbow Pain
What causes golfer's elbow?
Like Tennis Elbow, Golfer's Elbow, or Medial Epicondylitis is tendinosis and a type of overuse or Repetitive Strain Injury (RSI). Golfer's Elbow relates, to the condition being a common sports injury associated with Golf. However, one does not have to play Golf to develop Medial Epicondylitis. When playing Golf and hitting a ball, the swinging and gripping motion involves a repetitive motion and requires a fluid movement throughout the kinetic chain. Specific traumas and habitual behaviours can create subtle changes in tissue tension and mobility. Hence, although Golf's Elbow symptoms may relate to a particular arm/elbow trauma, there tends to be a more gradual onset. Negative changes affecting correct biomechanics become apparent faster when performing repetitive motions or activities. Increased mechanical load on muscle tendons can lead to irritation, inflammation, restricted mobility and myofascial pain. Once tissues are inflamed, it is very easy to irritate things further, especially when daily activities require specific soft-tissue and joint structure movement. Hence, overuse injuries can become chronic if left alone and not treated properly. There is a tendency for Golfer's Elbow symptoms to develop over time, even if the reason for symptoms was a specific elbow trauma. Research also indicates that trauma and overuse can lead to the formation of myofascial trigger points within muscle tissues, which has relevance to injury onset and recovery.
What are the symptoms of Golfer's Elbow?
Golfer's Elbow (Medial Epicondylitis) affects the forearm flexor muscles on the underside of the lower arm. Pain tends to occur near the elbow and in the section of tissues where the muscles attach to the bone with a tendon. On the contrary, Tennis Elbow (Lateral Epicondylitis) affects the forearm extensor muscles on the upper side of the lower arm. Most people experience Tennis Elbow pain near the elbow on the lower arm's upper side and in the tendon(s) section. Both flexor and extensor muscles are involved in wrist and hand (fingers) movements. Some types of activities place additional loads on the forearm extensor or flexor muscles, hence the different types of injury. There are other conditions that may have similar symptoms to Golfer's Elbow including Bursitis (Olecranon).
One might develop Medial Epicondylitis type symptoms from other sports and activities, such as hammering, Tennis (when using a forehand serve stroke), throwing activities (javelin, pitching in baseball) etc.
Golfer's Elbow Symptoms
- Pain or tenderness over the medial (inside) aspect of the Elbow.
- Pain and stiffness may be noticeable on waking in the morning.
- Symptoms might appear better with activity and then feel worse after rest.
- Pain may feel better after stretching and then worse later.
- Applying heat to the area may make things feel better at the time and worse later.
- Weightlifting using the arms may make symptoms feel better or worse at the time of exercise, but usually worse later and as the condition becomes worse.
- Symptoms improve with rest
- Possible weakness in gripping.
Does golfers elbow ever go away?
Golfer's Elbow will disappear like many other inflammatory conditions if managed correctly. Unfortunately, there is often a tendency to attempt self-treatment strategies, which may or may not be appropriate to individual circumstances. Applying the incorrect strategy often prolongs symptoms, and the internet has a wealth of good and bad content. Some typical self-injury management strategies include self-medication (anti-inflammatories), stretching, exercises and R.I.C.E. Each strategy may have merits, though at different times of injury management. Rest, Ice, Compression and Elevation (R.I.C.E) can prove helpful in the early stages of injury and reduce the negative aspects of too much inflammation, typically within the first 72hrs. However, the inflammatory response is part of the healing process, so such an approach can slow healing if overused. The author has seen many cases of people in various amateur sports using such an approach for months, effectively treating the symptom. Such a situation often leads to a chronic condition, resulting in multiple other problems.
Anti-inflammatories may reduce inflammation and pain, either locally or globally, depending on the type one is taking. However, hiding pain and inflammation will not address the reason for symptoms, worsening the overall condition. Equally, anti-inflammatories or other over-the-counter analgesic medications have many well-documented longer-term problems with prolonged use. There is a time and place for stretching and rehabilitative exercises, which can make things better or worse.
People can often inadvertently make symptoms worse, even with good intentions. The human body's response to injury and tissue repair typically involves an inflammatory response. The speed at which one feels the effects of tissue inflammation varies based mainly on the type of tissues injured. Tissues with an excellent vascular (blood) supply respond quickly to an injury, such as soft tissues like muscle. However, many tissues have a poor vascular supply of varying degrees, including ligaments, meniscus (within the knee), tendons and discs in the spine. Hence, activity may feel fine at the time in cases of poorly vascularised tissues, with the inflammatory response and accompanying symptoms arising much later. Massaging the area may feel good or even painful at the time, then better and then worse later. The pain created by massaging the injured area is likely to result in a release of endorphins, which provide temporary pain relief until they ware off. Many trained massage therapists lack adequate training in actual assessment and diagnostic skills and yet still attempt to treat conditions that are not really in their scope of practice. Also, there are many types of massage therapy and education and training ranging from zero to advanced. There are some things to look for and avoid when trying to find an ethical therapist or professional (see the article for some tips Finding a good ethical therapist).
If Golfer's Elbow is left to become Chronic, there is often a tendency to develop other upper extremity issues, increasing pain and grip strength weakness. As with most types of pain, we naturally make subtle adapt to avoid pain and still perform life's daily tasks, resulting in soft tissue adaptation. Although adaptations may reduce loads on injured tissues in the short term, they can lead to many other problems later. Adaptations create global changes in how we move, including how soft tissues and joint structures move. Equally, the human body is very good at learning new movement patterns and forgetting previous ones. In the case of Golfer's Elbow pain, adaptations to avoid pain often result in shoulder, back and even neck problems if left unaddressed. Hence, there is often more to address in Chronic cases than just the pain associated with Golfer's Elbow.
How long does golfers elbow last for?
How long it takes for Golfer's Elbow to resolve has a huge amount to do with the action taken by the person with symptoms at the time of injury and subsequently. Complete resolution of symptoms can take months, but that does not mean one needs professional treatment multiple times a week for months. However, it is important to follow advice to achieve the best and fastest outcome.
How can you treat golfer's elbow?
Any treatment approach needs to identify the root cause of the problem to work effectively. Due to multiple unique individual factors, no two injuries or conditions are the same. Hence, there is not a one treatment fits all solution. Having worked in the MSK Therapy field for over sixteen years, the author has encountered countless cases of Golfer's Elbow and other MSK conditions. Many of those cases were in non-golf players, along with complex Persistent Pain cases involving multiple conditions such as Golfer's Elbow, Tennis Elbow and carpal tunnel syndrome. Although there may be shared elements of a treatment process, actual treatments work better with a tailored and individualised treatment approach. Many effective manual therapy options are available, and outcomes can depend largely on individual practitioner approach, experience and technique application.
As with other MSK conditions, the author has found that Medial Epicondylitis requires a detailed assessment process and a range of manual therapy techniques. He often uses myofascial release (MFR) techniques, consumer education and prescriptive exercises. In some cases, there is a need to address casual factors such as restrictions in joint mobility. Early and appropriate intervention can often resolve Golfer's Elbow symptoms with minimal treatments, especially if patients actively participate in the process rather than passively.
The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.
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About the Author
As of December 31st 2020, the author chose to leave the Chiropractic profession due to a planned move back to Australia, where his training and education are not recognised. Terry no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. He developed an early interest in soft tissue therapy techniques and advanced myofascial release methods in 2006 for treating various conditions. Terry's interests in human performance and trauma have naturally led to him developing a specialism in treating work and sports-related musculoskeletal injuries and Chronic Pain symptoms.
The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to health's physical and mental aspects. He also needed to push his body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. He has also taught as a senior course coach at the Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects, including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the patients he sees and has treated over the last 16 years. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.