Golfer's Elbow & How To Fix It
Do I have golfer’s elbow?
The golfer’s elbow is a tendinosis problem affecting the flexor and pronator muscles (underside of the forearm) caused by overuse and excessive inflammatory reactions to micro-trauma/trauma at the elbow.
It is usually seen in patients who are golfers, racket sports players, lifters, engineers, and construction workers because they tend to experience excess or repeated stress at the elbow, often from activities that involve twisting or flexing their wrist repetitively.
Golfer’s elbow can be easily mixed up with other conditions, such as cubital tunnel syndrome and ulnar nerve entrapment. Therefore, doing an MRI (Magnetic Resonance Imaging) scan will be able to give you a clearer diagnosis.
Having poor shoulder control/stability or stiff wrists can result in more complex cases of the golfer’s elbow as these associated joints may have negatively adapted towards dysfunction or created a “bad pattern” of how the body moves in relation to their strength and mobility. This means that the mechanics on the rest of the upper limbs, which include the elbow joint, will be affected.
I will be writing a separate article on radiating pain and associative joints soon as it would be one to really indulge in, given how technical, interlinked, and in-depth it is.
TO NOTE:
If you are feeling that your injury could be caused by such added disorders or you have more than one musculoskeletal injury operating besides the elbow, I would suggest a trip down to the therapist in the meantime. Typically, patients with only inner elbow pain complaints are prone to “overtraining” which then causes the body’s inflammatory responses to kick in and compensate for the ‘overuse’.
How to fix golfer’s elbow?
Quick fix:
1) Icing + Acupuncture:
A 40-year-old retired elite athlete with 20 years of participation in wrestling and bodybuilding activities suffering from a golfer’s elbow underwent one treatment of dry needling on the injury site and reported to be pain-free just two days after treatment. However, to date, there is still low-quality evidence to support acupuncture in conjunction with icing to reduce soreness. More research and follow-up are needed to make a more substantial claim in the literature.
Systemic fixes:
1) Inflammatory Control
WHY?
Having good control over inhibiting inflammation already tackles one-half of the issue as it does not allow the injury to become worse and painful.
WHAT TO DO?
Even though this only requires you no more work except to improve your condition, it is easier said than done as this long-term solution includes avoiding:
- Sugary and processed foods
- Trans/saturated animal fats
- Excessive alcohol and smoking
- Stressful environments
- Air pollution
2) Stretches
WHY?
Stretching helps with instant pain relief and is vital in warm-ups before loading as it is thought to release “tightness” and increase the muscle length of these shortened muscles.
WHAT TO DO?
Wrist Flexor Stretch
3 sets x 30 seconds hold/side
Perform a couple of times a day.
Image Source: Medical News Today
3) Strength Training
WHY?
Best practices would recommend altering physical activity and intensity to pain levels appropriately. This does not mean no golfing altogether but altered patterns and duration until the injury becomes a non-issue.
WHAT TO DO?
Eccentric loading or the lowering/joint lengthening phase of the exercise (E.g. the going down portion when doing a squat or lowering your body when doing a pull up) have been shown to be very effective for improving golfer’s elbow.
Niklaus’s Top 4 Picks:
1. Eccentric Wrist Flexions
6 sets x 15 repetitions with slow lowering of the weight
Image Source: Total Restore Physiotherapy
2. Neutral-grip Eccentric Pull-ups
5 sets x 20 seconds lowering from top position
Image Source: Fit Life Fanatics
3. Concentration Curls
4 sets x 10 repetitions with 3 seconds on eccentric phase
Image Source: Coach Mag UK
4. 1-Arm Dumbbell Farmer’s Walks
3 sets x 30 seconds walk
Image Source: Men’s Health
The 1-arm dumbbell farmer’s walk is key to appropriately stressing the tendons and ligaments of the upper body and have shown to be effective in most patients I have treated. Not only do they safely load the joints in a stable and closed-packed position (hand or feet fixed to object/surface) but they challenge the core as well as expose any discrepancies between the left and the right which is commonly found in golfer’s and tennis players alike due to the reliance of the dominant hand in their respective sports.
Due to less blood supply and its collagen structures, tendons take more than thrice to quadruple the time to react to stimulus than muscles. This means a program over two to three months would have to be incorporated several times a week to see optimal results.
General Strength Exercises:
Extra work which could potentially get you higher success rates of recovering and getting back into the game? Why not?
1. Dumbbell Presses
3 sets x 10 repetitions
Image Source: Quora
2. Tricep Pushdowns
4 sets x 10 repetitions with 3 seconds on eccentric phase
Image Source: Weight Training Guide
3. Dumbbell Rows
5 sets x 10 repetitions
Image Source: Weight Training Guide
These exercises not only help reduce imbalances but speed up recovery as the tendons are very dense, thick and power-generating which require a multitude of angles and loads to encourage hypertrophy (muscle growth). Training musculature specific to golf will also increase overall strength and output for performance.
For those with chronic golfer’s elbow
Even with years of all forms of alternative and traditional therapies, surgery may be necessary to release or reattach the affected muscle if pain still persists and function is lost. Generally, surgery for a golfer’s elbow would be viable for less than 1% of the population and for good reason. I would only personally recommend that if all the options exhausted were a swing and a miss (no pun intended). The good news for such a drastic option is that success rates and efficacy are incredibly promising with 86-97% of all patients reporting good to excellent results.
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This article is written and contributed to SgFitFam by freelance writer, Niklaus Quek. He is currently a student physiotherapist, ACE Personal trainer (2016), HFE Pilates instructor (2020), and SWF Olympic Weightlifting Coach Level 1 (2014).
Edited by the SgFitFam Team.
References
Gabel, G.T. & Morrey, B.F. (1995). Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow. The Journal of Bone and Joint Surgery, 77(7), 1065-1069.
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006. Golfer's elbow: Overview. 2018 May 30.
Ollivierre, C. O., Nirschl, R. P., & Pettrone, F. A. (1995). Resection and Repair for Medial Tennis Elbow: A Prospective Analysis. The American Journal of Sports Medicine, 23(2), 214–221. https://doi.org/10.1177/036354659502300215.
Organixx. (2018). What Causes Inflammation? The Top 10 Worst Offenders. [online] Available at: https://organixx.com/what-causes-inflammation [Accessed 7 Feb. 2021].
Shariat, A., Noormohammadpour, P., Memari, A. H., Ansari, N. N., Cleland, J. A., & Kordi, R. (2018). Acute effects of one session dry needling on a chronic golfer's elbow disability. Journal of exercise rehabilitation, 14(1), 138–142. https://doi.org/10.12965/jer.1836008.004.
Sims, S.E., Miller, K., Elfar, J.C., & Hammert, W.C. (2014). Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand (New York, N.Y.), 9(4), 419–446. https://doi.org/10.1007/s11552-014-9642-x.
Tyler, T.F., Nicholas, S.J., Schmitt, B.M., Mullaney, M. & Hogan, D.E. (2014). Clinical Outcomes Of The Addition Of Eccentrics For Rehabilitation Of Previously Failed Treatments of Gofers Elbow. International Journal of Sports Physical Therapy, [online] 9(3), 365–370. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060314.
Vangsness, C. & Jobe, F. (1991). Surgical treatment of medial epicondylitis. Results in 35 elbows. The Journal of Bone and Joint Surgery. British volume, 73-B(3), 409–411.