Golfer’s elbow, contrary to its name, affects not only golfers but individuals participating in various sports and activities. Those who engage in racquet sports, baseball pitching, weight training, and physically demanding occupations like carpentry are at risk of developing this condition. Factors such as being overweight, smoking, and having type 2 diabetes can also increase the likelihood of experiencing golfer’s elbow.
This condition is characterized by pain in the medial epicondyle area of the elbow, which is the bony prominence on the inner side of the joint. The affected tendons belong to the forearm muscles responsible for flexing the wrist and pronating the forearm. Pain from golfer’s elbow tends to be gradual, becoming noticeable after activity or the following day. Other symptoms may include tingling in the wrist, throbbing at rest, pain during gripping or twisting motions, and a weakened grip.
This article will discuss effective rehabilitation methods, exercises, and management options for golfer’s elbow, based on the available literature and expert opinions.
Conditions That Mimic Golfer’s Elbow
It is essential to differentiate golfer’s elbow from other conditions that present similar symptoms, such as:
- Medial collateral ligament (MCL) tear: Also known as the ulnar collateral ligament, this ligament on the inside of the elbow can be injured in sports or activities that involve throwing or pitching. A sudden, sharp pain may indicate a tear in the MCL rather than golfer’s elbow.
- Nerve entrapment: Nerves running through the arm can become entrapped at various points, causing pain in the elbow region. This may occur in conjunction with golfer’s elbow or as a separate issue.
- Carpal tunnel syndrome: Although typically characterized by pain and tingling in the hand, carpal tunnel syndrome may also cause discomfort in the elbow area.
- Osteoarthritis: Degenerative changes in the elbow joint can lead to pain similar to golfer’s elbow.
Consulting with a physiotherapist or a medical professional specializing in this area will help determine the appropriate diagnosis and treatment plan.
Causes of Golfer’s Elbow
Golfer’s elbow is primarily an overuse injury, resulting from excessive or repetitive strain on the involved tendons. Factors that contribute to its development include inadequate recovery time, a sudden increase in activity volume, and physically demanding tasks or occupations.
It is crucial to recognize the importance of gradual progression in training and ensuring sufficient rest to prevent golfer’s elbow.
Diagnosing Golfer’s Elbow
A thorough patient history and physical examination are usually sufficient to diagnose golfer’s elbow. While imaging studies, such as ultrasound, can confirm the diagnosis, they are not always necessary. Key factors in a patient’s history include activity levels, the onset of pain, and whether the pain is sudden or gradual. Physical examination may involve testing for pain upon compressing the tendon, resisting wrist flexion or forearm pronation, and stretching the affected muscles. If these tests elicit pain in the medial epicondyle area, a diagnosis of golfer’s elbow is likely.
Treatment Options for Golfer’s Elbow
- Relative rest: During the initial phase of golfer’s elbow, it is crucial to allow the affected tendon to recover by avoiding aggravating activities. This period of rest can prevent the condition from worsening and promote healing.
- Pain management: Over-the-counter pain relievers, such as ibuprofen or naproxen, can help manage pain and inflammation. Applying ice to the affected area can also provide relief.
- Physical therapy: A physiotherapist can develop a tailored treatment plan that may include stretching, strengthening exercises, and manual therapy techniques to improve the tendon’s health and function.
- Bracing: Wearing a counterforce brace or a compression strap can help alleviate pain by redistributing the force exerted on the tendon.
- Corticosteroid injections: In some cases, corticosteroids may be injected into the affected area to reduce inflammation and pain. However, this treatment option should be used with caution, as repeated injections can weaken the tendon and increase the risk of rupture.
- Extracorporeal shockwave therapy (ESWT): This non-invasive treatment involves delivering shockwaves to the tendon to stimulate healing. ESWT has shown promising results for some patients with golfer’s elbow, but more research is needed to determine its long-term effectiveness.
- Surgery: In rare cases where conservative treatments have not been successful, surgery may be considered to repair the damaged tendon.
Exercises for Medial Epicondylitis
- Reducing High and Fast Load Activities:
High and fast load activities, such as overhead throwing or racket sports, can exacerbate golfer’s elbow pain. It is essential to decrease the volume of these activities (either frequency, duration, or repetitions) and manage pain levels within 24 hours after the activity. This approach helps break the cycle of increasing pain and disability.
- Adjunctive Options:
While braces, kinesio taping, dry needling, massage, or ice can provide temporary relief, none of these options increase the tendon’s capacity to bear load in the long term. Short-term use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may offer some relief, but prolonged use can lead to gastrointestinal issues.
- Early Rehab: Heavy and Slow Resistance Exercises:
The foundation of tendon rehab involves slow and heavy resistance exercises. For golfer’s elbow, this can include dumbbell curls, performed with a slow cadence (2-3 seconds up and down) and a weight that allows for 5-15 repetitions. Other effective exercises include pronation using a head-heavy object such as a hammer or broomstick, targeting the pronator teres muscle.
- Targeting the Shoulder:
Studies have shown that decreased shoulder external rotation, extension, and abduction peak torques may contribute to the development of golfer’s and tennis elbow. Including exercises that target these shoulder movements, such as cable pulleys for external rotation, lateral raises for abduction, and pullovers for extension, can help redistribute load and reduce stress on the elbow.
- Ulnar Glides:
Co-existing ulnar neuritis can be present in up to 50% of medial epicondylalgia cases, necessitating attention to the ulnar nerve. Ulnar nerve sliders and tensioners can be performed to target the nerve, starting with less provocative sliders and progressing to tensioners as tolerated.
Conclusion
This comprehensive rehab program for golfer’s elbow addresses the tendon’s capacity, load management, and other contributing factors such as shoulder strength and ulnar nerve involvement.
By following these guidelines and adjusting activities accordingly, individuals with golfer’s elbow can work towards reduced pain and improved function.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.