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Golfer’s Elbow

What is Golfer’s elbow?

Let’s get this out of the way, no, not only golfer’s get golfer’s elbow. To be honest, most of the people we see in our clinic with golfer’s elbow barely even golf. While many people are familiar with tennis elbow, which is an inflammatory condition of the tendons of the outside of the elbow, fewer people know about Golfer’s elbow or medial epicondylitis (which has also been called medial tennis elbow and even swimmer’s elbow). For this review we will refer to it as Golfer’s elbow. As elluded to earlier, golfer’s elbow is the layman’s term for medial epicondylitis, which is an inflammatory condition of the muscle and tendons of the inside of the elbow. The medial epicondyle is the bony part of your humerus, or upper arm bone the projects from the inside of your elbow. This boney projection is the attachment point, or origin, of many of the muscles in your forearm that help you to flex and move your wrist and forearm. Occasionally, with time and overuse (which by the way is the formula for most orthopaedic injuries) these tendons can become irritated or inflamed and with enough time can eventually start to change their composition/structure (referred to as tendonosis).

What are the symptoms of Golfer’s elbow?

Those who develop golfer’s elbow will notice a progressive onset of elbow stiffness and pain located on the inside of the elbow. This stiffness will often get worse after activity or after long periods of immobility (i.e. sleeping). Those with golfer’s elbow may even have some trouble falling asleep due to the pain. Often times their elbow will be tender to the touch on the inside. As it progresses, those with golfer’s elbow may notice increased weakness with gripping and dropping of objects and sometimes numbness and tingling on the inside of the elbow/forearm down to their hand, especially increased when trying to grab or lift objects.

What are some risk factors for Golfer’s elbow?

There are many risk factors for golfer’s elbow but some of the most common ones include:

Job type:
Those jobs that require repetitive and frequent lifting, or those that require you to work at a computer for hours on end. Additionally those jobs where you frequently use vibrating equipment (i.e. jackhammer) are also susceptible to this condition.

Gripping sports:
Those that frequently play sports which require a lot of gripping such as tennis, racquetball, lacrosse or golf.

Weight lifting:
Those who engage in weight lifting as an exercise, especially those that do a lot of: power cleans, snatches, deadlifts and heavy shoulder shrugs.

Overhead sports:
Those that play a lot of overhead sports or sports that require throwing such as: baseball, volleyball, softball, basketball.

Lifestyle:
Those that smoke, eat excessive sugars or drink excessively are at risk for developing golfer’s elbow secondary to compromised tissue healing and increased risk for inflammatory conditions.

Activity change:
Individuals who are fairly inactive and then abruptly start a new workout regimen, heavier weight lifting or change jobs to a more physically demanding job may increase their risk for developing golfer’s elbow.

Failure to warm-up or progress properly:
Those who do not take time to warm-up properly or try to advance your exercise program too rapidly may have an increased risk of developing golfer’s elbow.

Will it get better on its own?

As with most overuse orthopaedic injuries, there is a chance that this can get better on its own. That being said, taking the “wait and see” approach is NOT recommended. With injuries like Golfer’s elbow there is usually a reason why it developed and to take a passive approach is just begging for it to come back even if it gets better. Instead, I would recommend immediately reflecting on why you may have developed this in the first place (start with all the risk factors). After identifying the possible cause, start with risk factor modification (i.e. cut back on weight lifting temporarily, take 1-2 week break from your sport, stop smoking, eat less sugars, warm-up properly, etc.). If identifying and addressing some of your potential risk factors doesn’t help to ease your symptoms there are other things you can do for treatment to help. That being said, I would not go more than 2 weeks with these symptoms before seeking professional help from someone that specializes in orthopaedic conditions (i.e. an orthopedic/sports physical therapist).

What can you do to help ease the symptoms?

Activity modification:

As mentioned earlier, you may need to do some reflecting. Have you made any changes in your workout routine that could have facilitated this condition? Are you warming up? Are you practicing good lifestyle habits? Remember, “if you always do what you always did, then you’ll always get what you always got.” This condition will not go away unless you start to change something.

P.R.I.C.E:

The PRICE method is good for many common orthopedic overuse injuries. The acronym P.R.I.C.E stands for: protection, rest, ice compression, elevation. Below we will describe how to apply this to golfer’s elbow.

Protection: you may avoid activities that hurt your elbow, like the old doctor’s golden tenet: “if it hurts, don’t do it” (sounds like a no-brainer but people can be stubborn!). So if you’re doing any activities that require heavy lifting or a lot gripping, attempt to modify or stop doing those activities for a short period of time.

Rest: take 1-2 weeks off of any strenuous activity, let everything calm down. Taking some time off won’t set you back far. Taking months off because of an acute injury turning into a chronic injury will.

Ice: For this condition, I would recommend taking a dixie cup, filling it with water, freezing it, peeling off the top layer to expose the ice and then massage the sore area of your elbow for no more than 5-10 minutes.

Compression: For compression around the elbow you can purchase a simple “elbow strap.” What this will do is provide a little extra support for those irritated muscles/tendons to alleviate some of the stress placed upon them.

Elevation: Since the elbow doesn’t tend to accumulate excessive amounts of swelling this isn’t quite as applicable, however, laying down with your arm propped up at night won’t hurt anything.

NSAIDs:
Sometimes doctors will recommend taking NSAIDs such as ibuprofen for inflammatory conditions. However, taking NSAIDs in the long-term can have detrimental and possibly devastating side effects on your gut, leading to gastrointestinal bleeding. Generally you do not want to take these medications for more than a few weeks.

Physical therapy:
Physical therapy can be a great option for those that are struggling to control your symptoms on your own and do not want to seek more aggressive treatment (i.e. surgery or corticosteroid injections). A qualified orthopaedic physical therapist will perform an extensive upper quarter evaluation (evaluating your neck, shoulder, elbow and wrist) to see what physical impairments may exist that are contributing to your present symptoms. Often times elbow pain can be a mere byproduct or result of poor shoulder or wrist mobility or weakness in the muscles of your shoulder blade or rotator cuff. Additionally, sometimes elbow pain can be the result of nerve impingement at the cervical spine, which they will also rule in/out at the time of evaluation. From the initial evaluation they will prescribe neck, shoulder, elbow or wrist exercises or nerve glides to address your specific impairments. Some of the common exercises will be listed at the end of this article.

Do I need surgery for this condition?

Surgery for golfer’s elbow is fairly uncommon. Most of the time this injury will get better with time, activity modification and stretching/exercising. However, if you still have pain that is limiting your daily activities or impacting your exercise routine that persists after 6 months, you may want to get a consultation with an orthopedic surgeon.

What can healthcare providers do to help ease the symptoms?

As mentioned earlier, always start with reflection and activity modification. Then, if your symptoms persist for longer than a few weeks and you are not sure where to turn to always start with conservative care first (i.e. physical therapist vs. doctor or surgeon). Physical therapists may be able to assist you in your road to recovery by modifying your current exercises, prescribing new one, performing various soft-tissue techniques to promote tissue healing and return you back to your normal activities/exercises. If that doesn’t work, the next stop in the road would typically be to an orthopedic doctor who may do steroid or sometimes platelet rich plasma (using your own blood platelets to stimulate healing) injections. If that doesn’t work the next stop in the road would be surgery (that is your last card, most cases DO NOT require surgery). If you choose to go to an MD first and the first thing they recommend is surgery I would strongly recommend getting a second opinion.

Exercises for Golfer’s Elbow

Below is an overview of some of the common PT exercises that may be prescribed for this condition (keep in mind this is by no means comprehensive or individualized, however it is a good place to start).